Background/Purpose: Chronic intermittent diarrhea (CID) is a common clinical problem in axial spondylarthritis (axSpA) patients and eventually up to 13% of these are diagnosed with inflammatory bowel disease (IBD). Magnetic resonance (MR) enterography, i.e., MRE with the highest accuracy for Crohn’s disease (CD) lesions is becoming the recommended complimentary intervention to ileocolonoscopy in patients with suspected CD. We aimed to determine if a complimentary MRE (a) may change the rate of CD diagnosis in axSpA and (b) may be used as a non-invasive screening test for CID.

Methods: A total of 820 consecutive axSpA patients meeting the ASAS classification criteria (Mean disease duration of 4.3 years (6 months – 25 years) were screened for the presence of CID. Patients with a prior diagnosis of IBD, Celiac disease, inflammatory bowel syndrome (IBS) and amyloidosis were excluded. The cause of CID was investigated in 44 patients (mean age 39.5 years, 25 female) by: MRE (mural disease, bowel wall thickening and extra-luminal complications of Crohn’s disease) gastro-duodenoscopy, ileocolonoscopy with histopathologic assessment, testing for Celiac disease, bacterial and parasitic agents. MRE findings assessed were Four patients refused MRE and in additional three patients had contrast medium intolerance. And seven patients refused endoscopy. Patients with either intervention missing at the time of statistical analysis were excluded from the study.

Results: Thirty-seven patients with a non-bloody, mucous diarrhea (200-400 ml / per defecation, with a monthly duration of ≥ 2 – 3 days, four times a day accompanied by stomachache) were analyzed. Mean duration of diarrhea was 21 months (3 – 120 months) Thirty-six percent were smokers, 55% were NSAID users, and 20% were under anti-TNF treatment. Nine teen percent (n=6/32) were HLA-B27 positive, only. Family history of IBD was present in one patient.IBD was diagnosed in 12 patients; Ten with CD and two with Ulcerative colitis (UC). Four patients had normal histopathology, MRE and endoscopic findings. Remaining 21 had no conclusive diagnosis as no parasitic infections were detected by direct microscopy and stool cultures, as well as Entamoeba, clostridium difficile-, giardia antigens and celiac antibodies were negative in all patients. MRE was positive in all CD patients but abnormal endoscopic findings were detected in six CD patients, only. Both UC patients were diagnosed by ileocolonoscopy, i.e. MRE were negative. In the remaining patient group with non-specific chronic histopathologic changes and normal ileocolonoscopy only one had non-specific MRE findings.

Conclusion: Complimentary MRE increased the number of CD diagnosis in axSpA patients with CID. Evaluation of mural and extramural findings of the small intestine adds valuable information for diagnosis. Biopsy proven CD cases being all MRE positive may suggest a value of MRE as a non-invasive screening tool and larger clinical trials may be necessary.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/diagnostic-value-of-mr-enterography-as-a-complementary-intervention-to-colonoscopy-in-axial-spondylarthritis-patients-with-chronic-non-bloody-diarrhea/