Prognostic Value of Probe-Based Confocal Laser Endomicroscopy in Pediatric Inflammatory Bowel Diseases

Abstract

The incidence of inflammatory bowel diseases (IBD), including Crohn disease (CD) and ulcerative colitis (UC), is increasing in children. We recently demonstrated increased epithelial gaps in the non-inflamed duodenum of CD and UC patients, and high capillary flow rates in the duodenum of UC patients using probe-based confocal laser endomicroscopy (pCLE). The aim of the present study was to determine if increased epithelial gap density or capillary flow could predict the clinical course of IBD patients and response to therapy.A total of 26 patients (16 CD and 10 UC cases for the epithelial gap study and 9 UC patients for the vascular flow study -all also included in the gap study) were followed from the time of initial pCLE imaging for a minimum of 24 months. Clinical outcomes analysed included the occurrence of significant clinical events (hospitalizations, surgeries, disease flares), alterations in inflammatory parameters, and disease activity indices.High epithelial gaps and capillary flow rates did not predict the risk of clinical events or alterations in inflammatory parameters in IBD patients. CD patients with high gap density who were treated with infliximab had a significant reduction in ESR levels at 12 months.The study did not support an ability for pCLE to predict hospitalizations or flares. Future studies evaluating epithelial gap density and vascular changes in pediatric IBD patients and their relation with inflammatory parameters and sub-clinical molecular changes might be helpful in determining disease pathogenesis and better defining treatment options.