Capsule Endoscopy in the investigation of renal transplant recipients with chronic diarrhea

Abstract

Aim of the study: Diarrhea is a common but mostly unexplained symptom in renal transplant recipients (RTRs). We used capsule endoscopy to investigate the small bowel of
RTRs with chronic diarrhea and normal upper and lower
tract endoscopy. Patients and methods: We prospectively
enrolled RTRs with chronic diarrhea and non-immunocompromised patients with normal renal function and diarrhea (control group) that underwent capsule endoscopy. Results: Eighteen RTRs and 26 controls were included in the study. Findings were noted in 65.9% of the RTRs and in 19.2% of the controls. Findings considered as causative were detected in 33.3% of the RTRs and in 7.7% of the controls (Fisher's Exact Test x2=4.701, p<0.05). Among RTRs, abnormalities included lymphangiectasia in 4 (3 of them exhibited laboratory findings compatible with protein-losing enteropathy), mucosal alterations compatible with mycophenolate mofetil toxicity in 2 and CMV enterocolitis in 1, while among controls, Crohn's enteritis in 1 and celiac disease in 1. Symptomatic improvement as a result of undertaken therapeutic measures was observed in all cases. Conclusions: Capsule endoscopy proved to be a helpful diagnostic tool in RTRs with chronic diarrhea. Aphthoid ulcers probably constitute the endoscopic image of mycophenolate mofetil toxicity on the small bowel.