Endoscopic and histopathological hints on infections in patients of common variable immunodeficiency disorder with gastrointestinal symptoms

Abstract Purpose Common variable immunodeficiency disorder (CVID) patients could have gastrointestinal (GI) involvement and suffer from infections yet remain poorly understood. The study aims were to assess the clinical, endoscopic, and histopathological features of CVID patients with GI symptoms and their relationship with infections. Methods We conducted a retrospective observational study of 22 CVID patients with GI symptoms and endoscopic examinations at Peking Union Medical College Hospital between 2000 and 2020. Clinical features, infections, endoscopic and histopathological images were reassessed Results Chronic diarrhea was the commonest GI symptom occurred in 21/22(95.5%) patients in our CVID cohort. Over 80% patients had low body weight and malabsorption. Accordingly, small bowel villous atrophy was observed in 90.9% patients under endoscopy and mostly confirmed by histopathology. GI infections were found in 10 (45.5%) patients. 7 patients with diffuse and obvious nodular lymphoid hyperplasia (NLH) of small bowel under endoscopy had significantly higher infection rate (85.7% vs 26.7%, p<0.05), especially with giardia and bacteria. Small bowel biopsies showed 90.5% patients lacked plasma cells and 57.1% patients had increased intraepithelial lymphocytes (IELs), but not significantly different between GI infectious and non-infectious group. After intravenous immunoglobulin and anti-infection therapy most patients got better except one died of EBV ulcers massive bleeding. Conclusions CVID could involve GI tract especially the small bowel. Obvious NLH under endoscopy could be a hint for GI infection. Comprehensive endoscopic and histopathological evaluations might help to recognize CVID diagnosis and the possibility of co-infection leading to more proper treatment.