Original article—alimentary tract
Evidence of Endothelial Dysfunction in Patients With Inflammatory Bowel Disease

https://doi.org/10.1016/j.cgh.2008.10.021Get rights and content

Background & Aims

Chronic inflammation has a major role in the development and propagation of endothelial dysfunction, which can lead to coronary artery disease. Endothelial dysfunction has been described in patients with various and diverse chronic inflammatory conditions. Altered vascular flow has been proposed to mediate inflammation in inflammatory bowel disease (IBD), although the role of endothelial dysfunction remains obscure. The purpose of our study was to assess endothelial function in patients with IBD.

Methods

Ninety-eight subjects were included in this study; 48 with IBD (17 with ulcerative colitis and 31 with Crohn's disease) and 50 healthy controls. Endothelial function was assessed by pulse arterial tonometry (PAT) and brachial ultrasound to determine flow-mediated dilation and shear stress reactive hyperemia. The impact of disease activity, disease duration, and IBD therapy also was assessed.

Results

Baseline demographic characteristics, including cardiovascular risk factors, were similar in all groups. IBD patients showed microvascular endothelial dysfunction, with lower PAT indices (P < .01) and shear stress reactive hyperemia (P < .05) compared with controls. There was no relationship between microvascular endothelial dysfunction, disease duration, underlying therapy, or clinical disease activity. There was a positive association between lower PAT scores and recent abdominal pain (P < .05).

Conclusions

This was a large study assessing endothelial dysfunction in IBD. Both ulcerative colitis and Crohn's disease patients showed evidence of microvascular endothelial dysfunction. Future research could determine whether endothelial dysfunction is involved in the pathogenesis of IBD or increases the risk of cardiovascular events in this patient population.

Section snippets

Study Population

IBD patients and matched control subjects were recruited from the University of Calgary Medical Clinics and Foothills Hospital in Calgary, Alberta, Canada. A total of 50 age-matched controls and 50 IBD patients initially were recruited between September 2005 and November 2006. Two patients in the IBD group were excluded. One patient did not complete the testing and 1 patient was excluded because of a concomitant diagnosis of severe celiac disease. Thus, 48 patients with IBD were available for

Results

The baseline characteristics of the 2 populations (IBD and control) were similar (see Table 1). There were no significant differences between the 2 groups in sex, age, body mass index, waist circumference, or rates of dyslipidemia, hypertension, diabetes, and smoking. Although some patients were not clear about the exact year of diagnosis of IBD, 33% reported being diagnosed within 3 years, 31% in greater than 3 but fewer than 10 years, and 36% reported being diagnosed more than 10 years before

Discussion

Our results indicate that patients with IBD have evidence of systemic microvascular endothelial dysfunction, based on lower PAT scores and reactive hyperemia-induced shear stress, irrespective of cardiovascular risk factors. These changes may represent the mechanisms underlying the increased risk of ischemic heart disease in patients with IBD, as recently described by Bernstein et al.6 Disease duration and clinical disease activity, CRP, ESR, leukocyte count, anemia, and platelet count did not

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    • Cited by (0)

    This work was supported by the Canadian Institutes of Health Research (P.L.B. and T.J.A.) and the Crohn's and Colitis Foundation of Canada (P.L.B. and A.G.B.). P.L.B. is an Alberta Heritage Foundation for Medical Research (AHFMR) Scholar and T.J.A. is an AHFMR Senior Scholar. J.P.F. had a post-fellowship award from AHFMR. This study was funded by a grant from the Center for Advancement of Health, University of Calgary. Equipment for the pulse arterial tonometry measurements was supplied by Itamar Medical, Caesaria, Israel.

    The authors disclose no conflicts.

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