Patients With Common Variable Immune Deficiency Often Present GI Complications

As many as half of patients with common variable immune deficiency (CVID) experience noninfectious gastrointestinal manifestations that can resemble conditions such as celiac disease, pernicious anemia, or inflammatory bowel disease, according to a review article published in The American Journal of Gastroenterology.

“Although clinically and endoscopically these conditions mimic other gastrointestinal diseases, there are certain histologic features, such as paucity or absence of plasma cells and follicular lymphoid hyperplasia and a high frequency of CD81 T-cell infiltrates that help to make a distinction between CVID-related disease and other conditions,” wrote first author Jana G. Hashash, MD, MSc, of the Mayo Clinic, Jacksonville, Florida, and coauthors.

The article provides a comprehensive overview of gastrointestinal screening, diagnostic considerations, and therapeutic options for the individualized management of patients with CVID, whose conditions are often complex. CVID is associated with an increased risk of gastrointestinal tract cancers, the authors point out, most commonly lymphoma and gastric cancer.

No consensus guidelines address the treatment of noninfectious gastrointestinal complications of CVID. Nevertheless, treatment almost always begins with immunoglobulin replacement therapy. Many patients also require additional therapies.

“Treatment may be challenging,” the authors wrote, “with limited benefit from immunoglobulin therapy alone.”

For a personalized therapeutic approach suited to each patient, the article advises close collaboration among specialists.

“Multidisciplinary care between immunologists, gastroenterologists, and nutritionists is key,” they wrote, “in the management of patients with CVID with noninfectious GI manifestations.”

Reference:
Hashash JG, Squire J, Francis FF, Binion DG, Cross RK, Farraye FA. An expert opinion/approach: clinical presentations, diagnostic considerations, and therapeutic options for gastrointestinal manifestations of common variable immune deficiency. Am J Gastroenterol. 2022;117(11):1743-1752. doi:10.14309/ajg.0000000000002027