Ileocolonoscopy was performed on 354 patients with
spondyloarthropathies. Histologically, the population could be divided into 145 patients with normal gut histology, 88 patients with acute inflammatory lesions and 121 patients with chronic inflammatory lesions. A number of clinical,
biologic, radiologic and genetic variables were determined before ileocolonoscopy. Chronic gut lesions were associated with a family history of
ankylosing spondylitis (AS) and
Crohn's disease, several episodes of
diarrhea, an increased stool frequency, elevated inflammatory serum variables, reduced axial mobility, the presence of
sacroiliitis, bamboo spine, destructive joint lesions, a diagnosis of AS and
HLA-Bw62 positivity. As the frequency of
HLA-Bw62 is also increased in proven
Crohn's disease, this would suggest that chronic gut lesions are related to this disease. Acute inflammatory lesions were related to a higher fecal carriage of specific bacteria and to the diagnosis of undifferentiated
spondyloarthropathy, especially the enterogenic forms of
reactive arthritis. Consequently, these lesions also appear to be related to a bacterially induced gut
inflammation. Gut histology was normal in urogenital
inflammation and urogenital
reactive arthritis, suggesting a different portal of entry for
antigens. The 3 histologic pictures of the gut (normal, acute and chronic)
inflammation seem to correlate with different clinical,
biologic and radiologic manifestations of the disease concept of
spondyloarthropathies.