- D1.343 - Common Variable Immunodeficiency Associated Enteropathy: A Single-Center Experience

Gastrointestinal (GI) tract involvement is one of the cardinal non-infectious complications of common variable immunodeficiency (CVID). We aimed to assess the prevalence of GI involvement in adult CVID patients at our center and to describe GI symptoms, endoscopic/histopathological findings, and associated biochemical and immunological features.

Sixty-three adults (≥18 years) with confirmed CVID were retrospectively evaluated and categorized by the presence or absence of GI involvement. Between-group comparisons were performed using non-parametric statistical methods.

Of the cohort, 49.2% were female (31/63) and 50.8% male (32/63). Mean age was 42.8 ± 14.0 years and mean age at diagnosis was 34.4 ± 16.5 years. Among patients with available symptom data, chronic diarrhea was the most frequent symptom (31%; 18/58), followed by abdominal pain (19.3%; 11/57), bloating (7%; 4/57), and weight loss (5.3%; 3/57); the distribution of gastrointestinal symptoms is presented in Figure 1. Gastroscopy data were available in 34/63 patients; histopathology most commonly demonstrated chronic active gastritis (55.8%; 19/34), while Helicobacter pylori and foveolar hyperplasia were each reported in 20.5%. Colonoscopy data were available in 21/63 patients; colonic histopathology was abnormal in 60%, with cryptitis (35%) and colitis (20%) ranking first and second, respectively. Overall, GI involvement was present in 39/63 patients (61.9%) and was associated with older age (45.8 ± 13.3 vs 37.8 ± 13.9 years; p=0.010) and later diagnosis (38.0 ± 14.9 vs 28.6 ± 17.6 years; p=0.006). Baseline immunoglobulin levels and lymphocyte subsets did not differ (all p>0.05), whereas total protein (p=0.038) and albumin (p=0.004) were significantly lower in the GI involvement group. Demographic, immunological, and selected biochemical characteristics stratified by GI involvement are summarized in Table 1.

GI involvement is common in adult CVID and is most often manifested by chronic diarrhea, with heterogeneous endoscopic and histopathological findings. Older age and later diagnosis in patients with GI involvement suggest that GI complaints may contribute to delayed CVID recognition. In addition, GI involvement was accompanied by significantly lower total protein and albumin levels, supporting a potential adverse impact of gastrointestinal disease on nutritional status. These findings highlight the importance of systematic early assessment of gastrointestinal symptoms in CVID patients and, in symptomatic individuals, timely endoscopic/histopathological evaluation with close monitoring of nutritional parameters.