Morphological changes in colon mucosa and inflammatory biomarkers in patients with ulcerative colitis and arterial hypertension

Objective — to assess morphological changes in the colon mucosa in patients with ulcerative colitis (UC) and arterial hypertension (AH) or without it, to determine and compare biomarkers of inflammation such as faecal calprotectin, faecal lactoferrin, and serum zonulin. Materials and methods. The study involved 142 patients (76 men, 66 women) aged between 19 and 59 years. In 96 of them, a diagnosis of UC was made during colonoscopy with biopsy. Endoscopic assessment of UC severity was performed according to the Mayo ulcerative colitis system. After the biopsy, a standard histological examination was performed with a morphological assessment of the degree of disease activity. Patients had their blood pressure measured, and the presence of arterial hypertension was detected, followed by division into groups: Group I: «UC + AH» — patients with UC with concomitant arterial hypertension (49 patients); Group II: «UC without AH» — patients with UC without concomitant arterial hypertension (47 patients); group III: «AH without UC» — patients with arterial hypertension without UC (46 patients). Non‑invasive methods of research, namely the determination of faecal calprotectin (Bühlmann fCAL ELISA, Switzerland), faecal lactoferrin (ScheBo Lactoferrin Smart Stool Test, Germany) and serum zonulin (IDK Zonulin ELISA, Immunodiagnostic AG, Germany) were performed using ELISA. Results. Differences between the groups «UC + AH» and «AH without UC» and between the groups «UC without AH» and «AH without UC» in terms of faecal calprotectin, faecal lactoferrin, zonulin in the blood serum were statistically significant (p<0.001 for all comparisons), which confirmed the absence of UC in patients of the group «AH without UC» and its presence in other groups. To assess the correlation of UC disease activity according to endoscopy with inflammatory biomarkers, a correlation analysis was performed for patients with UC. Statistically significant direct correlations were found between the following main parameters: Mayo severity of UC and inflammatory biomarkers, and between inflammatory biomarkers. An inverse statistically significant correlation was found between the following parameters: patients’ age and serum zonulin (r=–0.207; p=0.043); duration of UC disease (r=–0.298; p=0.003). Histological examination of biopsy specimens from patients with arterial hypertension revealed uneven wall thickening with stratification in small arterial vessels in the submucosal layer due to mucoid and fibrinoid swelling. In both biopsies, there was a decrease in the number and size of vacuoles with mucin in the goblet cells of individual glands. No changes were detected in the biopsy specimens of patients in the «AH without UC» group. Conclusions. Measurement of blood pressure in patients with UC is recommended, as the presence of arterial hypertension worsens the course of UC and may lead to recurrence of the latter. Faecal biomarkers and serum zonulin determination offer a convenient, non‑invasive and inexpensive option for monitoring UC with and without arterial hypertension.