Capsule endoscopy findings for the diagnosis of Crohn’s disease: a nationwide case–control study

Esaki, Motohiro; Matsumoto, Takayuki; Ohmiya, Naoki; Washio, Ema; Morishita, Tadashi; Sakamoto, Kei; Abe, Hiroo; Yamamoto, Shojiro; Kinjo, Tetsu; Togashi, Kazutomo; Watanabe, Kenji; Hirai, Fumihito; Nakamura, Masanao; Nouda, Sadaharu; Ashizuka, Shinya; Omori, Teppei; Kochi, Shuji; Yanai, Shunichi; Fuyuno, Yuta; Hirano, Atsushi; Umeno, Junji; Kitazono, Takanari; Kinjo, Fukunori; Watanabe, Mamoru; Matsui, Toshiyuki; Suzuki, Yasuo

doi:10.1007/s00535-018-1507-6

Cited by 23 publications

(25 citation statements)

References 35 publications

(37 reference statements)

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“…If a diagnosis can be made during SBCE, although dependent on the case, treatment can be started immediately. For example, if characteristic findings with Crohn's disease such as longitudinal ulceration, cobblestone appearance chiefly in the ileum and longitudinal or circumferential alignment of erosions or linear erosions both in the jejunum and ileum are observed, 71 intensified medical treatment including biological agents can be started. When abnormalities are undetected by either CT or SBCE, we should determine whether further work-up is needed, according to the severity and frequency of OGIB, and the duration between bleeding onset and examination.…”

Section: Diagnostic Algorithm and Management Of Ogibmentioning

confidence: 99%

“…If a diagnosis can be made during SBCE, although dependent on the case, treatment can be started immediately. For example, if characteristic findings with Crohn’s disease such as longitudinal ulceration, cobblestone appearance chiefly in the ileum and longitudinal or circumferential alignment of erosions or linear erosions both in the jejunum and ileum are observed, intensified medical treatment including biological agents can be started.…”

Section: Diagnosismentioning

confidence: 99%

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Management of obscure gastrointestinal bleeding: Comparison of guidelines between Japan and other countries

Ohmiya

2019

Digestive Endoscopy

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Small‐bowel bleeding accounts for the majority of obscure gastrointestinal bleeding, but it is caused by various types of small bowel disease, upper gastrointestinal disease, and colorectal disease. For the diagnosis, history taking and physical examination are required, leading to a determination of what diseases are involved. Next, cross‐sectional imaging, such as computed tomography, should be carried out, followed by the latest enteroscopy such as small bowel capsule endoscopy and deep enteroscopy according to the severity of hemorrhage and patient condition. After a comprehensive diagnosis, medical, enteroscopic, or surgical treatment should be selected. This article reviews recent advances in the endoscopic diagnosis of obscure gastrointestinal bleeding and compares perspectives of the management of obscure gastrointestinal bleeding in Japan with that in other countries.

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Section: Diagnostic Algorithm and Management Of Ogibmentioning

confidence: 99%

Section: Diagnosismentioning

confidence: 99%

Management of obscure gastrointestinal bleeding: Comparison of guidelines between Japan and other countries

Ohmiya

2019

Digestive Endoscopy

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“…All items referred to small bowel CD lesions. The most frequently described items were ulcer ( 4 , 16 – 28 , 30 , 32 – 35 ) and erosion ( 16 , 17 , 19 – 24 , 26 , 29 , 33 – 35 ). Both definitions are characterized by a central mucosal defect with surrounding focal erythema and are distinguished from each other based on their size and depth of the defect.…”

Section: Resultsmentioning

confidence: 99%

“…Different terminology has been used concerning each feature: crater, white lesion, mucosal break, pale lesion, white/yellow base, loss of mucosal substance, red/pink collar, or red rim. Esaki and colleagues ( 35 ) also distinguished ulcers and erosions according to shape (i.e., oval, circular, longitudinal, and irregular).…”

Section: Resultsmentioning

confidence: 99%

Characterization of Mucosal Lesions in Crohn's Disease Scored With Capsule Endoscopy: A Systematic Review

Marquès-Camí

Serracarbasa

D’Haens³

et al. 2021

Front. Med.

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Background and Aims: There is little agreement on the nomenclature and description of Crohn's disease (CD) lesions that can be found in the small and large bowel using capsule endoscopy (CE). We performed a systematic review to identify mucosal lesions that have been described using CE in CD, in both the small bowel and colon, with the aim to make propositions to homogenize such descriptions.Methods: A systematic literature search was conducted using Embase, Medline (OvidSP), and Cochrane Central on August 6, 2019. Clinical studies providing nomenclature and descriptions for small bowel and colonic inflammatory lesions using CE in CD were selected for data collection.Results: In total, 851 articles were included for abstract screening out of which 219 were analyzed for full-text review. Twenty-two articles were selected for data extraction. Seven items, accompanied by clear descriptions, were found for the small bowel: i.e., ulcer, erosion, aphthoid lesion, edema, fissure, cobblestone appearance, and villous atrophy. No studies were found describing inflammatory items using CE in colonic CD.Conclusions: The most frequently described CD lesions using CE were ulcers and erosions. Subjective interpretation of CE inflammatory findings plays an important role. Based on our findings, a range of suggestions regarding items and descriptions is made that might form the basis of a pan-enteric CE activity index.

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“…With the advent of CE, various diseases have been clearly visualized, resulting in a paradigm shift in the diagnosis and treatment of small bowel disease. According to a nationwide study in Japan, the frequent findings of CE in patients with CD include cobblestone appearance (occurrence rate: 33%), longitudinal ulcer (78%), irregular ulcer (84%), liner erosion (90%), irregular erosion (89%), circumferential alignment of diminutive lesions (75%), and longitudinal alignment of diminutive lesions (56%) [ 15 ]. In this previous study, Esaki et al observed that the endoscopic diagnosis varied in endoscopist’s clinical knowledge and proficiency; hence, this issue should be overcome.…”

Section: Discussionmentioning

confidence: 99%

Chronic active EBV infection in refractory enteritis with longitudinal ulcers with a cobblestone appearance: an autopsied case report

et al. 2021

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Background Chronic active Epstein–Barr virus infection (CAEBV) is defined as Epstein–Barr virus (EBV)-positive T/NK cell-related neoplasia, and its major clinical symptom is systemic inflammation presenting as infectious mononucleocytosis, whereas enteritis and diarrhea are minor clinical symptoms. The complex mixture of tumorigenic processes of EBV-positive cells and physical symptoms of systemic inflammatory disease constitutes the varied phenotypes of CAEBV. Herein, we describe a case of CAEBV that was initially diagnosed as Crohn’s disease (CD) based on ileal ulcers and clinical symptoms of enteritis. Case presentation A 19-year-old woman complained of abdominal pain and fever. Blood examination showed normal blood cell counts without atypical lymphocyte but detected modest inflammation, hypoalbuminemia, slight liver dysfunction, and evidence of past EBV infection. The esophagogastroduodenoscopic findings were normal. However, colonoscopy revealed a few small ulcers in the terminal ileum. The jejunum and ileum also exhibited various forms of ulcers, exhibiting a cobblestone appearance, on capsule endoscopy. Based on these clinical findings, she was strongly suspected with CD. In the course of treatment by steroid and biologics for refractory enteritis, skin ulcers appeared about 50 months after her initial hospital visit. Immunohistology of her skin biopsy revealed proliferation of EBV-encoded small RNA (EBER)-positive atypical lymphocytes. We retrospectively assessed her previous ileal ulcer biopsy before treatment and found many EBER-positive lymphocytes. Blood EBV DNA was also positive. Therefore, she was diagnosed with extranodal NK/T-cell lymphoma with CAEBV-related enteritis rather than CD. She was treated with cyclosporine and prednisolone combination therapy for CAEBV-related systemic inflammation and chemotherapy for malignant lymphoma. Unfortunately, her disease continued to progress, leading to multiple organ failure and death at the age of 23 years. Conclusion Clinicians need to remember the possibility of CAEBV as a differential diagnosis of refractory enteritis. Enteritis with intestinal ulcer is a rare symptom of CAEBV, and it is impossible to acquire a definitive diagnosis by ulcer morphology only. In cases where the possibility of CAEBV remains, tissue EBVR expression should be checked by in situ hybridization and blood EBV DNA.

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Capsule endoscopy findings for the diagnosis of Crohn’s disease: a nationwide case–control study

Abstract: Circumferential or longitudinal alignment of diminutive lesions, especially in the upper small bowel, may be a diagnostic clue for CD under SBCE, while inter-observer variations should be cautiously considered when using SBCE.

Cited by 23 publications

References 35 publications

Management of obscure gastrointestinal bleeding: Comparison of guidelines between Japan and other countries

Management of obscure gastrointestinal bleeding: Comparison of guidelines between Japan and other countries

Characterization of Mucosal Lesions in Crohn's Disease Scored With Capsule Endoscopy: A Systematic Review

Chronic active EBV infection in refractory enteritis with longitudinal ulcers with a cobblestone appearance: an autopsied case report

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