The Prevalence and Outcome of Jejunal Lesions Visualized by Small Bowel Capsule Endoscopy in Crohn’s Disease

Flamant, Mathurin; Trang, Caroline; Maillard, Olivier; Sacher‐Huvelin, Sylvie; Rhun, Marc Le; Galmiche, Jean–Paul; Bourreille, Arnaud

doi:10.1097/mib.0b013e31828133c1

Cited by 118 publications

(67 citation statements)

References 22 publications

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“…On the other hand, up to one third of patients with CD may present with involvement of the SB alone and, in these cases, symptoms are more unspecific and diagnosis is more complex (15). Moreover, affectation of the proximal SB has been associated with younger patients, higher rates of stenosis and higher need for surgery (16).…”

Section: Discussionmentioning

confidence: 99%

Fecal calprotectin and C-reactive protein are associated with positive findings in capsule endoscopy in suspected small bowel Crohns disease

Valenzuela¹,

López²,

Fernández³

et al. 2016

Rev Esp Enferm Dig

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Background and aims:Capsule endoscopy is an extended tool for the diagnosis of small bowel Crohn's disease. However, factors associated with positive findings of this technique have not been well established. Our aim is to asses which factors are associated with a better diagnostic yield of capsule endoscopy in suspected small bowel Crohn's disease.Material and methods: This was a retrospective study including patients under capsule endoscopy because of suspected small bowel Crohn's disease. Demographic data of these patients, as well as symptoms and laboratory data including hemoglobin levels, count of leucocytes and platelets, and levels of C-reactive protein, erythrocyte sedimentation rate and fecal calprotectin were collected. Capsule endoscopy studies were classified as negative (no lesions) or positive (lesions suggestive of Crohn's disease). Descriptive, univariate and multivariate analysis were done, as well as diagnostic yield tests of the different markers for predicting lesions in capsule studies.Results: One hundred and twenty-four patients were included (85 women and 39 men). The average age was 38.21 years. Levels of C-reactive protein and fecal calprotectin were the markers more frequently associated with positive findings in capsule endoscopy. Calprotectin presented the best sensitivity as isolated marker. The association of altered levels of C-reactive protein and calprotectin showed the best specificity and predictive values.Conclusions: C-reactive protein and fecal calprotectin are appropriate biomarkers for selecting patients with suspected Crohn's disease of the small bowel for capsule endoscopy studies.

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Section: Discussionmentioning

confidence: 99%

Fecal calprotectin and C-reactive protein are associated with positive findings in capsule endoscopy in suspected small bowel Crohns disease

Valenzuela¹,

López²,

Fernández³

et al. 2016

Rev Esp Enferm Dig

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“…Furthermore, very recent studies show that proximal involvement is associated with younger age, nonsmoking status, coexistence of ileal involvement, and stenosing pattern. Specifically, jejunal involvement is associated with stenosing patterns requiring more surgery (46,47). Data are similar for CD with ileal involvement, which progresses towards stenosing and penetrating patterns more often than colonic CD (48).…”

Section: Assessment Of Extension In Crohn's Diseasementioning

confidence: 48%

Indications of capsule endoscopy in Crohn's disease

Luján-Sanchis

Sanchis-Artero

Suárez-Callol

et al. 2014

Rev. esp. enferm. dig.

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Capsule endoscopy currently plays a relevant role for Crohn's disease. This manuscript will discuss the current indications and practical uses of capsule endoscopy in this disease. It is a non-invasive technique that represents a significant advance in the endoscopic diagnosis of small bowel conditions. These circumstances, together with its diagnostic yield and excellent tolerability, make it considerably acceptable by both patients and physicians. This paper discusses the current evidence on the specific circumstances where capsule endoscopy may be indicated for three specific scenarios: Suspected Crohn's disease, indeterminate colitis, and established Crohn's disease, where it plays an extensive role. Furthermore, the impact and implications of capsule endoscopy results for follow-up are reviewed. These recommendations must be interpreted and applied in the setting of the integral, individual management of these patients. Understanding its appropriate use in daily clinical practice and an analysis of results may define endoscopic scoring systems to assess activity and mucosal healing in this condition. The present role of capsule endoscopy for Crohn's disease is subject to ongoing review, and appropriate usage uncovers novel applications likely to result in relevant changes for the future management of these patients.

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“…54 SBCE improves the detection of lesions in the proximal small bowel when compared to both CTE and MRE, detecting proximal lesions in up to 50% of patients with previously diagnosed ileal CD. 55 Jejunal involvement has been recognized as an independent marker of severity in CD, being associated with an increased risk of relapse, 55 higher use of corticosteroids (HR 1.24; 95% CI: 1.02 -1.50) and thiopurines (HR 1.26; 95% CI: 1.06 -1.49), higher rates of strictureplasties (RR 2.52; 95% CI: 1.60 -3.96), hospitalizations (RR 1.29; 95% CI: 1.14 -1.47), and longer hospitalization duration (RR, 1.30; 95% CI, 1.25 -1.34). 56 Recently, it was reported that treatment with thiopurines and/or biologics was started more often in patients with proximal small bowel lesions detected by SBCE [13/33 (39%) vs 1/17 (6%), p = 0.011, relative risk (RR) 6.5], particularly when severe (6%, 36% and 45% of patients with non-significant, mild and moderate-to-severe inflammation, respectively).…”

Section: Crohn's Diseasementioning

confidence: 99%

Current Clinical Indications for Small Bowel Capsule Endoscopy

Rosa

Cotter

2015

Acta Med Port

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RESUMOIntrodução: A enteroscopia por cápsula é o exame de primeira linha no diagnóstico de diversas patologias do intestino delgado. Este artigo tem por objectivo rever e analisar criticamente as indicações actuais para enteroscopia por cápsula na prática clínica. Material e Métodos: Revisão bibliográfica suportada em artigos indexados na PubMed. Resultados e Discussão: A enteroscopia por cápsula permite a avaliação não invasiva da mucosa do intestino delgado, com elevado rendimento diagnóstico. Em doentes com hemorragia digestiva de causa obscura, o rendimento da enteroscopia por cápsula aumenta quando realizada precocemente após o evento hemorrágico. O tratamento das angiectasias com enteroscopia assistida por balão permite diminuir a recidiva hemorrágica, enquanto o risco de recidiva em doentes com enteroscopia por cápsula "negativa" é controverso. A entero-TC/entero-RM podem superiorizar-se à enteroscopia por cápsula no diagnóstico de alguns tumores. O 'Smooth Protruding Index on Capsule Endoscopy' (score SPICE) auxilia na diferenciação entre verdadeiros tumores submucosos e abaulamentos não patológicos. A enteroscopia por cápsula é valiosa em doentes com suspeita de doença de Crohn quando a ileocolonoscopia não é diagnóstica, permitindo também estadiar a extensão e actividade das lesões em doentes com diagnóstico prévio de doença de Crohn, com potenciais implicações prognósticas e terapêuticas. A enteroscopia por cápsula permite ainda o diagnóstico de complicações em doentes com doença celíaca refractária. Conclusões: Actualmente, a importância da enteroscopia por cápsula é reconhecida no contexto da hemorragia digestiva de causa obscura e/ou suspeita de tumores do intestino delgado, bem como na suspeita de doença de Crohn ou em doentes com doença de Crohn conhecida para determinar a localização, extensão e actividade da doença, e ainda para a investigação de doentes com doença celíaca refractária. Palavras-chave: Doenças Intestinais; Endoscopia por Cápsula. ABSTRACT Introduction:Small bowel capsule endoscopy is currently the first line diagnostic examination for many diseases affecting the small bowel. This article aims to review and critically address the current indications of small bowel capsule endoscopy in clinical practice. Material and Methods: Bibliographic review of relevant and recent papers indexed in PubMed.

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The Prevalence and Outcome of Jejunal Lesions Visualized by Small Bowel Capsule Endoscopy in Crohn’s Disease

Abstract: Jejunal lesions are detected in more than half of the patients with Crohn's disease. The prevalence of jejunal lesions is higher when the terminal ileum is involved and associated with an increased risk of further clinical relapse. It may be regarded as a factor of severity.

Cited by 118 publications

References 22 publications

Fecal calprotectin and C-reactive protein are associated with positive findings in capsule endoscopy in suspected small bowel Crohns disease

Fecal calprotectin and C-reactive protein are associated with positive findings in capsule endoscopy in suspected small bowel Crohns disease

Indications of capsule endoscopy in Crohn's disease

Current Clinical Indications for Small Bowel Capsule Endoscopy

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The Prevalence and Outcome of Jejunal Lesions Visualized by Small Bowel Capsule Endoscopy in Crohn’s Disease

Abstract: Jejunal lesions are detected in more than half of the patients with Crohn's disease. The prevalence of jejunal lesions is higher when the terminal ileum is involved and associated with an increased risk of further clinical relapse. It may be regarded as a factor of severity.

Cited by 118 publications

References 22 publications

Fecal calprotectin and C-reactive protein are associated with positive findings in capsule endoscopy in suspected small bowel Crohns disease

Fecal calprotectin and C-reactive protein are associated with positive findings in capsule endoscopy in suspected small bowel Crohns disease

Indications of capsule endoscopy in Crohn's disease

Current Clinical Indications for Small Bowel Capsule Endoscopy

Contact Info

Product

Resources

About

Fecal calprotectin and C-reactive protein are associated with positive findings in capsule endoscopy in suspected small bowel Crohns disease

Fecal calprotectin and C-reactive protein are associated with positive findings in capsule endoscopy in suspected small bowel Crohns disease