Capsule Endoscopy in Refractory Diarrhea-Predominant Irritable Bowel Syndrome and Functional Abdominal Pain

Abstract

Background/AimsCapsule endoscopy is a diagnostic method for evaluating the small bowel lumen and can detect undiagnosed lesions. The aim of this study was to evaluate the diagnostic yield and clinical impact of capsule endoscopy in patients with refractory diarrhea-predominant irritable bowel syndrome and functional abdominal pain. MethodsThis study involved a retrospective analysis of prospectively collected data, maintained in a database. Patients with refractory diarrhea-predominant irritable bowel syndrome and functional abdominal pain within the period of March 2012 to March 2014 were included. Capsule endoscopy was used to detect small bowel pathologies in both groups. ResultsSixty-five patients (53.8% female) fulfilled the inclusion criteria and had a mean (±standard deviation) age of 50.9±15.9 years. Clinically significant lesions were detected via capsule endoscopy in 32.5% of the patients in the abdominal pain group and 54.5% of the patients in the diarrhea group. Overall, 48% of patients had small bowel pathologies detected during the capsule endoscopy study. Inflammatory lesions and villous atrophy were the most frequent lesions identified in 16.9% and 15.3% of patients in the abdominal pain and the diarrhea groups, respectively. ConclusionsRoutine use of capsule endoscopy in patients with irritable bowel syndrome should not be recommended. However, in patients with refractory conditions, capsule endoscopy may identify abnormalities.

Diagnostic yield of esophagogastroduodenoscopy, colonoscopy, and small bowel endoscopy in Thai adults with chronic diarrhea

“…However, BAE should only be performed under the guidance of small bowel imaging or VCE because of its invasiveness. In the present study, the diagnostic yield of VCE was 42.1%, comparable to the reported rate of 42.9–54.5% in previous studies [ 6 , 7 ]. Furthermore, our study showed that VCE could help to guide the abnormal findings prior to BAE in 4 patients and help to exclude small bowel mucosal lesions if the results were normal since no patients with normal VCE findings were later diagnosed with small bowel mucosal disease.…”

“…Celiac disease, giardia infection, Crohn’s disease, eosinophilic gastroenteritis, Whipple’s disease, and intestinal amyloid are probable diagnoses in these patients [ 4 ]. Among patients with normal esophagogastroduodenoscopy (EGD) and colonoscopy, video capsule endoscopy (VCE) provides a diagnostic yield ranging from 43 to 54% [ 6 , 7 ]. Deep enteroscopy with tissue sampling is a potential tool for diagnosing small bowel disease in patients presenting with chronic diarrhea [ 8 – 12 ], but data are limited.…”

Clinicopathological Features of Small Bowel Tumors Diagnosed by Video Capsule Endoscopy and Balloon-Assisted Enteroscopy: A Single Center Experience

“…VCE is widely used to diagnose small bowel diseases because it is non-invasive and relatively easy to perform. VCE allows for visualization of the small bowel mucosa and its abnormalities on video [ 7 , 13 , 14 ].…”

“…VCE allows for visualization of the small bowel mucosa and its abnormalities on video. 7,13,14 DBE not only enables full-length visual inspection of the small bowel, but also allows for direct intervention in the deep portions of the jejunum and ileum. It is therefore the most innovative diagnostic tool for small bowel diseases.…”

Refractory Irritable Bowel Syndrome and Functional Abdominal Pain Syndrome: Should Small Bowel Endoscopy Be Performed?

“…In the present issue, Valero et al [10] investigated the diagnostic yield and clinical impact of CE in IBS and FAPS cases refractory to treatment. A total of 65 patients were included and all had laboratory or endoscopic examinations to rule out other causes.…”