Development of significant disease in a cohort of patients with non-specific enteritis on capsule endoscopy: clinical suspicion and a high base line Lewis score are predictive of Crohn’s disease

Abstract

Background As with isolated ileitis the findings of nonspecific small bowel enteritis (NSE) on capsule endoscopy (CE) poses a clinical challenge. There is lack of available evidence to help clinicians to predict significant disease and long-term prognosis. Aim To define the natural history of NSE in an Irish cohort. Methods Patients with a finding of NSE were identified from a database. Subsequent investigations, treatments and diagnosis were recorded. Patients were grouped based on ultimate diagnosis: Crohn’s disease (CD), Irritable bowel syndrome (IBS), NSAIDs enteritis (NSAIDs), persistent NSE and no significant disease (NAD). Results 88 patients, 46 (52%) male, mean age 52 ± 17.8 years were included with a mean follow up of 23 ± months. The ultimate diagnoses were NAD = 43 (49%), CD = 17 (19%), IBS = 14 (16%), NSAIDs = 12 (14%) and persistent NSE = 2 (2%). Significantly, more patients diagnosed with CD on follow up were referred with suspected CD. CD = 14/17 (82%) vs 13/57 (23%), p < 0.001. While a diagnosis of CD was associated with a positive baseline Lewis score (> 135); 11/17 (65%) CD versus 16/ 71 (23%). Female gender was associated with an ultimate diagnosis of IBS (OR 5, p < 0.02). Older age was associated with NSAIDs enteritis, while more subjects without significant gastrointestinal disease were anemic on presentation. Conclusion The majority (49%) of NSE patients do not develop significant small bowel disease. CD occurred in 19% of NSE patients on follow up. Clinical suspicion and capsule severity are predictive of Crohn’s disease on initial CE.

Small-bowel capsule endoscopy and device-assisted enteroscopy for diagnosis and treatment of small-bowel disorders: European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Update 2022

“…A retrospective observational study by Freitas et al [97] investigated 102 patients found to have "isolated terminal ileitis" at ileocolonoscopy, endoscopic abnormalities proximal to the terminal ileum were found in 36.3 % of patients; one third (35/ 102) were finally diagnosed with CD. Similarly, isolated ileitis on SBCE can frequently herald an ultimate diagnosis of CD, even in patients with an initial negative ileocolonoscopy [98,99].…”

Capsule Endoscopy in Inflammatory Bowel Disease: A Systematic Review

“…High baseline LS (>135) and clinical suspicion were predictors of the subsequent development of CD. 40…”

Idiopathic terminal ileitis: myth or true entity?

“…In the study by Tse et al [23], only half of the patients underwent additional gastrointestinal imaging after endoscopy to rule out proximal small bowel disease. Colonoscopy with histology was the only investigation performed in all patients with a change in diagnosis at follow-up, except for Sihag et al [25], in which patients were followed-up with small bowel CE. Smith et al In patients who were eventually diagnosed as Crohn's disease, the time interval is an important factor; however, the follow-up period in the many studies are fairly heterogenous.…”