Endoscopic Skipping of the Distal Terminal Ileum in Crohn's Disease Can Lead to Negative Results From Ileocolonoscopy

Samuel, Sunil; Bruining, David H.; Loftus, Edward V.; Becker, Brenda D.; Fletcher, Joel G.; Mandrekar, Jayawant N.; Zinsmeister, Alan R.; Sandborn, William J.

doi:10.1016/j.cgh.2012.03.026

Cited by 187 publications

(105 citation statements)

References 31 publications

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“…MRE could overcome some inherent limitations of ileocolonoscopy. First, MRE enables the assessment of disease activity out of the reach of the endoscope due to disease location (isolated small bowel disease) or technical reasons, which may facilitate inclusion of a broader population of patients in trials [3]. Second, inclusion of patients based on MRE criteria at baseline may result in a selection of a more homogeneous patient population, increasing the efficiency of the study.…”

Section: Introductionmentioning

confidence: 99%

Comparison of three magnetic resonance enterography indices for grading activity in Crohn’s disease

et al. 2016

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Background Magnetic resonance enterography (MRE) is an accurate examination for assessing activity in Crohn's disease (CD). Various MRE indices have been developed for that purpose, but have not been directly compared. The aim of the study was to compare the diagnostic accuracy of three MRE indices for detecting and grading disease activity in CD, using endoscopy as gold standard. Methods MRE and ileocolonoscopies performed within 1 month in 43 patients with CD were analyzed. The magnetic resonance index of activity (MaRIA), Clermont, and London indices for each colonic segment and the terminal ileum were calculated. Simplified endoscopy score for CD (SES-CD) was considered the gold standard. Results Two hundred and twenty-four intestinal segments were included in the analysis. According to the established cut-off points for detecting active disease using MaRIA, Clermont, and London indices, the sensitivity of each index was 0.88, 0.89, and 0.71, and the specificity was 0.97, 0.78, and 0.99, respectively. The sensitivity for detecting ulcerations was 0.90 and 0.83 for the MaRIA and Clermont indices, respectively, with a specificity of 0.91 and 0.89. The AUROC curve for the MaRIA, Clermont, and London indices for detecting active disease was 0.92, 0.84, and 0.85, and for detecting ulcerations was 0.90 for the MaRIA, and 0.86 for Clermont index. Conclusions The three MRE-based indices evaluated in the current study have high diagnostic accuracy for assessment of disease activity. The MaRIA index has the best operational characteristics for detecting not only disease activity but also for grading severity, which supports its use in clinical studies and clinical practice.

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Section: Introductionmentioning

confidence: 99%

Comparison of three magnetic resonance enterography indices for grading activity in Crohn’s disease

et al. 2016

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“…Although a normal US may not obviate the need for endoscopic confirmation, it was however reassuring and suggested a need for a less urgent endoscopy as any disease missed was most likely relatively mild. There were no cases where the distal terminal ileum was normal on endoscopy and disease was isolated to the proximal small bowel, as has been reported in up to 30% of cases with small bowel involvement [30]; however, in 2 patients with both US and endoscopic activity (true positives), there was an estimation between 25 and 30 cm of active disease proximal to that region examined endoscopically. Thus, US also provided insight into the length or burden of the disease [31].…”

Section: Discussionmentioning

confidence: 82%

Point of Care Ultrasound Accurately Distinguishes Inflammatory from Non Inflammatory Disease in Patients Presenting with Abdominal Pain and Diarrhea

Al-Farhan¹,

Al-Darmaki²,

Shim³

et al. 2017

Gastroenterology

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Background. Approaches to distinguish inflammatory bowel disease (IBD) from noninflammatory disease that are noninvasive, accurate, and readily available are desirable. Such approaches may decrease time to diagnosis and better utilize limited endoscopic resources. The aim of this study was to evaluate the diagnostic accuracy for gastroenterologist performed point of care ultrasound (POCUS) in the detection of luminal inflammation relative to gold standard ileocolonoscopy. Methods. A prospective, single-center study was conducted on convenience sample of patients presenting with symptoms of diarrhea and/or abdominal pain. Patients were offered POCUS prior to having ileocolonoscopy. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) with 95% confidence intervals (CI), as well as likelihood ratios, were calculated. Results. Fifty-eight patients were included in this study. The overall sensitivity, specificity, PPV, and NPV were 80%, 97.8%, 88.9%, and 95.7%, respectively, with positive and negative likelihood ratios (LR) of 36.8 and 0.20. Conclusion. POCUS can accurately be performed at the bedside to detect transmural inflammation of the intestine. This noninvasive approach may serve to expedite diagnosis, improve allocation of endoscopic resources, and facilitate initiation of appropriate medical therapy.

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“…A enterro-TC pode ser útil quando associado a colonoscopia. Em um estudo de 2012 de 153 pacientes com doença de Crohn nos Estados Unidos, a entero-TC detectou a atividade da doença no intestino delgado em 36 dos 67 pacientes (54%) com exame de ileoscopia normal (SAMUEL et al, 2012).…”

Section: Tomografia Computadorizadaunclassified

Doença De Crohn

Papacosta¹,

Nunes²,

Pacheco³

et al. 2017

Rev Pat Tocantins

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INTRODUÇÃO: A doença de Crohn é qualificada como uma doença inflamatória intestinal, de caráter crônico, recidivante, transmural e que pode afetar qualquer parte do trato digestivo, desde a boca até o ânus, mas, principalmente, o intestino delgado e o cólon. São de cunho multifatorial, com prevalência e incidência variando de acordo com a genética, meio ambiente, microbiota intestinal e até mesmo um possível agente entérico infeccioso. É uma doença que afeta pessoas de várias idades, sexos e raças, apesar de se verificar maior incidência em jovens do sexo feminino e em regiões urbanas. METODOLOGIA: Trata-se de um artigo de revisão no qual, a partir das palavras “doença de Crohn” e “doença inflamatórias intestinais”, foi realizado busca por periódicos nos bancos de dados: PubMed, Scielo, Portal Periódicos CAPES e Google acadêmico. CONCLUSÃO: A doença de Crohn apresenta uma importante taxa de morbimortalidade no mundo, principalmente em regiões em franca urbanização e industrialização. O diagnóstico é um procedimento extremamente complicado devido a sua clínica inespecífica e pelos vários aspetos em comum com outras patologias. Dessa forma, ainda se faz necessário uma melhor investigação científica na área, com intuito de se desenvolver melhores técnicas diagnosticas e condutas a serem tomadas no seguimento e cura dessa patologia.Palavras-chave: Doença de Crohn, Doença inflamatórias intestinais, Diarreia. ABSTRACT INTRODUCTION: Crohn's disease is described as an inflammatory, chronic, recurrent, transmural inflammatory disease that can affect any part of the digestive tract, from the mouth to the anus, but especially the small intestine and colon. They are multifactorial, with prevalence and incidence varying according to genetics, environment, intestinal microbiota and even a possible infectious enteric agent. It is a disease that affects people of various ages, sexes and races, although there is a greater incidence in young women and in urban areas. METHODOLOGY: This is a review article in which, from the words "Crohn's disease" and "inflammatory bowel disease", a search was made for journals in the databases: PubMed, Scielo, Portal Periódicos CAPES and Google academic. CONCLUSION: Crohn's disease presents an important morbidity and mortality rate in the world, especially in regions where there is rapid urbanization and industrialization. Diagnosis is an extremely complicated procedure due to its nonspecific clinical and various aspects in common with other pathologies. Thus, a better scientific investigation in the area is still necessary, in order to develop better diagnostic techniques and behaviors to be taken in the follow-up and cure of this pathology. Keywords: Crohn's disease, Inflammatory bowel disease, Diarrhea.

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Endoscopic Skipping of the Distal Terminal Ileum in Crohn's Disease Can Lead to Negative Results From Ileocolonoscopy

Cited by 187 publications

References 31 publications

Comparison of three magnetic resonance enterography indices for grading activity in Crohn’s disease

Comparison of three magnetic resonance enterography indices for grading activity in Crohn’s disease

Point of Care Ultrasound Accurately Distinguishes Inflammatory from Non Inflammatory Disease in Patients Presenting with Abdominal Pain and Diarrhea

Doença De Crohn

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