Essential role of small bowel capsule endoscopy in reclassification of colonic inflammatory bowel disease type unclassified

Abstract

AIMTo evaluate the role of small bowel capsule endoscopy (SBCE) on the reclassification of colonic inflammatory bowel disease type unclassified (IBDU).METHODSWe performed a multicenter, retrospective study including patients with IBDU undergoing SBCE, between 2002 and 2014. SBCE studies were reviewed and the inflammatory activity was evaluated by determining the Lewis score (LS). Inflammatory activity was considered significant and consistent with Crohn’s disease (CD) when the LS ≥ 135. The definitive diagnosis during follow-up (minimum 12 mo following SBCE) was based on the combination of clinical, analytical, imaging, endoscopic and histological elements.RESULTSThirty-six patients were included, 21 females (58%) with mean age at diagnosis of 33 ± 13 (15-64) years. The mean follow-up time after the SBCE was 52 ± 41 (12-156) mo. The SBCE revealed findings consistent with significant inflammatory activity in the small bowel (LS ≥ 135) in 9 patients (25%); in all of them the diagnosis of CD was confirmed during follow-up. In 27 patients (75%), the SBCE revealed no significant inflammatory activity (LS < 135); among these patients, the diagnosis of Ulcerative Colitis (UC) was established in 16 cases (59.3%), CD in 1 case (3.7%) and 10 patients (37%) maintained a diagnosis of IBDU during follow-up. A LS ≥ 135 at SBCE had a sensitivity = 90%, specificity = 100%, positive predictive value = 100% and negative predictive value = 94% for the diagnosis of CD.CONCLUSIONSBCE proved to be fundamental in the reclassification of patients with IBDU. Absence of significant inflammatory activity in the small intestine allowed exclusion of CD in 94% of cases.

Integrating omics for a better understanding of Inflammatory Bowel Disease: a step towards personalized medicine

“…When features used to differentiate UC from CD in patients with IBD remain uncertain even after a complete workup, patients will be referred to as IBD-U until in some cases the disease develops its characteristic subtype features over time [6,7,33]. It is nowadays challenging to choose the best diagnostic tests and correctly classify IBD patients, especially with the increased frequency of disease heterogeneity and atypical phenotypes [19].…”

“…It is nowadays challenging to choose the best diagnostic tests and correctly classify IBD patients, especially with the increased frequency of disease heterogeneity and atypical phenotypes [19]. Moreover, clinicians are often faced with a difficult clinical decision for the IBD-U patients and frequently resort to mixing treatment protocols in an anticipation for the development of either UC or CD over time [6,7,33]. Such approaches often result in unsatisfactory patient outcomes, unnecessary treatment or, in some cases, inappropriate clinical care.…”

“…Based on the disease manifestation, IBD is classified into three major subtypes [4]: Ulcerative Colitis (UC), which primarily affects the colon, Crohn's disease (CD) which affects various GI sites [5], and a third subtype where histology assessments done on patients do not categorize to either UC or CD. This subtype is defined as "Inflammatory Bowel Disease, type unclassified" or "Undetermined" (IBD-U) [6,7]. IBD is a lifelong disease that substantially reduces the quality of life for the patients and their families [8].…”

Balloon-Assisted Enteroscopy and Capsule Endoscopy in Suspected Small Bowel Crohn’s Disease

“…In contrast, a negative CE for suspected CD has a very high negative predictive value of 96% for ruling out CD during follow-up [ 22 , 23 ]. In the absence of significant small bowel inflammatory activity, CE helps clinicians exclude the diagnosis of CD in 94% of cases [ 24 ].…”

Capsule endoscopy in Portugal

“…The national centre of data registry in gastroenterology (CEREGA), a structure of the Portuguese Gastroenterology Society, is currently recruiting patients for a multicentre prospective evaluation of the efficacy of endoscopic therapy for small bowel angioectasias after detection by small bowel capsule endoscopy. Relevant data on the role of capsule endoscopy in suspected Crohn's Disease (7-9), IBD-unclassified (10,11) …”