Small Bowel Lesions Detected With Wireless Capsule Endoscopy in Patients With Active Ulcerative Colitis and With Post-Proctocolectomy

Abstract

Background: Although rare, duodenal lesions have been reported in association with ulcerative colitis (UC); however, there have been very few reports on small bowel lesions, and many aspects of their pathology and frequency remain unknown. This study determined whether small bowel lesions are present in UC by using wireless capsule endoscopy (WCE). Patients and Methods: WCE was performed on 20 patients with active UC and 10 who had undergone proctocolectomy. Results: Small bowel lesions (e.g. edema or ulcers) were observed in 11 of the 30 patients (36.6%): in eight (40%) of the 20 patients with active UC and in three (33.3%) of the 10 post-proctocolectomy patients. Ulcers that extended over a long segment or whole tertile of the small bowel were observed in five patients, and the disease type was extensive colitis in three of these and pouchitis in the other two.Age at onset was significantly lower in the 20 active UC patients that had small bowel lesions. Conclusion: WCE revealed the presence of ulcers that extended over a long segment or a whole tertile in the small bowel in active extensive colitis and pouchitis. In future, it will be necessary to assess the clinical significance of small bowel lesions in UC in detail.

Comparison of Small Bowel Lesions Using Capsule Endoscopy in Ulcerative Colitis and Crohn’s Disease: A Single-Center Retrospective Analysis

“…This study investigated clinical features in UC patients with and without small bowel lesions, but found no differences in disease type or disease activity. This result differed from a previous study describing higher frequencies of small bowel lesions in active UC patients with extensive type UC [13]. However, in our study, endoscopic activity was significantly higher in the UC subgroup with small bowel lesions than in the subgroup without such lesions.…”

“…The presence of gastroduodenal lesions [5-10] and small bowel lesions [11-15] in UC has been reported in recent years, with an incidence of 4.7–7.6% [8, 9] for gastroduodenal lesions and 36–57% [13, 14] for small bowel lesions. Our study similarly found an incidence of 27.8% for small bowel lesions in UC, lending further support to the idea that such lesions are not uncommon in UC.…”

“…UC is restricted to the colon, except in cases of backwash ileitis [1, 2] and post-proctocolectomy pouchitis [3, 4] which involve lesions in the terminal ileum. Gastroduodenal lesions have been reported in UC [5-10], and a few cases of UC with small bowel lesions have also recently been reported [11, 12], but very few studies have been able to endoscopically assess these small bowel lesions [13-15]. …”

Inflammatory bowel disease and novel endoscopic technologies

“…Compared with CD, the role of CE in UC patients is limited. Recent studies indicated that small intestinal lesions were detected using CE in patients with UC . However, the clinical significance of these intestinal lesions in UC patients remains to be defined.…”

“…Recent studies indicated that small intestinal lesions were detected using CE in patients with UC. 16,17 However, the clinical significance of these intestinal lesions in UC patients remains to be defined. Recently, our group established the applicability of colon CE in patients with UC.…”