Unsuspected Small-Bowel Crohn’s Disease in Elderly Patients Diagnosed by Video Capsule Endoscopy

Abstract

Background Video capsule endoscopy (VCE) is increasingly performed among the elderly for obscure bleeding. Our aim was to report on the utility of VCE to uncover unsuspected Crohn's disease (CD) in elderly patients. Methods Retrospective review of VCE performed in elderly patients (≥70 y) at a tertiary hospital (2010–2015). All underwent prior negative bidirectional endoscopies. CD diagnosis was based on consistent endoscopic findings, exclusion of other causes, and a Lewis endoscopic score (LS) > 790 (moderate-to-severe inflammation). Those with lower LS (350–790) required histological confirmation. Known IBD cases were excluded. Results 197 VCE were performed (mean age 78; range 70–93). Main indications were iron deficiency anemia (IDA), occult GI bleeding (OGIB), chronic abdominal pain, or diarrhea. Eight (4.1%) were diagnosed as CD based on the aforementioned criteria. Fecal calprotectin (FCP) was elevated in 7/8 (mean 580 μg/g). Mean LS was 1824. Small-bowel CD detected by VCE led to a change in management in 4/8. One patient had capsule retention secondary to NSAID induced stricture, requiring surgical retrieval. Conclusions VCE can be safely performed in the elderly. A proportion of cases may have unsuspected small-bowel CD despite negative endoscopies. FCP was the best screening test. Diagnosis frequently changed management.

Octa‐nonagenarians can perform video capsule endoscopy safely and with a higher diagnostic yield than 65–79‐year‐old patients

“…24 Chao et al described newly diagnosed Crohn's disease by VCE in 8/197 (4.1%) older adult patients (age >70 years) evaluated for any indication. 25 Looking at our entire cohort, 8.4% of VCE studies had SB findings compatible with newly diagnosed Crohn's disease. The prevalence of newly diagnosed Crohn's disease among ≥80-year-old group was even higher, accounting for 12% of this age subgroup.…”

“…Yet, accumulating comorbidities such as diverticular disease, bowel ischemia, use of non‐steroidal anti‐inflammatory drugs (NSAID's), infectious and microscopic colitis, and other conditions that mimic inflammatory bowel disease, create a diagnostic challenge and might delay Crohn's disease diagnosis in older adult patients 24 . Chao et al described newly diagnosed Crohn's disease by VCE in 8/197 (4.1%) older adult patients (age >70 years) evaluated for any indication 25 . Looking at our entire cohort, 8.4% of VCE studies had SB findings compatible with newly diagnosed Crohn's disease.…”

Accuracy of Fecal Calprotectin in Detecting Small Bowel Crohn’s Disease: A Meta-Analysis and Systematic Review

“…A total of 27 articles were identified on initial search; 17 studies (N=1505) which met inclusion criteria were included in the analysis [3][4][5]7,9,[12][13][14][15][16][17][18][19][20][21][22][23]. Table 1 shows the search results and the characteristics for studies included in this meta-analysis.…”

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“…One study shows that video capsule endoscopy (VCE) can be safely performed in elderly because some of these patients can have unsuspected small intestine CD, despite negative conventional bidirectional gastrointestinal endoscopies, thus changing the course of treatment. Further studies in this particular age group would help identify clinical and biochemical parameters for stratifying the risks [10].…”