Abstract：
OBJECTIVE: Isolated small bowel Crohn\'s disease (SBCD) is reported to have a worse prognosis compared to other CD phenotypes. The aim of this study was to understand the correlation between Isolated SBCD and ileocolonic disease with blood and faecal biomarkers and also to identify differences in outcome and management between the two phenotypes.
METHODS: Patients with ileocolonic or isolated small bowel Crohn\'s Disease (SBCD) were identified from an existing capsule endoscopy (CE) database. Harvey Bradshaw Index (HBI), biomarkers: c-reactive protein (CRP) and faecal calprotectin (FC), Lewis score and findings on CE and subsequent follow up data were collected. SPSS was used to analyse the data.
RESULTS: In total 248 patients were included in the study. Patients were split into two groups- Isolated SBCD with 178 patient (median age 44 years (IQR 31-56); 41.5 % male) and Ileocolonic Crohn\'s with 70 patients (median age 31 years (IQR 22.7-49); 31.5 % male). A new diagnosis of SBCD was made in 38.7 % (n = 96), whilst 60.0 % (n = 144) had established CD. Patients with ileocolonic disease had a higher HBI in comparison to isolated SBCD [HBI = 7 (IQR 5-10) vs HBI = 6(IQR 4-9); P = 0.04 ]. There was no significant difference in the FC levels between isolated SBCD and ileocolonic disease [136ug/g (IQR 53.8-363.3) vs 171ug/g (IQR 68.5-485.5); p = 0.98]. In isolated SBCD group, 30.3 % (n = 54) CE showed proximal disease, 96 % (n = 171) showed distal disease and 26.4 % (n = 47) showed extensive disease. SBCE was superior to MRI at diagnosing proximal SBCD (P < 0.01). On multivariate logistic regression, we did not identify any predictors of disease severity defined as Lewis score > 790. Following SBCE, 68.5 % (n = 170) of the total patients had a management change. This included commencement or dose escalation of corticosteroids in 123 (49.5 %) patients, azathioprine in 80 (33.3 %) patients, methotrexate in 22 (9.1 %) patients and biological therapy in 110 (44.3 %) patients. HBI predicted a change in management (p < 0.01).
CONCLUSIONS: CE is an important modality for the diagnosis of active SBCD. It also helps guide treatment in patients identified with active disease.
METHODS: Patients with ileocolonic or isolated small bowel Crohn\'s Disease (SBCD) were identified from an existing capsule endoscopy (CE) database. Harvey Bradshaw Index (HBI), biomarkers: c-reactive protein (CRP) and faecal calprotectin (FC), Lewis score and findings on CE and subsequent follow up data were collected. SPSS was used to analyse the data.
RESULTS: In total 248 patients were included in the study. Patients were split into two groups- Isolated SBCD with 178 patient (median age 44 years (IQR 31-56); 41.5 % male) and Ileocolonic Crohn\'s with 70 patients (median age 31 years (IQR 22.7-49); 31.5 % male). A new diagnosis of SBCD was made in 38.7 % (n = 96), whilst 60.0 % (n = 144) had established CD. Patients with ileocolonic disease had a higher HBI in comparison to isolated SBCD [HBI = 7 (IQR 5-10) vs HBI = 6(IQR 4-9); P = 0.04 ]. There was no significant difference in the FC levels between isolated SBCD and ileocolonic disease [136ug/g (IQR 53.8-363.3) vs 171ug/g (IQR 68.5-485.5); p = 0.98]. In isolated SBCD group, 30.3 % (n = 54) CE showed proximal disease, 96 % (n = 171) showed distal disease and 26.4 % (n = 47) showed extensive disease. SBCE was superior to MRI at diagnosing proximal SBCD (P < 0.01). On multivariate logistic regression, we did not identify any predictors of disease severity defined as Lewis score > 790. Following SBCE, 68.5 % (n = 170) of the total patients had a management change. This included commencement or dose escalation of corticosteroids in 123 (49.5 %) patients, azathioprine in 80 (33.3 %) patients, methotrexate in 22 (9.1 %) patients and biological therapy in 110 (44.3 %) patients. HBI predicted a change in management (p < 0.01).
CONCLUSIONS: CE is an important modality for the diagnosis of active SBCD. It also helps guide treatment in patients identified with active disease.
摘要：
目的：据报道，与其他CD表型相比，孤立的小肠克罗恩病（SBCD）的预后较差。这项研究的目的是了解分离的SBCD和回肠结肠疾病与血液和粪便生物标志物之间的相关性，并确定两种表型之间的结果和管理差异。
方法：从现有的胶囊内镜（CE）数据库中确定了回肠结肠或孤立性小肠克罗恩病（SBCD）患者。哈维·布拉德肖指数（HBI），生物标志物：C反应蛋白（CRP）和粪便钙卫蛋白（FC），收集Lewis评分和CE的发现以及随后的随访数据。采用SPSS进行数据分析。
结果：共248例患者纳入研究。将患者分为两组：分离的SBCD患者178例（中位年龄44岁（IQR31-56）；男性占41.5%），结肠克罗恩病患者70例（中位年龄31岁（IQR22.7-49）；男性占31.5%）。新诊断为SBCD的占38.7%(n=96)，而60.0%(n=144)已建立CD。与孤立的SBCD相比，回肠结肠疾病患者的HBI较高[HBI=7（IQR5-10）vsHBI=6（IQR4-9）；P=0.04]。分离的SBCD和回肠结肠疾病之间的FC水平没有显着差异[136ug/g（IQR53.8-363.3）与171ug/g（IQR68.5-485.5）；p=0.98]。在孤立的SBCD组中，30.3%(n=54)CE显示近端疾病，96%(n=171)显示远端疾病,26.4%(n=47)显示广泛疾病。SBCE诊断近端SBCD优于MRI（P<0.01）。在多元逻辑回归中，我们没有发现任何定义为Lewis评分>790的疾病严重程度预测因子.在SBCE之后，68.5%(n=170)的患者有管理变更。这包括123例（49.5%）患者开始使用皮质类固醇或剂量递增，硫唑嘌呤在80例（33.3％）患者中，甲氨蝶呤治疗22例（9.1%），生物治疗110例（44.3%）。HBI预测了管理的变化(p<0.01)。
结论：CE是诊断活动性SBCD的重要方法。它还有助于指导确定患有活动性疾病的患者的治疗。
方法：从现有的胶囊内镜（CE）数据库中确定了回肠结肠或孤立性小肠克罗恩病（SBCD）患者。哈维·布拉德肖指数（HBI），生物标志物：C反应蛋白（CRP）和粪便钙卫蛋白（FC），收集Lewis评分和CE的发现以及随后的随访数据。采用SPSS进行数据分析。
结果：共248例患者纳入研究。将患者分为两组：分离的SBCD患者178例（中位年龄44岁（IQR31-56）；男性占41.5%），结肠克罗恩病患者70例（中位年龄31岁（IQR22.7-49）；男性占31.5%）。新诊断为SBCD的占38.7%(n=96)，而60.0%(n=144)已建立CD。与孤立的SBCD相比，回肠结肠疾病患者的HBI较高[HBI=7（IQR5-10）vsHBI=6（IQR4-9）；P=0.04]。分离的SBCD和回肠结肠疾病之间的FC水平没有显着差异[136ug/g（IQR53.8-363.3）与171ug/g（IQR68.5-485.5）；p=0.98]。在孤立的SBCD组中，30.3%(n=54)CE显示近端疾病，96%(n=171)显示远端疾病,26.4%(n=47)显示广泛疾病。SBCE诊断近端SBCD优于MRI（P<0.01）。在多元逻辑回归中，我们没有发现任何定义为Lewis评分>790的疾病严重程度预测因子.在SBCE之后，68.5%(n=170)的患者有管理变更。这包括123例（49.5%）患者开始使用皮质类固醇或剂量递增，硫唑嘌呤在80例（33.3％）患者中，甲氨蝶呤治疗22例（9.1%），生物治疗110例（44.3%）。HBI预测了管理的变化(p<0.01)。
结论：CE是诊断活动性SBCD的重要方法。它还有助于指导确定患有活动性疾病的患者的治疗。
