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.
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。