A recent study shows how useful capsule endoscopy (CE) can be in diagnosing Crohn disease (Clin Gastroenterol Hepatol 2014; 12: 609-15). Congratulations to one of my partners, Dr. Stan Cohen, who is one of the authors.
This prospective study examined 80 patients with signs and/or symptoms of small-bowel Crohn disease (age, 10-65 years) who underwent CE, small-bowel follow-through (SBFT), and colonoscopy.
Presenting suggestive features included the following:
- Diarrhea >6 weeks but less than 3 years
- Abdominal pain >6 weeks but less than 3 years
- Extraintestinal IBD manifestations: pyoderma gangrenosum, erythema nodosum, perianal disease, arthritis, aphthous stomatitis, and uveitis
- Along with abnormal laboratory/clinical finding:
- positive inflammatory marker: sedimentation rate, C-reactive protein, calprotectin/lactoferrin
- unexplained iron deficiency
- hypoalbuminemia
- positive IBD serology (eg. anti-Saccharomyces cerevisiae antibodies)
- or other clinical findings: recurrent fevers, GI bleeding, growth failure, abnormal radiologic study
Results:
- CE/colonoscopy in combination detected 107 of 110 inflammatory lesions (97.3%)
- SBFT/colonoscopy detected 63 lesions (57.3%)
- “The diagnostic yield of CE compared with colonoscopy was not different.”
- Of the 80 patients with suspected Crohn disease, 25 (31.3%) had the diagnosis confirmed. 9 patients had diagnostic findings on at least 2 of the 3 modalities. 11 were diagnosed with CE alone and 5 by colonoscopy alone.
The authors conclude that colonoscopy remains the initial diagnostic test of choice. However, “CE is safe and can establish the diagnosis of Crohn’s disease in patients when ileocolonoscopy results are negative or the terminal ileum cannot be evaluated.”
Take-home message: in patients with symptoms suggestive of Crohn disease, a negative colonoscopy is not sufficient to exclude the disease. Other modalities like CE or MRE may be needed.
Related post:
gutsandgrowth 
Colonoscopy is one of many tests that may be used to screen for colon cancer. Other tests include sigmoidoscopy, stool tests, and computed tomographic colonography. Which screening test you choose depends on your risk, preference and your doctor. Talk to your doctor about what puts you at risk and what test is best for you. Thanks for sharing detail information about this.
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