The utility of capsule endoscopy in the phenotype of Crohn’s disease. Data from England 2016–2021

IF 1.1 4区 医学 Q4 GASTROENTEROLOGY & HEPATOLOGY Arab Journal of Gastroenterology Pub Date : 2024-08-01 DOI:10.1016/j.ajg.2024.06.001
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Abstract

Background and study aims

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.

Patients and 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).

Conclusion

CE is an important modality for the diagnosis of active SBCD. It also helps guide treatment in patients identified with active disease.

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胶囊内镜对克罗恩病表型的实用性。2016-2021年英格兰数据。
背景和研究目的:据报道,孤立性小肠克罗恩病(SBCD)与其他 CD 表型相比预后较差。本研究旨在了解孤立型小肠克罗恩病和回结肠克罗恩病与血液和粪便生物标志物之间的相关性,并确定这两种表型在预后和管理方面的差异:从现有的胶囊内镜(CE)数据库中确定回结肠或孤立性小肠克罗恩病(SBCD)患者。收集了哈维-布拉德肖指数(HBI)、生物标记物:C反应蛋白(CRP)和粪便钙蛋白(FC)、刘易斯评分、CE检查结果以及后续随访数据。采用 SPSS 对数据进行分析:研究共纳入 248 名患者。患者分为两组--孤立性 SBCD 患者 178 名(中位年龄 44 岁(IQR 31-56);男性占 41.5%)和回结肠克罗恩病患者 70 名(中位年龄 31 岁(IQR 22.7-49);男性占 31.5%)。38.7%的患者(n = 96)被新诊断为SBCD,60.0%的患者(n = 144)已确诊为克罗恩病。与孤立的 SBCD 相比,回结肠疾病患者的 HBI 更高 [HBI = 7 (IQR 5-10) vs HBI = 6(IQR 4-9); P = 0.04]。孤立性 SBCD 和回结肠疾病的 FC 水平无明显差异 [136ug/g (IQR 53.8-363.3) vs 171ug/g (IQR 68.5-485.5); P = 0.98]。在孤立的 SBCD 组中,30.3%(n = 54)的 CE 显示近端病变,96%(n = 171)显示远端病变,26.4%(n = 47)显示广泛病变。在诊断近端 SBCD 方面,SBCE 优于 MRI(P 790)。SBCE检查后,68.5%的患者(n = 170)改变了治疗方案。这包括 123 例(49.5%)患者开始使用或加大剂量使用皮质类固醇,80 例(33.3%)患者使用硫唑嘌呤,22 例(9.1%)患者使用甲氨蝶呤,110 例(44.3%)患者使用生物疗法。HBI 预测了治疗方法的改变(p 结论:CE 是治疗肺结核的重要方法:CE是诊断活动性SBCD的重要方法。它还有助于指导已确定为活动性疾病患者的治疗。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Arab Journal of Gastroenterology
Arab Journal of Gastroenterology Medicine-Gastroenterology
CiteScore
2.70
自引率
0.00%
发文量
52
期刊介绍: Arab Journal of Gastroenterology (AJG) publishes different studies related to the digestive system. It aims to be the foremost scientific peer reviewed journal encompassing diverse studies related to the digestive system and its disorders, and serving the Pan-Arab and wider community working on gastrointestinal disorders.
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