Capsule Endoscopy May Reclassify Pediatric Inflammatory Bowel Disease: A Historical Analysis (original) (raw)
Related papers
Role of capsule endoscopy in inflammatory bowel disease: Anything new?
Artificial intelligence in gastrointestinal endoscopy, 2021
Capsule endoscopy (CE) is an innovative technological breakthrough that for the first time provides a noninvasive method to obtain high-resolution imaging of the entire small bowel. Since its recent inception, the diagnostic utility of CE has become well established for the evaluation of diverse ulcerative and inflammatory disorders of the jejunum and ileum. The incredible resolution of its lens (0.1 mm) detects focal villous edema or atrophy, denuded, as well as ulcerated mucosal lesions missed by other imaging techniques. CE has been shown by meta-analysis to be a more sensitive method to investigate patients for small bowel Crohn's disease, with an incremental yield above 30% versus other imaging modalities. In patients with indeterminate colitis, CE is useful in distinguishing between ulcerative and Crohn's colitis. Among patients with established Crohn's disease, CE may be employed to determine: (1) the extent and severity of small bowel involvement, (2) postoperative recurrence, (3) post-therapy mucosal healing, and (4) whether active small bowel inflammatory lesions exist in the clinical setting of functional bowel disorder. Complications are rare and include capsule retention at stricture sites. The new patency capsule can diminish the risk of the latter problem in at-risk patients. CE can also serve as a guide to sites that require biopsies or dilatation by push or double-balloon enteroscopy. However, other causes of small bowel lesions may mimic Crohn's disease. A standard terminology system has thus been developed, and a CE Crohn's disease severity scoring index is currently undergoing validation studies.
Capsule endoscopy in inflammatory bowel disease: when and how
Intestinal Research
Capsule endoscopy (CE) is emerging as an important investigation in inflammatory bowel disease (IBD); common types include the standard small bowel CE and colon CE. More recently, the pan-enteric CE was developed to assess the large and small bowel in patients with Crohn’s disease (CD). Emerging indications include noninvasive assessment for mucosal healing (both in the small bowel and the colon) and detection of postoperative recurrence in patients with CD. Given the increasing adoption, several CE scoring systems have been specifically developed for IBD. The greatest concern with performing CE, particularly in CD, is capsule retention, but this can be overcome by performing cross-sectional imaging such as magnetic resonance enterography and using patency capsules before performing the procedure. The development of software for automated detection of mucosal abnormalities typically seen in IBD may further increase its adoption.
Journal of Pediatric Gastroenterology and Nutrition, 2006
Background: The relationship between the increased intestinal permeability observed in several acute and chronic diseases and the expression of tight junctions (TJ) proteins is not well established. Our aim was to investigate the expression at transcriptional level of 3 transmembrane TJ proteins, Occludin, Claudin-1, Claudin-2 and of 2 scaffold TJ proteins, zonula occludens-1 (ZO-1) and Myosin 9B in intestinal biopsies from patients affected by celiac disease (CD), Crohn's disease (CrD), peptic ulcer disease (PUD) and type 1 diabetes (IDDM). Methods: Samples of small intestinal mucosa were taken from the second/third portion of the duodenum from all the subjects studied. After total RNA extraction and cDNA synthesis, quantitative real time polymerase chain reaction assays with SYBR Green was performed. Data were normalized by using18S rRNA as standard. Results: Shown in the Table. A significant down-regulation of all 5 genes studied was observed in patients affected by celiac disease before gluten-free diet, while no significant change was observed in IDDM patients. Conclusions: The down-regulation of TJ transmembrane or/and intracellular components observed in all but IDDM might explain the increased intestinal permeability reported in these pathological conditions. The meaning of TJs disruption in the pathogenesis of each of this pathological condition warrants further investigation. The normal transcriptional level observed in celiacs on GFD suggests that the down-regulation of TJs in CD is reversible and secondary to gliadin exposure rather than to a genetic predisposition.
Usefulness of wireless capsule endoscopy in paediatric inflammatory bowel disease
Digestive and Liver Disease, 2011
Background: Small bowel endoscopy is critical in revealing an inflammatory bowel disease (IBD) previously undetected and in classifying the IBD patients, i.e. Crohn's disease or ulcerative colitis. Methods: A prospective paediatric study on the usefulness of wireless capsule endoscopy (WCE) was performed in 117 children (age range: 4-17 years) with established or suspected IBD and compared with non endoscopic imaging tools. All patients underwent upper and lower gastrointestinal endoscopy. Results: In Crohn's disease patients (CD, n = 44), small bowel lesions were revealed by imaging tools in 8 and by WCE in 18 patients, respectively (p < 0.01). No small bowel involvement was observed in 29 ulcerative colitis patients by both imaging tools and WCE. Of 26 unclassified IBD, small bowel lesions typical of Crohn's disease were detected by imaging in 7 and by WCE in 16 (p < 0.05). Of 18 patients with suspected IBD, small bowel lesions typical of Crohn's disease were observed in 9 with WCE, vs. only in 4 with imaging (p < 0.01). No cases of capsule retention occurred. Conclusions: WCE is valuable in revealing small bowel lesions in children with a previous diagnosis of CD and unexplained clinical and laboratory data. It is also helpful in unclassified IBD patients. This tool can influence the management and the course of IBD.
Journal of Crohn's and Colitis, 2014
Background: Mucosal healing is increasingly recognised as an important treatment goal in Crohn's disease (CD). Data from colonic disease shows improved long-term outcomes in patients achieving complete mucosal healing. Little is currently known of this with regard to ileitis which is increasingly diagnosed using capsule endoscopy (SBCE). This is the first study to prospectively assess mucosal healing and deep remission rates following 52 weeks of therapy in a cohort of symptomatic small bowel CD patients commencing immunomodulator or biologic therapy. Methods: Baseline demographics, quality of life questionnaires and Harvey Bradshaw Index were collected along with C-reactive protein & calprotectin. Capsule endoscopy Crohn's disease activity (CECDAI) index was used to assess ileitis severity. All parameters were reassessed at week 52. Results at baseline & week 52 were compared using univariate analysis, p b 0.05 considered significant. Results: In total, 108 capsule procedures were performed on 43 patients. Based on the CECDAI, 39 (90%) demonstrated active small bowel CD at baseline with 28 (65%) undergoing 52 week assessment. In total, 12 (42%) participants achieved complete mucosal healing and deep remission by 52 week assessment (p b 0.0001 95% CI − 0.62 to − 0.22). Despite overall impressive mucosal healing rates, patients with strictures were less likely to demonstrate a decrease in CECDAI and were more likely to have symptoms. Conclusion: In patients with active small bowel CD symptomatic and biochemical response to treatment appears to be mirrored by endoscopic remission in 42% of individuals. Strictures identified prior to therapy appear to be a poor indicator for success of treatment.