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"The incidence of Crohn’s disease has increased in Scandinavia—as in other parts of the world—over recent decades. Although the disease is incurable, its serious outcome and adverse effects on quality of life, particularly critical for young patients, may be substantially reduced by early diagnosis and appropriate treatment.
This Grand Rounds patient is part of an ongoing 2-year study of Crohn’s disease and capsule endoscopy presented at UEGW 2004 and published in Gut.[1] The study now includes over 100 patients. My colleagues and I conclude that capsule endoscopy with the PillCam™ SB is a superior diagnostic tool for the small bowel and should the first-line imaging examination for patients with suspected, non-stricturing small bowel Crohn’s disease.”
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Case History
A 19-year-old female with one-year-history of abdominal pain, fatigue, weight loss and iron deficiency was referred to our clinic. The patient had to interrupt her studies due to the disabling symptoms. Severe functional disorder was suspected based on the normal examinations (listed below) before the capsule endoscopy, and referral to psychiatry was considered.
Previous Diagnostic Procedures
Examinations (each performed once, all within 3 months):
- Upper endoscopy: normal
- Colonoscopy, failed intubation of the terminal ileum, with biopsies: normal
- Push enteroscopy combined with chromoendoscopy and biopsies: normal
- Enteroclysis (barium): normal
Laboratory tests:
- Acute phase reactants (C-reactive protein, orosomucoids): normal
- Albumin and platelet count: normal
- Iron deficiency
- Feces occult blood test (x3): positive 2 of 3
PillCam™ SB Findings
Capsule endoscopy was performed after overnight fast, without further bowel preparation and with 8 hours ambulatory data registration. The PillCam SB video capsule revealed mucosal changes consistent with Crohn’s disease from the middle jejunum to the distal ileum.
Patient Management and Follow-up
The patient was treated with oral corticosteroids and became symptom free within a couple of weeks. She had discontinued the corticosteroids and is treated with azathioprine. After one-year of follow-up the patient is doing well without further symptoms. Next follow-up CE is scheduled for one year.
“At UEGW I was asked: How can CE influence patient management for Crohn’s disease? With CE, patients can be diagnosed earlier and treated earlier—and can benefit from improved quality of life. This can also result in significant cost savings for healthcare providers.”
About the Author
Ervin Toth MD, PhD, has been practicing gastroenterology since 1985. He is currently the Chief of the Endoscopy Unit of the Department of Medicine at Malmö University Hospital in Sweden, one of the largest endoscopic centers in Scandinavia. Dr Toth’s main interest is in diagnostic and therapeutic GI endoscopy, with a focus on chromoendoscopy and small bowel endoscopy. He has performed more than 30,000 endoscopic examinations—including push enteroscopy since 1994 and CE since 2001. He was among the first in Europe to incorporate capsule endoscopy into his practice and has personal experience performing more than 400 CEs. Today, capsule endoscopy, including use of the Patency Capsule for suspected strictures, is incorporated into his daily routine—with 1–2 examinations/day—for a broad range of small bowel indications. Dr Toth recently received a grant from Lund University for capsule endoscopy research using the PillCam video capsule. Dr Toth and his colleagues are expanding their CE practice to include esophageal capsule endoscopy applications.
This Grand Rounds is a featured case published in the GI insider™, a global publication that provides in-depth coverage of capsule endoscopy news for the medical community. Edited by Ellen Fischl Bodner, MS, a free-lance journalist focusing on medical and scientific publications.
References
[1] Toth E,Fork F,Almqvist P, Benoni C,Ekberg O,Grip O, Gustafson T, Lindgren S,Ohlsson, B, Olsson R, Sjoberg K,Verbaan H,Thorlacius H. Should Capsule enteroscopy be the firstline imaging examination in patients with suspected small bowel Crohn’s disease? Gut.2004;53(suppl VI):A3.
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