Clinical features of patients with negative results from traditional diagnostic work-up and Crohn's disease findings from capsule endoscopy.
BACKGROUND
Capsule endoscopy (CE) can detect Crohn's disease in patients with suggestive symptoms but with negative results from the traditional diagnostic work-up (ileocolonoscopy and small bowel follow-through). The objective of this study was to determine which clinical features predict the diagnosis of Crohn's disease by CE in this subgroup of patients.


METHODS
Twenty-three patients (7 men, 16 women; mean age: 40+/-15 y) with negative results from conventional imaging techniques were prospectively included in the study because of suspicion of Crohn's disease (long-standing abdominal pain and/or diarrhea and at least one of the following symptoms: anemia, weight loss, long-standing fever, perianal disease, extraintestinal manifestations typical of inflammatory bowel disease, elevated inflammatory parameters, or family history of inflammatory bowel disease).


RESULTS
CE diagnosed Crohn's disease in 6 patients (26%). Crohn's disease diagnosis was more frequent in patients with a combination of anemia and elevated inflammatory parameters than in patients without this combination (57% vs. 12.5%; P=0.04). The only statistically significant association between an inflammatory parameter and Crohn's disease was an increased platelet count.


CONCLUSIONS
CE is a useful tool for the diagnosis of subtle small bowel Crohn's disease. The diagnostic yield of CE in patients with suspicion of Crohn's disease but negative results from the traditional diagnostic work-up is significantly higher in patients with anemia and increased platelet count than in patients without this combination of clinical features.
Valle
Julio
J
Department of Gastroenterology, Hospital Virgen de la Salud, Toledo, Spain. juliov@sescam.jccm.es
Alcántara
Mariano
M
Pérez-Grueso
María José
MJ
Navajas
Javier
J
Muñoz-Rosas
Concepción
C
Legaz
Maria Luisa
ML
Cuena
Rafael
R
Carrobles
José María
JM
D000328:Adult; D000740:Anemia; D003424:Crohn Disease / Q000097:blood / Q000175:diagnosis* / Q000503:physiopathology*; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D005260:Female; D006801:Humans; D007421:Intestine, Small / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D010976:Platelet Count; D011237:Predictive Value of Tests; D014741:Video Recording / Q000295:instrumentation