title: Capsule endoscopy may reclassify pediatric inflammatory bowel disease: a historical analysis.
abstract: BACKGROUND
  Data are sparse on the role of capsule endoscopy (CE) in classifying disease type, affecting patient management, and altering health outcomes in pediatric inflammatory bowel disease (IBD). In a retrospective cohort analysis of symptomatic pediatric patients with previously diagnosed IBD, we evaluated whether data from CE would result in the recognition of new disease locations that could alter the current diagnosis and provide information to better manage the underlying disease.
  
  
  METHODS
  CE evaluation was performed in 28 patients an average of 4.2 +/- 3 years after original IBD diagnosis, and was prompted by exacerbation of underlying disease, growth failure/weight loss, or presurgical evaluation. Of the patients, 7 of 28 (25%) were originally diagnosed as having ulcerative colitis (UC) (n = 5) or indeterminate colitis (IC) (n = 2), while 21 of 28 (75%) were diagnosed as having Crohn disease (CD).
  
  
  RESULTS
  Following CE examination, 4 of 5 patients with UC and 1 of 2 patients with IC (total 5 of 7, 71% of UC/IC patients) had their disease reclassified to CD based upon newly diagnosed small bowel mucosal lesions. Moreover, 13 of 21 (62%) patients with CD were found at the time of CE examination to have more extensive small bowel disease with newly diagnosed jejunal disease found in 12 of 13 (92%) patients. In the 5 newly diagnosed patients with CD, all of them had therapeutic changes made. One capsule retention occurred.
  
  
  CONCLUSIONS
  Capsule endoscopy may lead to reclassification of IBD from UC/ IC to definitive CD. In addition, previously diagnosed patients with CD may be found to have a more significant burden of small bowel disease. Taken together, this information may facilitate more targeted and effective therapies and potentially lead to better patient outcomes.
authors.affiliation: Children's Center for Digestive Health Care, Children's Healthcare of Atlanta, Atlanta, GA 30342, USA. stancohen@aol.com
authors.forename: Stanley A
authors.initials: SA
authors.lastname: Cohen
authors.forename: Ian M
authors.initials: IM
authors.lastname: Gralnek
authors.forename: Hagit
authors.initials: H
authors.lastname: Ephrath
authors.forename: Larry
authors.initials: L
authors.lastname: Saripkin
authors.forename: William
authors.initials: W
authors.lastname: Meyers
authors.forename: Olga
authors.initials: O
authors.lastname: Sherrod
authors.forename: Angela
authors.initials: A
authors.lastname: Napier
authors.forename: Tamara
authors.initials: T
authors.lastname: Gobin
mesh_terms: D000293:Adolescent; D053704:Capsule Endoscopy / Q000009:adverse effects / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003093:Colitis, Ulcerative / Q000145:classification / Q000175:diagnosis / Q000473:pathology; D003424:Crohn Disease / Q000145:classification / Q000175:diagnosis / Q000473:pathology; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000145:classification* / Q000175:diagnosis* / Q000473:pathology; D008297:Male; D012189:Retrospective Studies