title: Small bowel capsule endoscopy impacts diagnosis and management of pediatric inflammatory bowel disease: a prospective study.
abstract: OBJECTIVE
  Accurately classifying inflammatory bowel disease (IBD) type in pediatric patients may impact medical decision-making, direct therapy, and improve outcomes.
  
  
  METHODS
  This was a prospective cohort study evaluating classification of IBD and patient management with use of capsule endoscopy in pediatric patients with suspected or known IBD. Treating physicians completed a questionnaire before and after capsule endoscopy (CE) assessing clinical suspicion of Crohn's disease (CD) diagnosis, patient management decisions, and perceived impact of CE findings.
  
  
  RESULTS
  Eighteen subjects [11F/7M, mean age 13.8 (± 2.5) years], 4 previously diagnosed with CD, 4 with ulcerative or indeterminate colitis (UC/IC), and 10 "suspected" to have IBD were included. Following CE, 2 of 4 (50%) UC/IC patients were reclassified as having small bowel CD. In the 4 subjects with known CD, 2 (50%) had CE evidence of more proximal small bowel mucosal disease than previously recognized. In the 10 subjects with "suspected" IBD, 8 (80%) had SB ulcerations leading to a definitive diagnosis of CD. Treating physicians reported CE helped diagnosing CD in 15 of 18 (83.3%) subjects and impacted medical decision-making in 13 of 18 (72.2%), leading to a change in medical management in 14 of 18 (77.8%).
  
  
  CONCLUSIONS
  In "suspected" pediatric IBD, CE often leads to a definitive diagnosis of CD. CE can lead to reclassification of IBD from UC/IC to CD and previously diagnosed CD patients may have a more significant burden of small bowel disease. These data may help integrate CE in evaluating IBD patients, lead to more targeted medical management changes and improve outcomes.
authors: Department of Gastroenterology, Bruce and Ruth Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, GI Outcomes Unit, Rambam Health Care Campus, Haifa, Israel. i_gralnek@rambam.health.gov.il
authors: Ian M
authors: IM
authors: Gralnek
authors: Stanley A
authors: SA
authors: Cohen
authors: Hagit
authors: H
authors: Ephrath
authors: Angela
authors: A
authors: Napier
authors: Tamara
authors: T
authors: Gobin
authors: Olga
authors: O
authors: Sherrod
authors: Jeffrey
authors: J
authors: Lewis
mesh_terms: D000293:Adolescent; D053704:Capsule Endoscopy; D002648:Child; D005260:Female; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000145:classification / Q000175:diagnosis* / Q000628:therapy*; D008297:Male; D011446:Prospective Studies; D016896:Treatment Outcome