title: Tailoring Crohn's disease treatment: the impact of small bowel capsule endoscopy.
abstract: OBJECTIVE
  Small bowel capsule endoscopy (SBCE) may detect proximal small bowel lesions that have been previously missed by ileocolonoscopy and small bowel imaging in patients with known ileal and/or colonic Crohn's disease (CD). We aimed to evaluate whether the therapeutic management is influenced by SBCE findings.
  
  
  METHODS
  Retrospective single center study. Inclusion of consecutive patients with known non-stricturing and non-penetrating ileal and/or colonic CD, submitted to SBCE to evaluate disease extension and activity, with ≥ 1 year follow-up. Lesions were classified with the Lewis score (LS) as non-significant (LS<135), mild (135≤LS≤790), or moderate-to-severe (LS>790). Therapeutic changes were assessed three months after SBCE.
  
  
  RESULTS
  Fifty consecutive patients (35±13 years, 52% females) were included. At ileocolonoscopy, disease location was ileal (L1) in 60%, colonic (L2) in 10% and ileocolonic (L3) in 30% of the patients. In 33 patients (66%) SBCE detected significant proximal lesions previously missed by other modalities. The proportion of patients on thiopurines and/or biologics before SBCE was 2/50 (4%); this was significantly higher three months after SBCE, 15/50 (30%), p=0.023. Treatment with thiopurines and/or biologics was started more often in patients with proximal small bowel lesions [13/33 (39%) vs. 1/17 (6%), p=0.011, relative risk (RR) 6.5], particularly when severe (6%, 36% and 45% of patients with non-significant, mild and moderate-to-severe inflammation, respectively).
  
  
  CONCLUSIONS
  SBCE diagnoses previously undetected lesions and it influences therapeutic management of CD, triggering an earlier introduction of immunomodulators and/or biological therapy.
authors.affiliation: Gastroenterology Department, Centro Hospitalar do Alto Ave, Guimarães, Portugal; Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, 4710-057 Braga, Portugal; ICVS/3B's, PT Government Associate Laboratory, 4710-057 Guimarães, Braga, Portugal. Electronic address: jcotter@chaa.min-saude.pt.
authors.forename: José
authors.initials: J
authors.lastname: Cotter
authors.affiliation: Gastroenterology Department, Centro Hospitalar do Alto Ave, Guimarães, Portugal. Electronic address: franciscacastro@chaa.min-saude.pt.
authors.forename: Francisca
authors.initials: F
authors.lastname: Dias de Castro
authors.affiliation: Gastroenterology Department, Centro Hospitalar do Alto Ave, Guimarães, Portugal. Electronic address: mj.moreira@netcabo.pt.
authors.forename: Maria João
authors.initials: MJ
authors.lastname: Moreira
authors.affiliation: Gastroenterology Department, Centro Hospitalar do Alto Ave, Guimarães, Portugal. Electronic address: brunorosa@chaa.min-saude.pt.
authors.forename: Bruno
authors.initials: B
authors.lastname: Rosa
mesh_terms: D000328:Adult; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D053704:Capsule Endoscopy; D003113:Colonoscopy; D003424:Crohn Disease / Q000188:drug therapy* / Q000473:pathology* / Q000601:surgery; D004363:Drug Utilization / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007421:Intestine, Small / Q000473:pathology*; D008297:Male; D012189:Retrospective Studies; D012720:Severity of Illness Index
chemical_list: D000893:Anti-Inflammatory Agents; D007155:Immunologic Factors; D007166:Immunosuppressive Agents
keywords: Capsule endoscopy; Crohn's disease; Lewis score; Small bowel