title: Video Capsule Endoscopy in Patients with Chronic Abdominal Pain with or without Associated Symptoms: A Retrospective Study.
abstract: BACKGROUND
  Chronic abdominal pain (CAP) is a common indication for gastroenterology referrals. More insidious causes of CAP isolated to the small bowel, such as malignancies and Crohn's disease, are rising in incidence and causing more gastroenterologists to evaluate their patients with video capsule endoscopy (VCE). However, the role of VCE in patients with CAP is still unclear.
  
  
  OBJECTIVE
  We assessed the efficacy of VCE in patients with CAP and whether it led to findings that contributed to disease management and meaningful interventions.
  
  
  METHODS
  This retrospective study evaluated 607 capsule endoscopy studies at an open referral endoscopy unit. Ninety of the studies were for CAP. These studies were compared to those performed for other indications to compare diagnostic yield. In addition, we investigated whether VCE led to an intervention that improved clinical outcomes.
  
  
  RESULTS
  Overall, the number of abnormal findings in CAP patients was significantly lower than VCE performed for other indications (24.4% vs 39.0%, respectively p = 0.009). When patients with CAP presented with other pertinent clinical findings (e.g. nausea, weight loss, anemia, history of in inflammatory bowel disease, etc.), the likelihood of an abnormal finding increased to a level that was not different from those who received VCE for other indications (27.1%, p = 0.10). The findings from VCE lead to changed management and improved outcomes in 16.2% of CAP patients with associated symptoms. However, the subgroup that benefited the most were those who had a prior history of Crohn's disease. Patients with CAP who did not have any associated symptoms continued to have a significantly lower abnormal finding rate compared to those who received VCE for other indications (19.4%, p = 0.03) and VCE rarely led to a change in management that would improve outcomes (5.6%).
  
  
  CONCLUSIONS
  VCE for CAP has a lower rate of abnormal findings than other indications. However, VCE is a useful diagnostic tool that can help provide a possible etiology of CAP in patients with associated symptoms. However, a change in management from VCE is likely to be limited to those with a history of Crohn's disease.
authors.affiliation: School of Medicine, University of California San Diego, La Jolla, California, United States of America.
authors.forename: Jeremy
authors.initials: J
authors.lastname: Egnatios
authors.affiliation: School of Medicine, University of California San Diego, La Jolla, California, United States of America; Department of Medicine, University of California San Diego, La Jolla, California, United States of America.
authors.forename: Khushboo
authors.initials: K
authors.lastname: Kaushal
authors.affiliation: School of Medicine, University of California San Diego, La Jolla, California, United States of America; Department of Medicine, University of California San Diego, La Jolla, California, United States of America; Division of Gastroenterology, University of California, San Diego, La Jolla, California, United States of America.
authors.forename: Denise
authors.initials: D
authors.lastname: Kalmaz
authors.affiliation: School of Medicine, University of California San Diego, La Jolla, California, United States of America; Department of Medicine, University of California San Diego, La Jolla, California, United States of America; Division of Gastroenterology, University of California, San Diego, La Jolla, California, United States of America.
authors.forename: Amir
authors.initials: A
authors.lastname: Zarrinpar
mesh_terms: D015746:Abdominal Pain / Q000175:diagnosis* / Q000628:therapy; D000328:Adult; D000368:Aged; D053704:Capsule Endoscopy; D002908:Chronic Disease / Q000628:therapy; D015331:Cohort Studies; D003151:Community Health Centers; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012017:Referral and Consultation; D012189:Retrospective Studies; D062606:Tertiary Care Centers