title: Lewis Score--Prognostic Value in Patients with Isolated Small Bowel Crohn's Disease.
abstract: OBJECTIVE
  Small bowel capsule endoscopy (SBCE) allows mapping of small bowel inflammation in Crohn's disease (CD). We aimed to assess the prognostic value of the severity of inflammatory lesions, quantified by the Lewis score (LS), in patients with isolated small bowel CD.
  
  
  METHODS
  A retrospective study was performed in which 53 patients with isolated small bowel CD were submitted to SBCE at the time of diagnosis. The Lewis score was calculated and patients had at least 12 months of follow-up after diagnosis. As adverse events we defined disease flare requiring systemic corticosteroid therapy, hospitalization and/or surgery during follow-up. We compared the incidence of adverse events in 2 patient subgroups, i.e. those with moderate or severe inflammatory activity (LS ≥790) and those with mild inflammatory activity (135 ≤ LS < 790).
  
  
  RESULTS
  The LS was ≥790 in 22 patients (41.5%), while 58.5% presented with LS between 135 and 790. Patients with a higher LS were more frequently smokers (p = 0.01), males (p = 0017) and under immunosuppressive therapy (p = 0.004). In multivariate analysis, moderate to severe disease at SBCE was independently associated with corticosteroid therapy during follow-up, with a relative risk (RR) of 5 (p = 0.011; 95% confidence interval [CI] 1.5-17.8), and for hospitalization, with an RR of 13.7 (p = 0 .028; 95% CI 1.3-141.9).
  
  
  CONCLUSIONS
  In patients with moderate to severe inflammatory activity there were higher prevalences of corticosteroid therapy demand and hospitalization during follow-up. Thus, stratifying the degree of small bowel inflammatory activity with SBCE and LS calculation at the time of diagnosis provided relevant prognostic value in patients with isolated small bowel CD.
authors.affiliation: Gastroenterology Department, Centro Hospitalar do Alto Ave, Guimarães, Portugal franciscacastro@chaa.min-saude.pt.
authors.forename: F
authors.initials: F
authors.lastname: Dias de Castro
authors.affiliation: Gastroenterology Department, Centro Hospitalar do Alto Ave, Guimarães, Portugal.
authors.forename: Pedro
authors.initials: P
authors.lastname: Boal Carvalho
authors.affiliation: Gastroenterology Department, Centro Hospitalar do Alto Ave, Guimarães, Portugal.
authors.forename: Sara
authors.initials: S
authors.lastname: Monteiro
authors.affiliation: Gastroenterology Department, Centro Hospitalar do Alto Ave, Guimarães, Portugal.
authors.forename: Bruno
authors.initials: B
authors.lastname: Rosa
authors.affiliation: Unidade de Saúde Pública, ACES Porto Ocidental, Porto, Portugal.
authors.forename: João
authors.initials: J
authors.lastname: Firmino-Machado
authors.affiliation: Gastroenterology Department, Centro Hospitalar do Alto Ave, Guimarães, Portugal.
authors.forename: Maria João
authors.initials: MJ
authors.lastname: Moreira
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 Braga/Guimarães, Portugal.
authors.forename: José
authors.initials: J
authors.lastname: Cotter
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D053704:Capsule Endoscopy; D003424:Crohn Disease / Q000175:diagnosis* / Q000188:drug therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007421:Intestine, Small; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D012720:Severity of Illness Index
chemical_list: D000305:Adrenal Cortex Hormones; D000893:Anti-Inflammatory Agents
keywords: Crohn’s disease; Lewis score; prognosis; small bowel capsule endoscopy