title: Essential role of small bowel capsule endoscopy in reclassification of colonic inflammatory bowel disease type unclassified.
abstract: OBJECTIVE
  To evaluate the role of small bowel capsule endoscopy (SBCE) on the reclassification of colonic inflammatory bowel disease type unclassified (IBDU).
  
  
  METHODS
  We performed a multicenter, retrospective study including patients with IBDU undergoing SBCE, between 2002 and 2014. SBCE studies were reviewed and the inflammatory activity was evaluated by determining the Lewis score (LS). Inflammatory activity was considered significant and consistent with Crohn's disease (CD) when the LS ≥ 135. The definitive diagnosis during follow-up (minimum 12 mo following SBCE) was based on the combination of clinical, analytical, imaging, endoscopic and histological elements.
  
  
  RESULTS
  Thirty-six patients were included, 21 females (58%) with mean age at diagnosis of 33 ± 13 (15-64) years. The mean follow-up time after the SBCE was 52 ± 41 (12-156) mo. The SBCE revealed findings consistent with significant inflammatory activity in the small bowel (LS ≥ 135) in 9 patients (25%); in all of them the diagnosis of CD was confirmed during follow-up. In 27 patients (75%), the SBCE revealed no significant inflammatory activity (LS < 135); among these patients, the diagnosis of Ulcerative Colitis (UC) was established in 16 cases (59.3%), CD in 1 case (3.7%) and 10 patients (37%) maintained a diagnosis of IBDU during follow-up. A LS ≥ 135 at SBCE had a sensitivity = 90%, specificity = 100%, positive predictive value = 100% and negative predictive value = 94% for the diagnosis of CD.
  
  
  CONCLUSIONS
  SBCE proved to be fundamental in the reclassification of patients with IBDU. Absence of significant inflammatory activity in the small intestine allowed exclusion of CD in 94% of cases.
authors.affiliation: Sara Monteiro, Francisca Dias de Castro, Pedro Boal Carvalho, Bruno Rosa, Maria João Moreira, José Cotter, Department of Gastroenterology, Hospital da Senhora da Oliveira-Guimarães, Rua dos Cutileiros, Creixomil, 4835-044 Guimarães, Portugal.
authors.forename: Sara
authors.initials: S
authors.lastname: Monteiro
authors.affiliation: Sara Monteiro, Francisca Dias de Castro, Pedro Boal Carvalho, Bruno Rosa, Maria João Moreira, José Cotter, Department of Gastroenterology, Hospital da Senhora da Oliveira-Guimarães, Rua dos Cutileiros, Creixomil, 4835-044 Guimarães, Portugal.
authors.forename: Francisca
authors.initials: F
authors.lastname: Dias de Castro
authors.affiliation: Sara Monteiro, Francisca Dias de Castro, Pedro Boal Carvalho, Bruno Rosa, Maria João Moreira, José Cotter, Department of Gastroenterology, Hospital da Senhora da Oliveira-Guimarães, Rua dos Cutileiros, Creixomil, 4835-044 Guimarães, Portugal.
authors.forename: Pedro
authors.initials: P
authors.lastname: Boal Carvalho
authors.affiliation: Sara Monteiro, Francisca Dias de Castro, Pedro Boal Carvalho, Bruno Rosa, Maria João Moreira, José Cotter, Department of Gastroenterology, Hospital da Senhora da Oliveira-Guimarães, Rua dos Cutileiros, Creixomil, 4835-044 Guimarães, Portugal.
authors.forename: Bruno
authors.initials: B
authors.lastname: Rosa
authors.affiliation: Sara Monteiro, Francisca Dias de Castro, Pedro Boal Carvalho, Bruno Rosa, Maria João Moreira, José Cotter, Department of Gastroenterology, Hospital da Senhora da Oliveira-Guimarães, Rua dos Cutileiros, Creixomil, 4835-044 Guimarães, Portugal.
authors.forename: Maria João
authors.initials: MJ
authors.lastname: Moreira
authors.affiliation: Sara Monteiro, Francisca Dias de Castro, Pedro Boal Carvalho, Bruno Rosa, Maria João Moreira, José Cotter, Department of Gastroenterology, Hospital da Senhora da Oliveira-Guimarães, Rua dos Cutileiros, Creixomil, 4835-044 Guimarães, Portugal.
authors.forename: Rolando
authors.initials: R
authors.lastname: Pinho
authors.affiliation: Sara Monteiro, Francisca Dias de Castro, Pedro Boal Carvalho, Bruno Rosa, Maria João Moreira, José Cotter, Department of Gastroenterology, Hospital da Senhora da Oliveira-Guimarães, Rua dos Cutileiros, Creixomil, 4835-044 Guimarães, Portugal.
authors.forename: Miguel Mascarenhas
authors.initials: MM
authors.lastname: Saraiva
authors.affiliation: Sara Monteiro, Francisca Dias de Castro, Pedro Boal Carvalho, Bruno Rosa, Maria João Moreira, José Cotter, Department of Gastroenterology, Hospital da Senhora da Oliveira-Guimarães, Rua dos Cutileiros, Creixomil, 4835-044 Guimarães, Portugal.
authors.forename: José
authors.initials: J
authors.lastname: Cotter
keywords: Capsule endoscopy; Crohn’s disease; Inflammatory bowel disease; Inflammatory bowel disease type unclassified; Lewis score; Reclassification