Digestive and Liver Disease 39 (2007) 148–154 Alimentary Tract Clinical outcome of patients examined by capsule endoscopy for suspected small bowel Crohn’s disease C.M. Girelli ∗ , P. Porta, V. Malacrida, F. Barzaghi, F. Rocca Gastroenterology and Digestive Endoscopy Service. 1st Division of Internal Medicine, Hospital of Busto Arsizio, Italy Received 20 August 2006; accepted 30 October 2006 Available online 29 December 2006 Abstract Background. Capsule endoscopy has a greater diagnostic yield than radiology for detecting subtle inflammatory changes of the small bowel mucosa, but the clinical significance of these abnormalities is still uncertain because of the lack of long-term follow-ups. Aim and methods. To verify the accuracy of capsule endoscopy in a cohort of patients with suspected Crohn’s disease of the small bowel, taking as ‘gold standard’ the final diagnosis made after a long follow-up. From April 2002 to March 2005, we enrolled and examined by capsule endoscopy 27 consecutive patients with abdominal pain and diarrhea lasting more than 3 months and at least one of the following: anaemia, weight loss, fever, extra-intestinal manifestation(s) of inflammatory bowel disease. All patients already had an unremarkable pan-endoscopy, serology for celiac disease and intestinal radiology inconclusive for small bowel abnormality. On the basis of capsule endoscopy findings, patients were distributed in three groups; Group A had severe stricturing lesions requiring surgery; Group B, moderate inflammatory lesions further investigated invasively; Group C, minimal inflammatory changes or normal findings, clinically observed every 3 months (median 21 months, range 15–29). Results. Small bowel inflammatory lesions were found in 16 of the 27 patients (diagnostic yield 59%). Three had surgery (Group A) and Crohn’s disease was confirmed in two; the remainder had ileal adenocarcinoma in a pathological context of chronic inflammation. Crohn’s disease was histologically confirmed in four of the five patients in Group B. Group C comprised 19 patients; Crohn’s disease was confirmed in seven out of eight with positive capsule endoscopy, while only one of the patients with normal findings later developed overt ileal Crohn’s disease. Sensitivity, specificity, positive and negative likelihood ratio were, respectively, 93%, 84%, 5.8 and 0.08. Assuming a 50% pre-test probability of disease, capsule endoscopy gave a post-test probability of 85%. Conclusions. In our selected cohort, capsule endoscopy was highly sensitive in detecting small bowel inflammatory changes, enhancing by nearly 35% the pre-test probability of structural small bowel disease. Focal erythema and luminal debris may limit the specificity of capsule endoscopy. © 2006 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved. Keywords: Capsule endoscopy; Crohn’s disease; Diagnosis; Small bowel 1. Introduction Crohn’s disease (CD) is a chronic, idiopathic, inflamma- tory disorder that can affect any segment of the alimentary tract though it involves only the small bowel in nearly 30–40% of cases, with a preference for the distal ileum [1]. ∗ Corresponding author at: UO Medicina 1, Ospedale di Circolo di Busto Arsizio, via Arnaldo da Brescia 1, 21052 Busto Arsizio (VA), Italy. Tel.: +39 0331699265; fax: +39 0331699544. E-mail address: cargirel@libero.it (C.M. Girelli). The diagnosis of small bowel CD can pose a clinical chal- lenge, for various reasons. First, there is no pathognomonic hallmark of the disease and the diagnosis is usually based on a collection of clinical symptoms, endoscopic, radiologic, laboratory and histopathologic findings; second, non-specific symptoms overlap those of irritable bowel syndrome (IBS) and other, less common conditions such as tuberculosis, Behc ¸et’s disease and malignancy; third, the small bowel is poorly accessible to the flexible endoscope; fourth, the early mucosal lesions may be subtle and often undetectable by radiological techniques such as abdominal ultrasound 1590-8658/$30 © 2006 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.dld.2006.10.018