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Comparison of Lewis Score and Capsule Endoscopy Crohn’s Disease Activity Index in Patients with Crohn’s Disease

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Abstract

Background/Aims

Small bowel capsule endoscopy (SBCE) is used to visualize mucosal inflammatory changes in the small intestine of patients with Crohn’s disease (CD). The Lewis score (LS) and Capsule Endoscopy Crohn’s Disease Activity Index (CECDAI) are used to evaluate the visualized images. We determined the score disagreement between LS and CECDAI in patients with CD.

Methods

We evaluated 184 SBCE procedures in 102 CD patients with small bowel lesions. Patients were classified according to the Montreal classification. LS and CECDAI were calculated, and cases with disagreement between the two scores were identified. We investigated the characteristics of disagreement, and analyzed the relationships with the Crohn’s Disease Activity Index (CDAI) and C-reactive protein.

Results

LS (504 ± 1160) correlated strongly with CECDAI (6 ± 5.4) (Spearman’s rank correlation coefficient ρ = 0.81, p < 0.0001). LS values of 135 and 790 were equivalent to CECDAI values of 4.9 and 6.9, respectively. The inflammatory changes by LS were significantly observed in several tertiles in the CECDAI discrepancy group (LS < 135, CECDAI ≥ 4.9) compared with the normal agreement group (LS < 135, CECDAI < 4.9) (p < 0.0001). In both groups, CDAI was also significantly different between Montreal L1 and L3 groups (p = 0.0232, p = 0.0196, respectively). LS inflammation score was 0 in six cases in the LS discrepancy group (LS ≥ 135, CECDAI ≤ 4.9, n = 10); the high LS scores were in patients with high stricture scores.

Conclusions

Discrepancies between the LS and CECDAI scores were observed in some patients. Cases with high CECDAI alone exhibited extensive inflammation and high disease activity (clinical symptoms and biomarker levels). CECDAI seems to better reflect active intestinal inflammation than LS.

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Abbreviations

CD:

Crohn’s disease

CDAI:

Crohn’s Disease Activity Index

SBCE:

Small bowel capsule endoscopy

CECDAI:

Capsule Endoscopy Crohn’s Disease Activity Index

CRP:

C-reactive protein

LS:

Lewis score

PC:

Patency capsule

SES-CD:

Simple Endoscopic Score for Crohn’s Disease

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Authors and Affiliations

  1. Institute of Gastroenterology, Tokyo Women’s Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan

    Teppei Omori, Harutaka Kambayashi, Shun Murasugi, Ayumi Ito, Maria Yonezawa, Shinichi Nakamura & Katsutoshi Tokushige

Authors
  1. Teppei Omori
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  2. Harutaka Kambayashi
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  3. Shun Murasugi
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  4. Ayumi Ito
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  5. Maria Yonezawa
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  6. Shinichi Nakamura
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  7. Katsutoshi Tokushige
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Contributions

TO and SN: study concept and design. HK, SM, AI, MY and TO: data acquisition. TO: statistical analysis and drafting of the first version of the manuscript. TO, SN, and KT: critical revision and approval of the final version of the manuscript.

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Correspondence to Teppei Omori.

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Omori, T., Kambayashi, H., Murasugi, S. et al. Comparison of Lewis Score and Capsule Endoscopy Crohn’s Disease Activity Index in Patients with Crohn’s Disease. Dig Dis Sci 65, 1180–1188 (2020). https://doi.org/10.1007/s10620-019-05837-7

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  • DOI: https://doi.org/10.1007/s10620-019-05837-7

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