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Small Bowel Capsule Endoscopy Impacts Diagnosis and Management of Pediatric Inflammatory Bowel Disease: A Prospective Study

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Abstract

Purpose

Accurately classifying inflammatory bowel disease (IBD) type in pediatric patients may impact medical decision-making, direct therapy, and improve outcomes.

Methods

This was a prospective cohort study evaluating classification of IBD and patient management with use of capsule endoscopy in pediatric patients with suspected or known IBD. Treating physicians completed a questionnaire before and after capsule endoscopy (CE) assessing clinical suspicion of Crohn’s disease (CD) diagnosis, patient management decisions, and perceived impact of CE findings.

Results

Eighteen subjects [11F/7M, mean age 13.8 (±2.5) years], 4 previously diagnosed with CD, 4 with ulcerative or indeterminate colitis (UC/IC), and 10 “suspected” to have IBD were included. Following CE, 2 of 4 (50%) UC/IC patients were reclassified as having small bowel CD. In the 4 subjects with known CD, 2 (50%) had CE evidence of more proximal small bowel mucosal disease than previously recognized. In the 10 subjects with “suspected” IBD, 8 (80%) had SB ulcerations leading to a definitive diagnosis of CD. Treating physicians reported CE helped diagnosing CD in 15 of 18 (83.3%) subjects and impacted medical decision-making in 13 of 18 (72.2%), leading to a change in medical management in 14 of 18 (77.8%).

Conclusions

In “suspected” pediatric IBD, CE often leads to a definitive diagnosis of CD. CE can lead to reclassification of IBD from UC/IC to CD and previously diagnosed CD patients may have a more significant burden of small bowel disease. These data may help integrate CE in evaluating IBD patients, lead to more targeted medical management changes and improve outcomes.

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Conflict of interest

Prof. Gralnek and Dr. Cohen are consultants for and have received research funding from Given Imaging Ltd., Yoqneam, Israel. Hagit Ephrath is an employee of Given Imaging Ltd. This study was funded in part by Given Imaging, Ltd.

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Authors and Affiliations

  1. Department of Gastroenterology, Bruce and Ruth Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, GI Outcomes Unit, Rambam Health Care Campus, Haifa, Israel

    Ian M. Gralnek

  2. Children’s Center for Digestive Health Care, Children’s Healthcare of Atlanta, Atlanta, GA, USA

    Stanley A. Cohen, Angela Napier, Tamara Gobin, Olga Sherrod & Jeffrey Lewis

  3. Given Imaging Ltd., Yoqneam, Israel

    Hagit Ephrath

Authors
  1. Ian M. Gralnek
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  2. Stanley A. Cohen
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  3. Hagit Ephrath
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  4. Angela Napier
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  5. Tamara Gobin
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  6. Olga Sherrod
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  7. Jeffrey Lewis
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Corresponding author

Correspondence to Ian M. Gralnek.

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Gralnek, I.M., Cohen, S.A., Ephrath, H. et al. Small Bowel Capsule Endoscopy Impacts Diagnosis and Management of Pediatric Inflammatory Bowel Disease: A Prospective Study. Dig Dis Sci 57, 465–471 (2012). https://doi.org/10.1007/s10620-011-1894-5

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  • DOI: https://doi.org/10.1007/s10620-011-1894-5

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