Skip to main content

Advertisement

SpringerLink
Log in

Characteristics and prognosis of isolated small-bowel Crohn’s disease

  • Original Article
  • Published:
International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Background

Previous studies suggest that Crohn’s disease (CD) with both small bowel and colon involvement is more serious than colonic CD. However, clinical features of isolated small-bowel CD have not been fully investigated.

Methods

In this retrospective case-control study, 89 patients were divided into two groups according to capsule endoscopy, ileocolonoscopy, and enhanced computed tomography results. The case group was isolated small-bowel CD (n = 50) and the control group was CD with both small bowel and colon involvement (n = 39). We collected data of the patients and analyze it.

Results

In univariate analysis, isolated small-bowel CD group had higher percentage of stricture, Lewis score, platelet, plateletcrit and lower Harvey-Bradshaw index, high-sensitivity C-reactive protein, and erythrocyte sedimentation rate. In multivariable analysis, it had lower Harvey-Bradshaw index (p = 0.000), which meaned relatively mild symptoms. However, it had higher Lewis score (p = 0.007), which meaned more serious small-bowel inflammation. The Kaplan-Meier survival curve also suggested that isolated small-bowel CD patients were more likely to accept partial small intestinal resection surgery (p = 0.029).

Conclusions

Isolated small-bowel CD is easily overlooked for milder clinical symptoms and relatively limited lessions, but severe small-bowel histological injury results in owing worse clinical outcomes. Clinicians should pay more attention to the isolated small-bowel CD and take aggressive intervention during therapy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Gomollón F, Dignass A, Annese V et al (2017) 3rd European evidence-based consensus on the diagnosis and management of Crohn’s disease 2016: part 1: diagnosis and medical management. J Crohns Colitis 11(1):3–25

    Article  Google Scholar 

  2. Chouraki V, Savoye G, Dauchet L, Vernier-Massouille G, Dupas JL, Merle V, Laberenne JE, Salomez JL, Lerebours E, Turck D, Cortot A, Gower-Rousseau C, Colombel JF (2011) The changing pattern of Crohn’s disease incidence in northern France: a continuing increase in the 10- to 19-year-old age bracket (1988–2007). Aliment Pharmacol Ther 33(10):1133–1142

    Article  CAS  Google Scholar 

  3. Vernier-Massouille G, Balde M, Salleron J, Turck D, Dupas JL, Mouterde O, Merle V, Salomez JL, Branche J, Marti R, Lerebours E, Cortot A, Gower-Rousseau C, Colombel JF (2008) Natural history of pediatric Crohn’s disease: a population-based cohort study. Gastroenterology 135:1106–1113

    Article  Google Scholar 

  4. Wagtmans MJ, van Hogezand RA, Griffioen G, Verspaget HW, Lamers CB (1997) Crohn’s disease of the upper gastrointestinal tract. Neth J Med 50:S2–S7

    Article  CAS  Google Scholar 

  5. Lescut D, Vanco D, Bonniere P et al (1993) Perioperative endoscopy of the whole small bowel in Crohn’s disease. Gut 34:647–649

    Article  CAS  Google Scholar 

  6. Ng SC, Tang W, Ching JY et al (2013) Incidence and phenotype of inflammatory bowel disease based on results from the Asia-pacific Crohn’s and colitis epidemiology study. Gastroenterology 145:158–165

    Article  Google Scholar 

  7. Higuero T, Merle C, Thiéfin G, Coussinet S, Jolly D, Diebold MD, Zeitoun P, Cadiot G (2004) Jejunoileal Crohn’s disease: a case-control study. Gastroenterol Clin Biol 28(2):160–166

    Article  Google Scholar 

  8. Attard TM, Horton KM, DeVito K, Darbari A, Oliva-Hemker M, Thompson R, Cuffari C (2004) Pediatric jejunoileitis: a severe Crohn’s disease phenotype that requires intensive nutritional management. Inflamm Bowel Dis 10(4):357–360

    Article  CAS  Google Scholar 

  9. Neurath MF, Travis SP (2012) Mucosal healing in inflammatory bowel diseases: a systematic review. Gut 61:1619–1635

    Article  CAS  Google Scholar 

  10. Schnitzler F, Fidder H, Ferrante M, Noman M, Arijs I, van Assche G, Hoffman I, van Steen K, Vermeire S, Rutgeerts P (2009) Mucosal healing predicts long-term outcome of maintenance therapy with infliximab in Crohn’s disease. Inflamm Bowel Dis 15:1295–1301

    Article  Google Scholar 

  11. Frøslie KF, Jahnsen J, Moum BA, Vatn MH, IBSEN Group (2007) Mucosal healing in inflammatory bowel disease: results from a Norwegian population-based cohort. Gastroenterology 133:412–422

    Article  Google Scholar 

  12. IBD Working Group of the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) (2005) Inflammatory bowel disease in children and adolescents: recommendations for diagnosis-the Porto criteria. J Pediatr Gastroenterol Nutr 41:1–7

    Article  Google Scholar 

  13. Melmed GY, Dubinsky MC, Rubin DT et al (2018) Utility of video capsule endoscopy for longitudinal monitoring of Crohn’s disease activity in the small bowel: a prospective study. Gastrointest Endosc 4

  14. Greener T, Klang E, Yablecovitch D, Lahat A, Neuman S, Levhar N, Avidan B, Yanai H, Dotan I, Chowers Y, Weiss B, Saibil F, Amitai MM, Ben-Horin S, Kopylov U, Eliakim R, Israeli IBD Research Nucleus (IIRN) (2016) The impact of magnetic resonance enterography and capsule endoscopy on the re-classification of disease in patients with known Crohn’s disease: a prospective Israeli IBD research nucleus (IIRN) study. J Crohns Colitis 10(5):525–531

    Article  Google Scholar 

  15. Voderholzer WA, Beinhoelzl J, Rogalla P, Murrer S, Schachschal G, Lochs H, Ortner MA (2005) Small bowel involvement in Crohn’s disease: a prospective comparison of wireless capsule endoscopy and computed tomography enteroclysis. Gut 54(3):369–373

    Article  CAS  Google Scholar 

  16. Eliakim R, Fischer D, Suissa A, Yassin K, Katz D, Guttman N, Migdal M (2003) Wireless capsule video endoscopy is a superior diagnostic tool in comparison to barium follow-through and computerized tomography in patients with suspected Crohn’s disease. Eur J Gastroenterol Hepatol 15(4):363–367

    Article  Google Scholar 

  17. Dubcenco E, Jeejeebhoy KN, Petroniene R, Tang SJ, Zalev AH, Gardiner GW, Baker JP (2005) Capsule endoscopy findings in patients with established and suspected small bowel Crohn’s disease: correlation with radiologic, endoscopic, and histologic findings. Gastrointest Endosc 62(4):538–544

    Article  Google Scholar 

  18. Hara AK, Leighton JA, Heigh RI, Sharma VK, Silva AC, de Petris G, Hentz JG, Fleischer DE (2006) Crohn disease of the small bowel: preliminary comparison among CT enterography, capsule endoscopy, small bowel follow-through, and ileoscopy. Radiology 238(1):128–134

    Article  Google Scholar 

  19. Chong AK, Taylor A, Miller A, Hennessy O, Connell W, Desmond P (2005) Capsule endoscopy vs. push enteroscopy and enteroclysis in suspected small bowel Crohn’s disease. Gastrointest Endosc 61(2):255–261

    Article  Google Scholar 

  20. Marmo R, Rotondano G, Piscopo R, Bianco MA, Cipolletta L (2005) Meta-analysis: capsule enteroscopy vs. conventional modalities in diagnosis of small bowel diseases. Aliment Pharmacol Ther 22(7):595–604

    Article  CAS  Google Scholar 

  21. Sorrentino D, Nguyen VQ (2018) Clinically significant small bowel Crohn’s disease might only be detected by capsule endoscopy. Inflamm Bowel Dis 24(7):1566–1574

    Article  Google Scholar 

  22. Harvey RF, Bradshaw JM (1980) A simple index of Crohn’s-disease activity. Lancet 1(8167):514

    Article  CAS  Google Scholar 

  23. Gralnek IM, Defranchis R, Seidman E, Leighton JA, Legnani P, Lewis BS (2008) Development of a capsule endoscopy scoring index for small bowel mucosal inflammatory change. Aliment Pharmacol Ther 27(2):146–154

    Article  CAS  Google Scholar 

  24. Satsangi J, Silverberg MS, Vermeire S, Colombel JF (2006) The Montreal classification of inflammatory bowel disease: controversies, consensus, and implications. Gut 55:749–753

    Article  CAS  Google Scholar 

  25. Annese V, Daperno M, Rutter MD et al (2013) European evidence based consensus for endoscopy in inflammatory bowel disease. J Crohns Colitis 7(12):982–1018

    Article  Google Scholar 

  26. Lazarev M, Huang C, Bitton A, Cho JH, Duerr RH, McGovern D, Proctor DD, Regueiro M, Rioux JD, Schumm PP, Taylor KD, Silverberg MS, Steinhart AH, Hutfless S, Brant SR (2013) Relationship between proximal Crohn’s disease location and disease behavior and surgery: a cross-sectional study of the IBD genetics consortium. Am J Gastroenterol 108:106–112

    Article  CAS  Google Scholar 

  27. Choi M, Lim S, Choi MG et al (2017) Effectiveness of capsule endoscopy compared with other diagnostic modalities in patients with small bowel Crohn’s disease: a meta-analysis. Gut Liver 11(1):62–72

    Article  Google Scholar 

  28. Leighton JA, Gralnek IM, Cohen SA et al (2014) Capsule endoscopy is superior to small bowel follow-through and equivalent to ileocolonoscopy in suspected Crohn’s disease. Clin Gastroenterol Hepatol 12(4):609–615

    Article  Google Scholar 

  29. Niv Y (2017) Small bowel mucosal healing assessment by capsule endoscopy as a predictor of long-term clinical remission in patients with Crohn’s disease: a systematic review and meta-analysis. Eur J Gastroenterol Hepatol 13

  30. Sidhu R, Brunt LK, Morley SR, Sanders DS, McAlindon M (2010) Undisclosed use of nonsteroidal anti-inflammatory drugs may underlie small-bowel injury observed by capsule endoscopy. Clin Gastroenterol Hepatol 8:992–995

    Article  Google Scholar 

  31. Cotter J, Dias de Castro F, Magalhães J et al (2015) Validation of the Lewis score for the evaluation of small-bowel Crohn’s disease activity. Endoscopy 47(4):330–335

    PubMed  Google Scholar 

  32. Dias de Castro F, Boal Carvalho P, Monteiro S et al (2015) Lewis score--prognostic value in patients with isolated small bowel Crohn’s disease. J Crohns Colitis 9(12):1146–1151

    Article  CAS  Google Scholar 

  33. Vermeire S, Schreiber S, Sandborn WJ, Dubois C, Rutgeerts P (2010) Correlation between the Crohn’s disease activity and Harvey-Bradshaw indices in assessing Crohn’s disease severity. Clin Gastroenterol Hepatol 8(4):357–363

    Article  Google Scholar 

  34. Kwon JH, Im JP, Ye BD, Cheon JH, Jang HJ, Lee KM, Kim YS, Kim SW, Kim YH, Song GA, Han DS, Kim WH, Kim JS (2016) Disease phenotype, activity and clinical course prediction based on C-reactive protein levels at diagnosis in patients with Crohn’s disease: results from the CONNECT study. Gut Liver 10(4):595–603

    Article  CAS  Google Scholar 

  35. Tang J, Gao X, Zhi M, Zhou HM, Zhang M, Chen HW, Yang QF, Liang ZZ (2015) Plateletcrit: a sensitive biomarker for evaluating disease activity in Crohn’s disease with low hs-CRP. J Dig Dis 16(3):118–124

    Article  CAS  Google Scholar 

Download references

Funding

This work was supported by the Major Science and Technology Project of Medical and Health of Zhejiang Province of China, No.WKJ-ZJ-1516.

Author information

Authors and Affiliations

  1. Department of Gastroenterology, Zhejiang University School of Medicine First Affiliated Hospital, #79 Qingchun Road, Hangzhou, 310003, Zhejiang Province, China

    Juan Du, Haojie Du, Hongtan Chen, Bingling Zhang & Chunxiao Chen

  2. Department of Gastroenterology, Taizhou Hospital of Zhejiang Province, Taizhou, Zhejiang, China

    Lingyan Shen

  3. Department of Endocrinology, Zhejiang University School of Medicine First Affiliated Hospital, Zhejiang, China

    Weiwei Xu

  4. Department of Gastroenterology, Wenling First People’s Hospital, Wenling, China

    Zhongchen Zhang

Authors
  1. Juan Du
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Haojie Du
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hongtan Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Lingyan Shen
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Bingling Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Weiwei Xu
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Zhongchen Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Chunxiao Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

CCX, DJ, DHJ, and CHT designed the research; SLY and ZZC collected material and clinical data from patients; DHJ, ZBL, and XWW analyzed data; DJ and DHJ contributed to drafting the manuscript; CCX, CHT, XWW, SLY, and ZBL revised the manuscript; all authors approved the final version of the manuscript.

Corresponding author

Correspondence to Chunxiao Chen.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Juan Du and Haojie Du are shared first co-authors

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Du, J., Du, H., Chen, H. et al. Characteristics and prognosis of isolated small-bowel Crohn’s disease. Int J Colorectal Dis 35, 69–75 (2020). https://doi.org/10.1007/s00384-019-03432-w

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00384-019-03432-w

Keywords

Search

Navigation