Introduction The small bowel is a common site for Crohn's disease but remains relatively inaccessible endoscopically for the majority of its part. There has been variable success in diagnosing active Crohn's disease by conventional radiological imaging methods.1 The British Society of Gastroenterology (BSG) guidelines on small bowel capsule endoscopy (CE) recommend that CE should be considered in patients with a high suspicion of small bowel Crohn's disease undetected by conventional means.2
Methods We carried out a retrospective audit of all patients referred for CE in our hospital between 2005 and 2009 with suspected small bowel Crohn's disease undetected by conventional means to evaluate the diagnostic yield of CE and its impact on management.
Results Small bowel Crohn's disease was suspected in patients with symptoms of abdominal pain or diarrhoea and weight loss, positive family history of inflammatory bowel disease, extra-intestinal manifestations or investigational findings including iron deficiency anaemia (IDA), raised CRP/ESR or hypoalbuminaemia. All patients presenting with symptoms of abdominal pain had small bowel radiology before proceeding to CE in line with BSG guidelines.4 202 patients underwent CE during the study period of which 34 (16.8%) patients were referred to exclude small bowel Crohn's disease. 19 (56%) patients were females. A diagnosis of Crohn's disease was made in 13 (38%) patients on CE based on the findings of erosions, aphthous ulcers etc. 13 (38%) patients had a normal examination, 2 (6%) had NSAID induced ulcers, 1 (3%) was diagnosed with coeliac disease, 1 (3%) had erosive gastropathy, 2 (6%) had discrete aphthous ulcers of query significance and 2 (6%) had limited views due to poor bowel preparation for which a repeat CE examination was requested. CE changed management in 19 (56%) patients and included the following – 12 patients with Crohn's disease were managed conservatively while one had surgery, NSAIDs were stopped in two, proton pump inhibitor was started in one, gluten free diet was initiated in one and two patients underwent repeat endoscopic examination which excluded Crohn's disease.
Conclusion In our selected cohort, small bowel Crohn's disease was diagnosed in 38% of patients that was undetectable by conventional means. This figure is slightly lower than that mentioned in the literature (43–71%).3 Other significant diagnoses were obtained in 12% of cases (NSAID induced ulcers, coeliac disease and erosive gastropathy) and were managed conservatively with good outcome.
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