Unsuspected Small-Bowel Crohn's Disease in Elderly Patients Diagnosed by Video Capsule Endoscopy.

Diagnostic and Therapeutic Endoscopy Pub Date : 2018-01-29 eCollection Date: 2018-01-01 DOI:10.1155/2018/9416483
Che-Yung Chao, Carl Frederic Duchatellier, Ernest G Seidman
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引用次数: 5

Abstract

Background: Video capsule endoscopy (VCE) is increasingly performed among the elderly for obscure bleeding. Our aim was to report on the utility of VCE to uncover unsuspected Crohn's disease (CD) in elderly patients.

Methods: Retrospective review of VCE performed in elderly patients (≥70 y) at a tertiary hospital (2010-2015). All underwent prior negative bidirectional endoscopies. CD diagnosis was based on consistent endoscopic findings, exclusion of other causes, and a Lewis endoscopic score (LS) > 790 (moderate-to-severe inflammation). Those with lower LS (350-790) required histological confirmation. Known IBD cases were excluded.

Results: 197 VCE were performed (mean age 78; range 70-93). Main indications were iron deficiency anemia (IDA), occult GI bleeding (OGIB), chronic abdominal pain, or diarrhea. Eight (4.1%) were diagnosed as CD based on the aforementioned criteria. Fecal calprotectin (FCP) was elevated in 7/8 (mean 580 μg/g). Mean LS was 1824. Small-bowel CD detected by VCE led to a change in management in 4/8. One patient had capsule retention secondary to NSAID induced stricture, requiring surgical retrieval.

Conclusions: VCE can be safely performed in the elderly. A proportion of cases may have unsuspected small-bowel CD despite negative endoscopies. FCP was the best screening test. Diagnosis frequently changed management.

Abstract Image

视频胶囊内镜诊断老年小肠克罗恩病的临床研究。
背景:视频胶囊内窥镜(VCE)越来越多地用于老年人隐晦出血。我们的目的是报告VCE在老年患者中发现未被怀疑的克罗恩病(CD)的效用。方法:回顾性分析2010-2015年某三级医院老年患者(≥70岁)VCE的治疗情况。所有患者既往均行双向内窥镜检查。CD诊断基于一致的内镜检查结果,排除其他原因,Lewis内镜评分(LS) > 790(中度至重度炎症)。低LS(350-790)的患者需要组织学证实。排除已知的IBD病例。结果:行VCE 197例(平均年龄78岁;范围70 - 93)。主要适应症为缺铁性贫血(IDA)、隐蔽性消化道出血(OGIB)、慢性腹痛或腹泻。8例(4.1%)根据上述标准诊断为乳糜泻。粪钙保护蛋白(FCP)升高7/8(平均580 μg/g)。平均LS为1824。VCE检测到的小肠CD导致4/8的管理改变。1例患者继发于非甾体抗炎药引起的狭窄,需要手术取出。结论:老年人行VCE是安全的。尽管内窥镜检查呈阴性,但仍有一部分病例可能患有未被怀疑的小肠乳糜泻。FCP是最佳筛选试验。诊断频繁变更处理。
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