Clinical features of patients with negative results from traditional diagnostic work-up and Crohn's disease findings from capsule endoscopy.

INTRODUCTION

Capsule endoscopy (CE) can detect Crohn's disease in patients with suggestive symptoms but with negative results from the traditional diagnostic work-up (ileocolonoscopy and small bowel follow-through). The objective of this study was to determine which clinical features predict the diagnosis of Crohn's disease by CE in this subgroup of patients.

MATERIAL AND

METHODS

Twenty-three patients (7 men, 16 women; mean age: 40+/-15 y) with negative results from conventional imaging techniques were prospectively included in the study because of suspicion of Crohn's disease (long-standing abdominal pain and/or diarrhea and at least one of the following symptoms: anemia, weight loss, long-standing fever, perianal disease, extraintestinal manifestations typical of inflammatory bowel disease, elevated inflammatory parameters, or family history of inflammatory bowel disease).

RESULTS

CE diagnosed Crohn's disease in 6 patients (26%). Crohn's disease diagnosis was more frequent in patients with a combination of anemia and elevated inflammatory parameters than in patients without this combination (57% vs. 12.5%; P=0.04). The only statistically significant association between an inflammatory parameter and Crohn's disease was an increased platelet count.

CONCLUSIONS

CE is a useful tool for the diagnosis of subtle small bowel Crohn's disease. The diagnostic yield of CE in patients with suspicion of Crohn's disease but negative results from the traditional diagnostic work-up is significantly higher in patients with anemia and increased platelet count than in patients without this combination of clinical features.