视频胶囊内镜检查在伴有或不伴有相关症状的慢性腹痛患者中的应用：一项回顾性研究。
Video Capsule Endoscopy in Patients with Chronic Abdominal Pain with or without Associated Symptoms: A Retrospective Study.
机构信息
School of Medicine, University of California San Diego, La Jolla, California, United States of America.
School of Medicine, University of California San Diego, La Jolla, California, United States of America; Department of Medicine, University of California San Diego, La Jolla, California, United States of America.
出版信息
PLoS One. 2015 Apr 20;10(4):e0126509. doi: 10.1371/journal.pone.0126509. eCollection 2015.
BACKGROUND
Chronic abdominal pain (CAP) is a common indication for gastroenterology referrals. More insidious causes of CAP isolated to the small bowel, such as malignancies and Crohn's disease, are rising in incidence and causing more gastroenterologists to evaluate their patients with video capsule endoscopy (VCE). However, the role of VCE in patients with CAP is still unclear.
AIMS
We assessed the efficacy of VCE in patients with CAP and whether it led to findings that contributed to disease management and meaningful interventions.
METHODS
This retrospective study evaluated 607 capsule endoscopy studies at an open referral endoscopy unit. Ninety of the studies were for CAP. These studies were compared to those performed for other indications to compare diagnostic yield. In addition, we investigated whether VCE led to an intervention that improved clinical outcomes.
RESULTS
Overall, the number of abnormal findings in CAP patients was significantly lower than VCE performed for other indications (24.4% vs 39.0%, respectively p = 0.009). When patients with CAP presented with other pertinent clinical findings (e.g. nausea, weight loss, anemia, history of in inflammatory bowel disease, etc.), the likelihood of an abnormal finding increased to a level that was not different from those who received VCE for other indications (27.1%, p = 0.10). The findings from VCE lead to changed management and improved outcomes in 16.2% of CAP patients with associated symptoms. However, the subgroup that benefited the most were those who had a prior history of Crohn's disease. Patients with CAP who did not have any associated symptoms continued to have a significantly lower abnormal finding rate compared to those who received VCE for other indications (19.4%, p = 0.03) and VCE rarely led to a change in management that would improve outcomes (5.6%).
CONCLUSIONS
VCE for CAP has a lower rate of abnormal findings than other indications. However, VCE is a useful diagnostic tool that can help provide a possible etiology of CAP in patients with associated symptoms. However, a change in management from VCE is likely to be limited to those with a history of Crohn's disease.
背景
慢性腹痛（CAP）是胃肠病学转诊的常见指征。越来越多的隐匿性小肠病因，如恶性肿瘤和克罗恩病，导致 CAP 的发病率上升，促使更多的胃肠病学家通过视频胶囊内镜（VCE）来评估他们的患者。然而，VCE 在 CAP 患者中的作用仍不清楚。
目的
我们评估了 VCE 在 CAP 患者中的疗效，以及它是否能提供有助于疾病管理和有意义干预的发现。
方法
本回顾性研究评估了开放转诊内镜单位的 607 例胶囊内镜研究。其中 90 例为 CAP。将这些研究与其他指征进行比较，以比较诊断率。此外，我们还研究了 VCE 是否导致改善临床结果的干预措施。
结果
总体而言，CAP 患者的异常发现数量明显低于 VCE 用于其他指征的数量（分别为 24.4%和 39.0%，p=0.009）。当 CAP 患者出现其他相关临床发现（如恶心、体重减轻、贫血、炎症性肠病史等）时，异常发现的可能性增加到与接受 VCE 用于其他指征的患者无差异的水平（27.1%，p=0.10）。VCE 的发现导致 16.2%有相关症状的 CAP 患者的治疗方式发生改变，并改善了结果。然而，受益最多的是那些有克罗恩病病史的患者。没有任何相关症状的 CAP 患者与接受 VCE 用于其他指征的患者相比，异常发现的比例仍然显著降低（19.4%，p=0.03），VCE 很少导致改善结果的治疗方式改变（5.6%）。
结论
VCE 用于 CAP 的异常发现率低于其他指征。然而，VCE 是一种有用的诊断工具，可以帮助提供 CAP 患者相关症状的可能病因。然而，VCE 可能改变管理的情况可能仅限于有克罗恩病病史的患者。
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