Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Department of Endoscopy, Nagoya University Hospital, Nagoya, Japan.
J Gastroenterol Hepatol. 2021 Jul;36(7):1851-1858. doi: 10.1111/jgh.15366. Epub 2020 Dec 22.
Endoscopic evaluation of disease activity, including mucosal healing, is poorly established in Crohn's disease. We previously reported that patients with a Lewis score (LS) on capsule endoscopy < 270 had a lower risk of exacerbation without additional treatment. This study investigated prognostic predictors in patients undergoing capsule endoscopy and determined the optimal LS cut-off value.
In a retrospective single-center study, 102 patients with Crohn's disease who underwent capsule endoscopy were reviewed. We reviewed the clinical course and the patients' characteristics, Crohn's Disease Activity Index, laboratory findings, LS, and Prognostic Nutritional Index (PNI) for factors potentially associated with Crohn's disease-related emergency hospitalization. Subsequently, we prospectively enrolled 66 patients with Crohn's disease and analyzed clinical outcomes according to these factors.
In the retrospective study, LS ≥ 270 and PNI < 45 were identified as independent predictors of Crohn's disease-related emergency hospitalization with hazard ratios of 9.48 and 3.01, respectively. Even in patients with LS ≥ 270, cumulative hospitalization rates decreased after intervention based on capsule endoscopy findings. The prospective study confirmed that patients with LS ≥ 270 or PNI < 45 had a significantly higher risk of Crohn's disease-related emergency hospitalization and that additional treatment reduced the risk of relapse.
LS and PNI are the best available prognostic predictors in patients with Crohn's disease without gastrointestinal stenosis and can guide decisions on treatment escalation. Patients with LS ≥ 270 and PNI < 45 were at increased risk for exacerbation, and additional treatments should be considered for this group.
在克罗恩病中，内镜评估疾病活动度，包括黏膜愈合，尚未得到充分确立。我们之前报告过，胶囊内镜检查的 Lewis 评分（LS）<270 的患者在不进行额外治疗的情况下，病情恶化的风险较低。本研究旨在探讨胶囊内镜检查患者的预后预测因素，并确定最佳 LS 截断值。
在一项回顾性单中心研究中，我们对 102 例接受胶囊内镜检查的克罗恩病患者进行了回顾性分析。我们回顾了临床病程和患者特征、克罗恩病活动指数、实验室检查结果、LS 和预后营养指数（PNI），以确定与克罗恩病相关的紧急住院治疗相关的潜在因素。随后，我们前瞻性纳入了 66 例克罗恩病患者，并根据这些因素分析了临床结局。
在回顾性研究中，LS≥270 和 PNI<45 被确定为克罗恩病相关紧急住院的独立预测因素，风险比分别为 9.48 和 3.01。即使在 LS≥270 的患者中，根据胶囊内镜检查结果进行干预后，累积住院率也有所下降。前瞻性研究证实，LS≥270 或 PNI<45 的患者发生克罗恩病相关紧急住院的风险显著增加，而额外的治疗可降低复发风险。
LS 和 PNI 是无胃肠道狭窄的克罗恩病患者最好的预后预测指标，可以指导治疗升级决策。LS≥270 和 PNI<45 的患者病情恶化风险增加，应考虑对该组患者进行额外治疗。
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