Department of Medicine, University of Ottawa, Ottawa, ON, Canada.
Ottawa Hospital Research Institute, Ottawa, ON, Canada.
J Crohns Colitis. 2023 Nov 8;17(10):1624-1630. doi: 10.1093/ecco-jcc/jjad078.
Accurate tools to distinguish Crohn's disease [CD] from cryptoglandular disease in patients with perianal fistulas without detectable luminal inflammation on ileocolonoscopy and abdominal enterography (isolated perianal fistulas [IPF]) are lacking. We assessed the ability of video capsule endoscopy [VCE] to detect luminal inflammation in patients with IPF.
We studied consecutive adults [>17 years] with IPF who were evaluated by VCE after a negative ileocolonoscopy and abdominal enterography between 2013 and 2022. We defined luminal CD by VCE as diffuse erythema, three or more aphthous ulcers, or a Lewis score greater than 135. We compared rates of intestinal inflammation in this cohort with age- and sex-matched controls without perianal fistulas, who underwent VCE for other indications. We excluded persons with pre-existing inflammatory bowel disease [IBD] and exposure to non-steroidal anti-inflammatory drugs or immunosuppressive treatments.
A total of 45 patients with IPF underwent VCE without complications. Twelve patients [26%] met our definition of luminal CD. Luminal CD was more common in patients with IPF than in controls [26% vs 3%; p <0.01]. Among patients with IPF, male sex (OR [odds ratio], 9.2; 95% confidence interval [CI] [1.1-79.4]), smoking (OR, 4.5; 95% CI [0.9-21.2]), abscess (OR, 6.3; 95% CI [1.5-26.8]), rectal enhancement on magnetic resonance imaging [MRI] (OR, 9.0; 95% CI [0.8-99.3]), and positive antimicrobial serology (OR, 7.1; 95% CI, [0.7-70.0]) were more common in those with a positive VCE study.
VCE detected small intestinal inflammation suggestive of luminal CD in approximately one-quarter of patients with IPF. Larger studies are required to validate these findings.
对于经结肠镜和腹部影像学检查（孤立性肛周瘘管[IPF]）未发现腔道炎症的肛周瘘管患者，缺乏能够准确区分克罗恩病（CD）和隐匿性腺体疾病的工具。我们评估了视频胶囊内镜（VCE）检测 IPF 患者腔道炎症的能力。
我们研究了 2013 年至 2022 年间，经结肠镜和腹部影像学检查阴性后接受 VCE 检查的连续成年（>17 岁）IPF 患者。我们通过 VCE 将腔道 CD 定义为弥漫性红斑、3 个或更多口疮性溃疡或 Lewis 评分大于 135。我们将该队列的肠道炎症发生率与无肛周瘘管的年龄和性别匹配的对照组进行了比较，这些对照组因其他指征接受了 VCE 检查。我们排除了有既往炎症性肠病（IBD）和非甾体抗炎药或免疫抑制治疗暴露史的患者。
45 例 IPF 患者行 VCE 检查，无并发症发生。12 例患者（26%）符合我们对腔道 CD 的定义。IPF 患者中腔道 CD 的发生率高于对照组（26%比 3%；p<0.01）。在 IPF 患者中，男性（比值比[OR]，9.2；95%置信区间[CI] [1.1-79.4]）、吸烟（OR，4.5；95% CI [0.9-21.2]）、脓肿（OR，6.3；95% CI [1.5-26.8]）、直肠 MRI 增强（OR，9.0；95% CI [0.8-99.3]）和抗菌血清学阳性（OR，7.1；95% CI，[0.7-70.0]）更常见于 VCE 检查阳性的患者。
VCE 检测到约四分之一的 IPF 患者存在提示腔道 CD 的小肠炎症。需要更大的研究来验证这些发现。
