Bae June Hwa, Park Su Hyun, Park Jung-Bin, Baek Ji Eun, Hong Seung Wook, Hwang Sung Wook, Yang Dong-Hoon, Ye Byong Duk, Byeon Jeong-Sik, Myung Seung-Jae, Yang Suk-Kyun, Kim Kyeong Ok, Jang Byung Ik, Lee Mi Rae, Kim Eun Soo, Park Sang Hyoung
Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Division of Gastroenterology, Department of Internal Medicine, Daegu Catholic University School of Medicine, Daegu, Korea.
Intest Res. 2025 Jul;23(3):290-301. doi: 10.5217/ir.2024.00056. Epub 2024 Aug 29.
BACKGROUND/AIMS: Video capsule endoscopy is rarely used to diagnose Crohn's disease in patients with negative ileocolonoscopy or cross-sectional image findings. We evaluated clinical characteristics and long-term outcomes of these rare cases.
This multicenter study included patients with Crohn's disease from 3 tertiary hospitals from January 2007 to October 2022. Patients with normal findings on ileocolonoscopy and computed tomography (CT)/magnetic resonance (MR) enterography but had ulcerations at the small bowel detected by video capsule endoscopy were included. The controls were patients with abnormal findings on endoscopy or CT/MR enterography. Controls were case-matched in a ratio of 3:1 for sex, calendar year of diagnosis, and age at diagnosis.
Among 3,752 patients, 24 (0.6%) were diagnosed with Crohn's disease using video capsule endoscopy findings. The disease location (P< 0.001) and behavior at diagnosis (P= 0.013) of the cases significantly differed from that of controls. The perianal fistula modifier (25.0% vs. 33.3%, P= 0.446) did not differ significantly between the 2 groups. Initial disease activity and C-reactive protein and fecal calprotectin levels were significantly lower in cases versus controls. The median Lewis score was 838 (interquartile range, 393-1,803). Over 10 years of follow-up, the cases showed significantly lower cumulative risk of complicated behavior, biologics use, Crohn's disease-related hospitalization, and surgeries (log-rank test P< 0.05).
Patients with Crohn's disease whose lesions were observed only by video capsule endoscopy were rare, and exhibit different clinical characteristics and a more favorable long-term disease course compared to those who were conventionally diagnosed.
背景/目的：对于回结肠镜检查或横断面影像检查结果为阴性的患者，很少使用视频胶囊内镜诊断克罗恩病。我们评估了这些罕见病例的临床特征和长期预后。
这项多中心研究纳入了2007年1月至2022年10月期间来自3家三级医院的克罗恩病患者。纳入回结肠镜检查和计算机断层扫描（CT）/磁共振（MR）小肠造影结果正常，但视频胶囊内镜检查发现小肠有溃疡的患者。对照组为内镜检查或CT/MR小肠造影结果异常的患者。对照组按性别、诊断年份和诊断年龄以3:1的比例进行病例匹配。
在3752例患者中，24例（0.6%）通过视频胶囊内镜检查结果被诊断为克罗恩病。病例组的疾病部位（P<0.001）和诊断时的行为（P=0.013）与对照组有显著差异。两组间肛周瘘管修正因子（25.0%对33.3%，P=0.446）无显著差异。病例组的初始疾病活动度、C反应蛋白和粪便钙卫蛋白水平显著低于对照组。Lewis评分中位数为838（四分位间距，393 - 1803）。经过10多年的随访，病例组出现复杂行为、使用生物制剂、因克罗恩病住院和手术的累积风险显著更低（对数秩检验P<0.05）。
仅通过视频胶囊内镜观察到病变的克罗恩病患者很少见，与传统诊断的患者相比，其临床特征不同，长期病程更有利。
