B Crohn Disease

Capsule endoscopy is superior to other diagnostic modalities in detecting small bowel disease when the suspicion for Crohn disease is high (Table 33-4). A meta-analysis demonstrated that capsule endoscopy is superior to small bowel radiography, colonoscopy with ileoscopy, CT enterography or enteroclysis, and push enteroscopy for the detection of nonstricturing small bowel Crohn disease (incremental yields of 40%, 15%, 38%, and 38%, respectively). Overall, capsule endoscopy had a yield of 46-72% for detecting small bowel Crohn disease. It had a yield of 33-70% in patients with suspected Crohn disease, and a yield of 68-86% in patients with established Crohn disease. It is possible, however, that the yield of capsule endoscopy for suspected Crohn disease is significantly lower in practice, as patients being evaluated for possible Crohn disease do not always fulfill the selection criteria used in studies. In a study of patients being evaluated for abdominal pain who had undergone previous endoscopic or radiographic evaluations, a cause was detected

Table 33-4. Factors associated with positive capsule endoscopy studies in patients with suspected small bowel Crohn disease.

Abdominal pain Diarrhea Weight loss

Nonspecific abnormalities on small bowel imaging Elevated erythrocyte sedimentation rate Anemia

Low serum albumin

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