Capsule Endoscopy Identifies Undiagnosed Cases of Crohn's Disease

A small capsule that takes "snapshots” of the small intestine as it travels through the digestive tract has been shown to help clinicians find cases of Crohn's disease that had gone undiagnosed for up to 15 years.

Presenting at the American College of Gastroenterology's meeting held in October 2007 in Philadelphia, PA, USA, the researchers, from Wake Forest University Baptist Medical Center (Winston-Salem, NC, USA), reported that of 198 video capsule endoscopies that were performed to evaluate unexplained gastrointestinal bleeding, physicians found six cases of Crohn's disease, which had not been diagnosed previously, in spite the patients having colonoscopies and a variety of other imaging tests.

The study is the first to estimate the prevalence of the Crohn's disease (approximately 3%) among patients having capsule endoscopy to evaluate unexplained bleeding. "With capsule endoscopy, we were able to diagnose cases that previously were difficult or impossible to diagnose,” said Richard Bloomfeld, M.D., gastroenterologist and senior researcher. "Some of the patients had been having transfusions for years because of anemia from unexplained bleeding.”

The study was presented by Sakeitha Crowder, M.D., a resident in internal medicine.
Capsule endoscopy has become a standard tool to evaluate unexplained bleeding in the stomach and intestines. Patients swallow a small capsule containing a video camera that takes two images per second over eight hours. "It allows us to see 20 feet of small intestine between the stomach and large intestine--areas that we cannot reach with other tests,” said Dr. Bloomfeld. "It's easy, painless, and requires no sedation.”

Crohn's disease is a disorder that causes inflammation of the digestive tract. It is generally easy to diagnose with a colonoscopy or through symptoms that include abdominal pain and diarrhea. In some instances, however, the disease affects part of the intestine that cannot be reached with colonoscopy.

The mean age of study patients who were diagnosed with Crohn's disease was 35 years. All were being evaluated for iron deficiency anemia requiring blood transfusions. Only two patients had abdominal pain and diarrhea--the typical symptoms of Crohn's disease. The length of time that patients had anemia until they were successfully diagnosed ranged from 11 months to 15 years. After an accurate diagnosis, the patients were successfully treated with medications and none required surgery.

"This study suggests the importance of using capsule endoscopy to fully evaluate people with unexplained gastrointestinal bleeding,” said Dr. Bloomfeld.


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Wake Forest University Baptist Medical Center