Evaluation of capsule endoscopy for small bowel Crohn disease at 14th week of Infliximab therapy / 中华消化内镜杂志

ABSTRACT

Objective To evaluate clinical remission in patients with small bowel Crohn's disease (SBCD) who have received infliximab(IFX) therapy and to evaluate capsule endoscopy combined with ileocolonoscopy for mucosal healing at 14th week of IFX therapy.Methods Clinical data of 23 SBCD patients who received IFX were retrospectively analyzed.Laboratory indices [routine blood tests,C-reactive protein (CRP)and albumin],Crohn's disease activity index (CDAI),Lewis score (LS),Crohn's disease simplified endoscopic score (SES-CD),side effects and complications were compared before IFX treatment and at 14th week of IFX therapy.Results In 23 SBCD patients,both CDAI and CRP levels significantly decreased (P＜0.01) while body mass index (BMI) and albumin levels increased at 14th week (P＜0.05),compared with those before treatment.The clinical remission rate at 14th week was 91.3％ (21/23).There were 8/23 (34.8％)SBCD patients achieving mucosal healing in small bowel,12/21 (57.1％) in terminal ileum and colon,and 7/21 (33.3％) in both small bowel and colon.Twelve patients achieved both clinical remission and biochemical remission at 14th week and all of them achieved mucosal healing in both terminal ileum and colon (SES-CD ≤ 2).However,there were 5 (41.7％) of them still with small bowel inflammation (LS＞ 135).Conclusion IFX plays a role in promoting clinical remission and mucosal healing in SBCD patients.Mucosal healing of CD patients in terminal ileum and other parts of small intestine are not synchronized.For CD patients with small bowel and colon involved,the evaluation of the whole gastrointestinal tract by capsule endoscopy combined with ileocolonoscopy is recommended on condition that they have no intestinal obstruction or severe stricture.