CLINICAL OUTCOME OF PATIENTS EXAMINED BY SMALL BOWEL CAPSULE ENDOSCOPY WITH NON-SPECIFIC ENTERITIS

Aims As with isolated ileitis on colonoscopy the finding of nonspecific enteritis (NSE) on capsule endoscopy (CE) not meeting established diagnostic criteria poses a clinical challenge. There is lack of available evidence to help clinicians to predict significant disease and long-term prognosis. We aimed to define the natural history of NSE in an Irish cohort.

Methods A retrospective longitudinal cohort study. Patients with NSE on CE were identified. Clinical records were reviewed, and subsequent investigations, treatments and diagnoses were recorded.Exclusion criteria: known Crohn’s disease, enteritis meeting a diagnostic threshold, < 3 moths follow up or patients from external institutions. Patients were grouped based on ultimate diagnosis: Crohn’s disease (CD), Irritable bowel syndrome (IBS), NSAID enteritis (NSAIDE), no significant disease (NAD), persistent NSE and other non-inflammatory conditions.Clinical and demographic parameters were compared between groups.

Results 157 (48%) cases were identified, 69 excluded. Of the NSE group (n= 88), 46 (52%) were male, mean age 52, mean follow up 23 months, baseline mean CRP, faecal calprotectin and Lewis Scores were 8.7, 63.8 and 597, respectively. Ultimate diagnoses: NAD 35 (40%), CD 17 (19%), NSAIDs 12 (14%), IBS 14 (16%), persistent NSE 2 (2%), other 8 (9%). Female gender was associated with IBS (OR 4.7, p < 0.02) and older age with NSAIDs enteritis (mean 64 vs 49 years, p < 0.006). Both NSAIDs and CD were associated with a higher baseline Lewis Score (831.7 vs 308.5, p=0.02). Anaemia was associated with NSAID enteritis (p=0.001). Faecal calprotectin and CRP were similar among groups. Significantly more CD patients were referred with suspected CD 82% vs 17%, p < 0.009. While anaemia was a more frequent indication in NSAIDE (75% vs 19%, p =0.05).

Conclusions Our study shows that 33% of patients have clinically significant disease (CSD) on follow up. Clinical suspicion and capsule severity are predictive of CSD.