Journal of Yeungnam Medical Science

Yeungnam University College of Medicine, Yeungnam University Institute Medical Science (영남대 의대 학술지 편집위원회)
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Comparison of small bowel findings using capsule endoscopy between Crohn's disease and intestinal tuberculosis in Korea

  • Kim, Yong Gil (Department of Internal Medicine, Soonchunhyang University College of Medicine) ;
  • Kim, Kyung-Jo (Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Min, Young-Ki (Department of Physiology, Soonchunhyang University College of Medicine)
  • Received : 2019.08.17
  • Accepted : 2019.11.05
  • Published : 2020.04.30
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Abstract

Background: Little is known about capsule endoscopy (CE) findings in patients with intestinal tuberculosis who exhibit small bowel lesions. The aim of the present study was to distinguish between Crohn's disease (CD) and intestinal tuberculosis based on CE findings. Methods: Findings from 55 patients, who underwent CE using PillCam SB CE (Given Imaging, Yoqneam, Israel) between February 2003 and June 2015, were retrospectively analyzed. Results: CE revealed small bowel lesions in 35 of the 55 patients: 19 with CD and 16 with intestinal tuberculosis. The median age at diagnosis for patients with CD was 26 years and 36 years for those with intestinal tuberculosis. On CE, three parameters, ≥10 ulcers, >3 involved segments and aphthous ulcers, were more common in patients with CD than in those intestinal tuberculosis. Cobblestoning was observed in five patients with CD and in none with intestinal tuberculosis. The authors hypothesized that a diagnosis of small bowel CD could be made when the number of parameters in CD patients was higher than that for intestinal tuberculosis. The authors calculated that the diagnosis of either CD or intestinal tuberculosis would have been made in 34 of the 35 patients (97%). Conclusion: The number of ulcers and involved segments, and the presence of aphthous ulcers, were significantly higher and more common, respectively, in patients with CD than in those with intestinal tuberculosis. Cobblestoning in the small bowel may highly favor a diagnosis of CD on CE.

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References

  1. Almadi MA, Ghosh S, Aljebreen AM. Differentiating intestinal tuberculosis from Crohn's disease: a diagnostic challenge. Am J Gastroenterol 2009;104:1003-12. https://doi.org/10.1038/ajg.2008.162
  2. Horvath KD, Whelan RL. Intestinal tuberculosis: return of an old disease. Am J Gastroenterol 1998;93:692-6. https://doi.org/10.1016/S0002-9270(98)00087-2
  3. Marshall JB. Tuberculosis of the gastrointestinal tract and peritoneum. Am J Gastroenterol 1993;88:989-99.
  4. Snider DE Jr, Roper WL. The new tuberculosis. N Engl J Med 1992;326:703-5. https://doi.org/10.1056/NEJM199203053261011
  5. Thia KT, Loftus EV Jr, Sandborn WJ, Yang SK. An update on the epidemiology of inflammatory bowel disease in Asia. Am J Gastroenterol 2008;103:3167-82. https://doi.org/10.1111/j.1572-0241.2008.02158.x
  6. Yang SK, Yun S, Kim JH, Park JY, Kim HY, Kim YH, et al. Epidemiology of inflammatory bowel disease in the Songpa-Kangdong district, Seoul, Korea, 1986-2005: a KASID study. Inflamm Bowel Dis 2008;14:542-9. https://doi.org/10.1002/ibd.20310
  7. Solem CA, Loftus EV Jr, Fletcher JG, Baron TH, Gostout CJ, Petersen BT, et al. Small-bowel imaging in Crohn's disease: a prospective, blinded, 4-way comparison trial. Gastrointest Endosc 2008;68:255-66. https://doi.org/10.1016/j.gie.2008.02.017
  8. Lee YJ, Yang SK, Byeon JS, Myung SJ, Chang HS, Hong SS, et al. Analysis of colonoscopic findings in the differential diagnosis between intestinal tuberculosis and Crohn's disease. Endoscopy 2006;38:592-7. https://doi.org/10.1055/s-2006-924996
  9. Park SH, Yang SK, Yang DH, Kim KJ, Yoon SM, Choe JW, et al. Prospective randomized trial of six-month versus nine-month therapy for intestinal tuberculosis. Antimicrob Agents Chemother 2009;53:4167-71. https://doi.org/10.1128/AAC.00874-09
  10. Gong F, Swain P, Mills T. Wireless endoscopy. Gastrointest Endosc 2000;51:725-9. https://doi.org/10.1067/mge.2000.105724
  11. Fireman Z, Mahajna E, Broide E, Shapiro M, Fich L, Sternberg A, et al. Diagnosing small bowel Crohn's disease with wireless capsule endoscopy. Gut 2003;52:390-2. https://doi.org/10.1136/gut.52.3.390
  12. Reddy DN, Sriram PV, Rao GV, Reddy DB. Capsule endoscopy appearances of small-bowel tuberculosis. Endoscopy 2003;35:99. https://doi.org/10.1055/s-2003-36415
  13. Loftus EV Jr, Silverstein MD, Sandborn WJ, Tremaine WJ, Harmsen WS, Zinsmeister AR. Crohn's disease in Olmsted County, Minnesota, 1940-1993: incidence, prevalence, and survival. Gastroenterology 1998;114:1161-8. https://doi.org/10.1016/S0016-5085(98)70421-4
  14. Lingenfelser T, Zak J, Marks IN, Steyn E, Halkett J, Price SK. Abdominal tuberculosis: still a potentially lethal disease. Am J Gastroenterol 1993;88:744-50.
  15. Chung KM, Kim HS, Park SY, Lim SR, Ryang DY, Jeong HK, et al. The changes in incidence of Crohn's disease and intestinal tuberculosis in Korea. Korean J Gastroenterol 2008;52:351-8.
  16. Mehdizadeh S, Chen GC, Barkodar L, Enayati PJ, Pirouz S, Yadegari M, et al. Capsule endoscopy in patients with Crohn's disease: diagnostic yield and safety. Gastrointest Endosc 2010;71:121-7. https://doi.org/10.1016/j.gie.2009.06.034
  17. Mow WS, Lo SK, Targan SR, Dubinsky MC, Treyzon L, Abreu-Martin MT, et al. Initial experience with wireless capsule enteroscopy in the diagnosis and management of inflammatory bowel disease. Clin Gastroenterol Hepatol 2004;2:31-40. https://doi.org/10.1016/S1542-3565(03)00289-1
  18. Voderholzer WA, Beinhoelzl J, Rogalla P, Murrer S, Schachschal G, Lochs H, et al. Small bowel involvement in Crohn's disease: a prospective comparison of wireless capsule endoscopy and computed tomography enteroclysis. Gut 2005;54:369-73. https://doi.org/10.1136/gut.2004.040055
  19. Rana SS, Sharma V, Sharma R, Nada R, Gupta R, Bhasin DK. Capsule endoscopy in small bowel Crohn's disease and Tuberculosis. Trop Doct 2017;47:113-8. https://doi.org/10.1177/0049475516686542
  20. Cheon JH, Kim YS, Lee IS, Chang DK, Ryu JK, Lee KJ, et al. Can we predict spontaneous capsule passage after retention? A nationwide study to evaluate the incidence and clinical outcomes of capsule retention. Endoscopy 2007;39:1046-52. https://doi.org/10.1055/s-2007-966978
  21. Liao Z, Gao R, Xu C, Li ZS. Indications and detection, completion, and retention rates of small-bowel capsule endoscopy: a systematic review. Gastrointest Endosc 2010;71:280-6. https://doi.org/10.1016/j.gie.2009.09.031
  22. Cheifetz AS, Kornbluth AA, Legnani P, Schmelkin I, Brown A, Lichtiger S, et al. The risk of retention of the capsule endoscope in patients with known or suspected Crohn's disease. Am J Gastroenterol 2006;101:2218-22. https://doi.org/10.1111/j.1572-0241.2006.00761.x
  23. Triester SL, Leighton JA, Leontiadis GI, Gurudu SR, Fleischer DE, Hara AK, et al. A meta-analysis of the yield of capsule endoscopy compared to other diagnostic modalities in patients with non-stricturing small bowel Crohn's disease. Am J Gastroenterol 2006;101:954-64. https://doi.org/10.1111/j.1572-0241.2006.00506.x
  24. Rondonotti E, Soncini M, Girelli CM, Russo A, de Franchis R; Collaborators on behalf of Aigo S, et al. Short article: Negative small-bowel cross-sectional imaging does not exclude capsule retention in high-risk patients. Eur J Gastroenterol Hepatol 2016;28:871-5. https://doi.org/10.1097/MEG.0000000000000628
  25. Herrerias JM, Caunedo A, Rodriguez-Tellez M, Pellicer F, Herrerias JM Jr. Capsule endoscopy in patients with suspected Crohn's disease and negative endoscopy. Endoscopy 2003;35:564-8. https://doi.org/10.1055/s-2003-40241
  26. Jayanthi V, Robinson RJ, Malathi S, Rani B, Balambal R, Chari S, et al. Does Crohn's disease need differentiation from tuberculosis? J Gastroenterol Hepatol 1996;11:183-6. https://doi.org/10.1111/j.1440-1746.1996.tb00058.x
  27. Leong RW, Lau JY, Sung JJ. The epidemiology and phenotype of Crohn's disease in the Chinese population. Inflamm Bowel Dis 2004;10:646-51. https://doi.org/10.1097/00054725-200409000-00022
  28. Yang SK, Loftus EV Jr, Sandborn WJ. Epidemiology of inflammatory bowel disease in Asia. Inflamm Bowel Dis 2001;7:260-70. https://doi.org/10.1097/00054725-200108000-00013
  29. Sawczenko A, Sandhu BK. Presenting features of inflammatory bowel disease in Great Britain and Ireland. Arch Dis Child 2003;88:995-1000. https://doi.org/10.1136/adc.88.11.995
  30. Petruzziello C, Onali S, Calabrese E, Zorzi F, Ascolani M, Condino G, et al. Wireless capsule endoscopy and proximal small bowel lesions in Crohn's disease. World J Gastroenterol 2010;16:3299-304. https://doi.org/10.3748/wjg.v16.i26.3299

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