Assessment of mucosal healing during biological therapy of small bowel Crohn’s disease by capsule endoscopy: a prospective observational study

Česká verzia

Authors: N. Machková ¹; D. Ďuricová ¹ ; M. Bortlík ^1,2; Luděk Hrdlička ¹; M. Lukáš Jr. ^1,2; M. Lukáš ^1,3
Authors place of work: Klinické a výzkumné centrum pro střevní záněty ISCARE a 1. LF UK Praha ¹; Interní klinika 1. LF UK a ÚVN Praha ²; Ústav klinické biochemie a laboratorní diagnostiky 1. LF UK Praha ³
Published in the journal: Gastroent Hepatol 2013; 67(1): 17-21
Category: IDB: Original Article

Summary

Background:
Efficacy of anti-TNFα therapy in mucosal healing of Crohn’s disease in the small bowel is examined less than in the large bowel due to more difficult detection of mucosal changes.

Aim and methods:
The aim of the prospective study was to assess the efficacy of anti-TNFα therapy in mucosal healing of small bowel CD using capsule endoscopy (CE). Patients with CD involving small (+/- large) bowel, who were indicated to anti-TNFα therapy were included.

Results:
25 patients (18 treated with infliximab, 7 with adalimumab) were examined by CE (Mirocam(R), IntroMedic, South Korea) at the start of biologic treatment and 19 of them during the maintenance phase of therapy. Mucosal inflammatory changes were assessed by the Lewis score (LS). The median LS at base line was 1,350 (range 337–7,840) with 28% having mild (LS 135–790) and 72% moderate to severe mucosal inflammation (LS > 790). A significant reduction of LS to 402.5 with the range of 0–4,432 (p < 0.001) was observed after median of 32 weeks of treatment, with 83% of patients having only mild mucosal inflammation or normal mucosal finding (LS < 135). Only one (2.3%) capsule retention was observed; other complications were not observed.

Conclusion:
Anti-TNFα therapy is effective in mucosal healing of small bowel CD. Capsule endoscopy detected mucosal changes effectively, was well tolerated and relatively safe.

Key words:
Crohn’s disease – small intestine – mucosal healing – capsule endoscopy

The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manuscript met the ICMJE „uniform requirements“ for biomedical papers.

Submitted:
7. 2. 2013

Accepted:
9. 2. 2013

Zdroje

1. Bourreile A, Ignjatovic A, Aabakken E et al. Role of small bowel endoscopy in the management of patients with inflammatory bowel disease: an international OMED-ECCO consensus. Endoscopy 2009; 41: 618–637.

2. Douda T. Kapslová endoskopie u IBD. Endoskopie 2010; 19(3–4): 117–120.

3. Tachecí I, Bureš J, Dědek P et al. Kapslová endoskopie. Nucleus HK 2008: 180–196.

4. Kornbluth A, Colombel JF, Leigton JA et al. ICCE consensus for inflammatory bowel disease. Endoscopy 2005; 37: 1051–1054.

5. Lewis BS. Expanding role of capsule endoscopy in inflammatory bowel disease. World J Gastroenterol 2008; 14(26): 4137–4141.

6. Efthymiou A, Viazis A, Mantzaris G et al. Does clinical response correlate with mucosal healing in patients with Crohn’s disease of small bowel? A prospective case-series study using wireless capsule endoscopy. Inflamm Bowel Dis 2008; 14(11): 1542–1547.

7. Tachecí I, Suchánek Š, Drastich P et al. Standard ČGS pro kapslovou endoskopii tenkého střeva. Gastroent Hepatol 2011; 65(4): 195–201.

8. Gralnek IM, Defrankis R, Seidman E et al. Development of a capsule endoscopy scoring index for small bowel mucosal inflammatory change. Aliment Pharmacol Ther 2008; 27(2): 146–154.

9. Froslie KF, Jahnsen J, Moum BA et al. Mucosal healing in inflammatory bowel disease: results from a Norwegian population--based cohort. Gastroenterology 2007; 133(2): 412–422.

10. Baert F, Moortgat L, Van Assche G et al. Mucosal healing predicts sustained clinical remission in patients with early stage Crohn’s disease. Gastroenterology 2010; 138(2): 463–468.

11. Van Assche G, Vermeire S, Rutgeerts P. Mucosal healing and anti TNFs in IBD. Curr Drug Targets 2010; 11(2): 227–233.

12. Schnitzler F, Fidder H, Ferrante M et al. Mucosal healing predicts long-term outcome of maitenance therapy with infliximab in Crohn’s disease. Inflamm Bowel Dis 2009; 15(9): 1295–1301.

13. Hrdlička L. Doporučený postup pro vyšetřování tenkého střeva u pacientů s Crohnovou chorobou. Gastroent Hepatol 2011; 65(2): 65–69.

14. Swain P. Wireless capsule endoscopy and Crohn’s disease. Gut 2005; 54(3): 323–326.

15. Voderholzer WA, Ortner M, Rogalla P et al. Small bowel involvement in Crohn’s disease a prospective comparison of wireless capsule endoscopy and computed tomography enteroclysis. Gut 2005; 54(3): 323–326.

16. Cheifetz AS, Kornbluth AA, Legnani P et al. The risk of retention of the capsule endoscope in patients with known or suspected Crohn’s disease. Am J Gastroenterol 2006; 101(10): 2218–2222.

17. Rosa B, Moreira MJ, Rebelo A et al. Lewis score: A useful clinical tool for patient with suspected Crohn’s disease submitted to capsule endoscopy. J Crohn Colitis 2012; 6(6): 692–697.

18. Gal E, Geller A, Fraser G et al. Assessment and validation of the new capsule endoscopy Crohn’s disease activity index (CECDAI). Dig Dis Sci 2008; 53(7): 1933–1937.