Are Inflammatory Markers Abnormal in Patients with Suspected Crohnʼs Disease Undergoing Video Capsule Endoscopy?

Abstract

Purpose: Diagnosis of Crohn's disease (CD) involving the small bowel can be challenging. A combination of various factors such as clinical presentation, inflammatory markers (ESR, CRP) and inflammatory indices such as elevated WBC, low Hgb in addition to radiology and endoscopic findings can lead to the definite diagnosis. The introduction of video capsule endoscopy (VCE) has facilitated the identification of small bowel mucosa changes not visible with other traditional endoscopic or radiographic imaging modalities thus may help in the diagnosis of CD. The aim of our study was to evaluate whether inflammatory markers (ESR, CRP) and indices (leukocytosis, low Hgb,) were abnormal in patients with suspected CD undergoing VCE. Methods: A retrospective analysis of prospectively collected VCE database was performed at our center. Medical records were reviewed for 62 consecutive patients with suspected CD who underwent VCE evaluation from February 2006 to May 2011. Inflammatory markers such as ESR, CRP and indices of inflammation such as elevated WBC, low Hgb were compared among subjects remaining only with suspected CD and subjects with definite and confirmed by VCE CD. Results: A total of 380 patients underwent VCE of which 62 (16%) had suspected or known IBD and had successfully completed VCE. Of these 62 patients, 10 (16 %) were confirmed to have a prior diagnosis of inflammatory bowel disease (4 patients UC, 6 patients CD) and 52 were suspected of having CD. Patients with CD diagnosed prior to VCE were therefore excluded from the analysis. The overall mean age was 39.5 SD=14.82 and overall 40 patients were females (64%). Patients had symptoms for duration of 4.1y SD 6.58. Of the 56 subjects with suspected CD, 3 (5.3%) were eventually diagnosed with definite CD based on VCE findings. In this definite CD group diagnosed based on VCE, only 1 patient had laboratory values available for the analysis with normal inflammatory markers and indices. In the group of patients with suspected CD but not proven by VCE, 9 (16%) patients had elevated inflammatory markers (ESR or CRP), 12 (22%) had abnormal low Hgb and 2 patients (3.7%) had leukocytosis. Conclusion: Our analysis highlights that inflammatory markers and indices can be abnormal in patients undergoing VCE with suspected CD who either are diagnosed as having CD or not diagnosed as having CD. The majority of patients undergoing VCE who do not have CD do not have inflammatory markers present. Inflammatory markers and indices may play a role in diagnosing CD in patients but further prospective larger studies are warranted.