Abstract
Background Small bowel capsule endoscopy (CE) is a useful tool for evaluating the mucosal changes in patients with Crohn's disease (CD). The Lewis score (LS) on CE could be used to objectively assess the inflammatory activity of the small bowel mucosa. However, only few reports on the correlation between the LS and CD prognosis exist. This study is aimed at evaluating the clinical significance of the LS by determining the cutoff value of the LS that could predict CD-related emergency hospitalization. Methods This retrospective single-center study included 125 patients who underwent CE for small bowel CD. Eighty-six patients whose treatment was not changed after CE were analyzed. Inflammatory activity was assessed with the LS. We examined the clinical course of the patients who could be observed for 1 year after CE and investigated the LS cutoff value that could predict CD-related emergency hospitalization within 1 year. We also examined the hospitalization-free and clinical relapse-free rates using the LS cutoff value and evaluated the factors related to emergency hospitalization. Results The LS cutoff value that could predict CD-related emergency hospitalization within 1 year was 264 (area under the curve, 0.92 (P < 0.001); sensitivity, 0.80; and specificity, 0.94). The cumulative hospitalization-free rate and cumulative clinical relapse-free rate were significantly higher in patients with a LS < 264 (P < 0.001). Multivariate analysis showed that a LS < 264 was a statistically significant factor (P = 0.001; 95% CI, 0.010–0.308). Conclusion A LS of 264 is a useful cutoff value that could predict CD-related emergency hospitalization. This LS cutoff value may help determine treatment strategies for CD.
Highlights
Crohn’s disease (CD) is a chronic inflammatory disorder of the gastrointestinal tract characterized by transluminal inflammation and progressive disease that causes complications, such as stenosis, fistula, perianal complications, and colorectal cancer [1]
The treatment paradigm has shifted from targeting the symptoms to reducing inflammatory activity and achieving mucosal healing (MH); MH is regarded as a predictive factor of the long-term prognosis of patients with CD [5,6,7,8]
Of the 125 patients, 33 patients whose treatment was changed after CE were excluded; treatment was changed in 27 patients because of the endoscopic findings or symptoms at the time of initial CE and in six patients because of positive findings in capsule endoscopy, colonoscopy, and double balloon endoscopy performed during the follow-up, they did not develop any symptom
Summary
Crohn’s disease (CD) is a chronic inflammatory disorder of the gastrointestinal tract characterized by transluminal inflammation and progressive disease that causes complications, such as stenosis, fistula, perianal complications, and colorectal cancer [1]. Some studies reported a poor correlation of clinical indices, such as the CD activity index (CDAI), with endoscopic and biochemical disease activity [11] Inflammatory biomarkers, such as C-reactive protein (CRP), provide useful information on the inflammatory burden of the disease, approximately 30% of patients with CD had Gastroenterology Research and Practice no elevated CRP levels even during relapse [12, 13]. This study is aimed at evaluating the clinical significance of the LS by determining the cutoff value of the LS that could predict CD-related emergency hospitalization. We examined the hospitalization-free and clinical relapse-free rates using the LS cutoff value and evaluated the factors related to emergency hospitalization. This LS cutoff value may help determine treatment strategies for CD
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