P52 The utility of capsule endoscopy in the phenotype of crohn’s disease

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<h3>Introduction</h3> Isolated small bowel Crohn’s disease (CD) is reported to have a worse prognosis compared to colonic CD. The aim of this study was to understand the correlation between Crohn’s phenotype with biomarkers to identify differences in outcome and management. <h3>Methods</h3> Patients with ileocolonic or isolated small bowel CD were identified from an existing capsule endoscopy (CE) database. Harvey Bradshaw Index (HBI), biomarkers- c-reactive protein (CRP) and Faecal calprotectin (FC) , findings on CE and subsequent follow up data were collected. SPSS was used to analyse the data. <h3>Results</h3> 196 patients with CD were included in this study (median age 42.4 years (17- 83 years ; SD 16.5). A new diagnosis of small bowel CD was made in 36.7%(n=72), whilst 63.3% (n=124) had established CD. Magnetic resonance imaging/MRI was abnormal in 43.8% only. Seventy seven percent (n=150) had isolated SB disease whilst 24% had ileocolonic disease (n=46) with corresponding higher HBI values (isolated ileal disease :HBI median 5 +/-4.1 vs ileocolonic disease 7 +/- 4.8 p=0.006). Faecal calprotectin (FC) levels did not differ between subgroups (102ug/g vs 171 ug/g, p=0.105). CE showed distal disease in 95.4% (n=187), proximal involvement in 35.2% (n=69) and extensive disease in 2.6%(n=5).The median Lewis score (LS) was 562(SD 1147). Patients with extensive disease had a higher LS than other groups (1050+/-1393 vs 450 +/-960; p=0.001) The correlation between CRP and LS on CE was significant (p=0.0001) as was HBI (p=0.002). In contrast FC correlated poorly with LS on CE (p=0.158). Patients were followed up for a median of 31 months ( range 1-68 months; SD 18) following their CE and management was altered in 67.3% (n=132) post CE. This included steroids in 52% (n=102), azathioprine (n=70, 35.7%) and methotrexate in 5.1% (n= 10) and commencement of biologics in 51.5% (n=101). HBI and CRP pre CE predicted a change in management (p=0.005 and 0.003 respectively) whilst FC did not (p=0.458) . Similarly, there was no corelation between the LS and histology taken at colonoscopy or subsequent enteroscopy (p= 0.611). Patients with isolated small bowel crohn’s disease were more likely to require biologic therapy compared to those with ileo- colonic disease (p= 0.007), however histological confirmation of terminal ileal disease had no impact on outcome (p=0.722). <h3>Conclusion</h3> CE is an important modality for the diagnosis of SB CD. CRP and HBI help predict patients who have active disease on CE. Patients with isolated SB CD on CE have a greater requirement for biological therapy.