Abstract
Purpose: The use of capsule endoscopy (CE) for the evaluation of Crohn's disease (CD) has become increasingly common. However, how well CE findings predict CD clinical activity remains uncertain. This pilot study aims to correlate CE findings, using the Lewis score, with the Crohn's disease activity index (CDAI) in patients starting therapy with an anti-tumor necrosis factor (anti-TNF) antibody. Methods: Patients with active CD starting anti-TNF therapy underwent CE at initiation of treatment, at 10 wks, and at 26 wks. The Lewis score, based on CE evaluation of small bowel villous edema, ulceration, and stenosis, was calculated by an expert capsule endoscopist blinded to the patient's clinical status. At each study visit, a CDAI was calculated, H&P performed, and lab studies obtained. Results were analyzed with students paired t-test. Results: Five patients have completed the study to date. Average CDAI before treatment was 308, at 10 wks 203, and at 26 wks 287. The decrease in CDAI score after 10 wks and 26 wks were not statistically significant (p=0.10 and 0.12, respectively). Average Lewis scores before treatment was 1,157, at 10 wks 1,854, and at 26 wks 1490. Changes in the Lewis score were also not statistically significant (p=0.11 and 0.49, respectively). No correlation between Lewis score and CDAI was found. (Figures 1 and 2) Conclusion: In our study, Lewis scores did not correlate with the CDAI in subjects managed with anti-TNF therapy. In fact, Lewis scores were worse at 10 wks even though CDAI scores improved. These results suggest that the Lewis score may not correlate with clinical disease activity in CD patients receiving anti-TNF therapy. More patients need to be studied to confirm these preliminary results. Acknowledgements: This study is supported by the ASGE Given Capsule Endoscopy Research Award.FigureFigure
Published Version
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