Abstract
Crohn’s disease (CD) is one of the two types of inflammatory bowel disease (IBD) characterized by immune-mediated granulomatous bowel inflammation leading to a variety of intestinal and extra-intestinal manifestations. Although gastrointestinal endoscopy remains an important investigation in macroscopic diagnosis, the subgroup of 20-30% patients with small bowel-limited disease does not benefit either from endoscopy or barium studies. We report a case of a young Sri lankan male who presented with long term malabsorption and chronic hypoalbuminemia, extensively investigated for the underlying cause finally being diagnosed to have small bowel Crohn’s disease following wireless video capsule endoscopy. The case highlights the fact that with the advent and increased use of wireless capsule endoscopy, a better alternative is available for evaluating suspected small bowel CD without radiation exposure and its use should be made popular among the clinicians since the facility is available in the government sector and the prevalence of IBD is found to be significant in the local population than it was once thought to be.
Highlights
Crohn’s disease (CD) is one of the two types of inflammatory bowel disease (IBD) characterized by immune-mediated granulomatous bowel inflammation leading to a variety of intestinal and extra-intestinal manifestations (1)
Gastrointestinal (GI) endoscopy and barium contrast studies remain two of the important and widely available investigations in diagnosis of CD with different sensitivities and specificities depending on various factors (2, 3)
The follow-up double balloon enteroscopy demonstrated areas of scalloping with erosions. These findings were in favour of either Crohn’s disease or non-steroidal anti-inflammatory drug-induced enteropathy and histology of the biopsies showed increased intraepithelial lymphocytes. Since his history was negative for longterm non-steroidal antiinflammatory drug ingestion, the diagnosis was made as small bowel CD and he was commenced on oral prednisolone 40mg/day, azathioprine 25mg/day, iron and folate supplementation and bone protective therapy
Summary
Crohn’s disease (CD) is one of the two types of inflammatory bowel disease (IBD) characterized by immune-mediated granulomatous bowel inflammation leading to a variety of intestinal and extra-intestinal manifestations (1). A 30-year-old male presented with malaise, non-specific abdominal pain, back pain, progressive lack of weight gain and anorexia for 15 years and ankle swelling for 5 years He did not have any urinary symptoms, any past or contact history of tuberculosis and had not been on longterm non-steroidal anti-inflammatory drugs. The follow-up double balloon enteroscopy demonstrated areas of scalloping with erosions These findings were in favour of either Crohn’s disease or non-steroidal anti-inflammatory drug-induced enteropathy and histology of the biopsies showed increased intraepithelial lymphocytes. Since his history was negative for longterm non-steroidal antiinflammatory drug ingestion, the diagnosis was made as small bowel CD and he was commenced on oral prednisolone 40mg/day, azathioprine 25mg/day, iron and folate supplementation and bone protective therapy. A significant clinical improvement was observed with resolution of constitutional symptoms, with a weight gain of 8 kg, ESR declining to 23mm/1st hour, Hb rising to 10.4g/dl (11-18g/dl) and serum albumin rising up to 33g/L (36-48g/dL) within the first 2 months of treatment
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
