Introduction: Small bowel capsule endoscopy (SBCE) is currently the most sensitive diagnostic technique to detect early small bowel inflammation. The Lewis Score (LS) aims to standardize the quantifi cation of small bowel inflammatory activity detected by the SBCE. Our objective was to evaluate the diagnostic and prognostic accuracy of the LS in patients with suspected Crohn's disease (CD) undergoing SBCE. Methods: We performed a retrospective study including patients who underwent SBCE for suspected CD between 2010 and 2015. Inflammatory activity was assessed with the LS. Subsequent diagnosis of CD was established within 12 months after the SBCE, according to international guidelines. Results: We included 148 patients (56% women, mean age 39±14 years). A LS >135 was detected in 52 (35%) patients. During follow-up, a CD diagnosis was established in 46 (31%) patients: 40 (77%) patients with LS >135 and 6 (6%) patients with LS ≤135 (p < 0.001). Patients with and without subsequent diagnosis of CD had a median LS of 562 (IQR: 225-1350) and 0 (IQR: 0-124), respectively (p < 0.001). The LS showed good diagnostic accuracy with AUROC of 0.92 (p < 0.001) (Fig. 1). Considering a cutoff of 135, this score had a sensitivity, specificity, positive predictive value, and negative predictive value for the diagnosis of CD of 87%, 88%, 78%, and 94%, respectively. During the first year after diagnosis there was no significant association of LS with the need of immunomodulatory therapy (immunomodulatory therapy 574 vs. no 450; p = 0.224), biological therapy (biological therapy 586 vs. no 527; p = 0.352), intestinal resection surgery (surgery 586 vs. no 454; p = 0.691) and hospitalization due to CD flair (hospitalization 361 vs. no 458, p = 0.508).Figure 1Conclusion: The LS (cutoff 135) is very useful in the diagnosis of CD in patients undergoing SBCE. However, this score was not significantly associated with prognostic variables.