Prognostic Value in Patients with Isolated C.D. (Reg. Logística)

Background and aims: Small bowel capsule endoscopy (SBCE) allows mapping of small bowel
inflammation in Crohn’s disease (CD). We aimed to assess the prognostic value of the severity of
inflammatory lesions, quantified by the Lewis score (LS), in patients with isolated small bowel CD.
Methods: A retrospective study was performed in which 53 patients with isolated small bowel
CD were submitted to SBCE at the time of diagnosis. The Lewis score was calculated and patients
had at least 12 months of follow-up after diagnosis. As adverse events we defined disease flare
requiring systemic corticosteroid therapy, hospitalization and/or surgery during follow-up. We
compared the incidence of adverse events in 2 patient subgroups, i.e. those with moderate or
severe inflammatory activity (LS ≥790) and those with mild inflammatory activity (135 ≤ LS < 790).
Results: The LS was ≥790 in 22 patients (41.5%), while 58.5% presented with LS between 135 and
790. Patients with a higher LS were more frequently smokers (p = 0.01), males (p = 0017) and under
immunosuppressive therapy (p = 0.004). In multivariate analysis, moderate to severe disease at
SBCE was independently associated with corticosteroid therapy during follow-up, with a relative
risk (RR) of 5 (p = 0.011; 95% confidence interval [CI] 1.5–17.8), and for hospitalization, with an RR
of 13.7 (p = 0 .028; 95% CI 1.3–141.9).
Conclusion: In patients with moderate to severe inflammatory activity there were higher
prevalences of corticosteroid therapy demand and hospitalization during follow-up. Thus,
stratifying the degree of small bowel inflammatory activity with SBCE and LS calculation at the
time of diagnosis provided relevant prognostic value in patients with isolated small bowel CD.

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