Reclassification of Inflammatory Bowel Disease Type Unclassified by Small Bowel Capsule Endoscopy

Ana-Maria Singeap; Catalin Sfarti; Irina Girleanu; Laura Huiban; Cristina Muzica; Sergiu Timofeiov; Carol Stanciu; Anca Trifan

doi:10.3390/medicina59122064

Reclassification of Inflammatory Bowel Disease Type Unclassified by Small Bowel Capsule Endoscopy

Medicina (Kaunas). 2023 Nov 23;59(12):2064. doi: 10.3390/medicina59122064.

Authors

Ana-Maria Singeap^{1

2}, Catalin Sfarti^{1

2}, Irina Girleanu^{1

2}, Laura Huiban^{1

2}, Cristina Muzica^{1

2}, Sergiu Timofeiov^{3

4}, Carol Stanciu^{1

2}, Anca Trifan^{1

2}

Affiliations

¹ Department of Gastroenterology, Faculty of Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania.
² Institute of Gastroenterology, "St. Spiridon" University Hospital, 700111 Iasi, Romania.
³ Department of Surgery, Faculty of Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania.
⁴ Department of Surgery, "St. Spiridon" University Hospital, 700111 Iasi, Romania.

Abstract

Background and Objectives: Ulcerative colitis (UC) and Crohn's disease (CD) are idiopathic inflammatory bowel diseases (IBDs) without a unique, gold standard diagnostic test. UC and Crohn's colitis are impossible to distinguish in approximately 10% of cases. The term IBD type unclassified (IBD-U) is recommended for cases of chronic colitis showing overlapping endoscopic, radiological, and biopsy histological features between UC and CD, while indetermined colitis is reserved for colectomy specimens. Our aim was to assess the role of small-bowel capsule endoscopy (SBCE) in the diagnostic work-up of IBD-U. Materials and Methods: We retrospectively studied the cases of IBD-U explored by SBCE in a tertiary referral gastroenterology center. Patients were investigated using SBCE after contraindications were excluded. Diagnostic criteria for small bowel CD consisted in more than three ulcerations, irregular ulcers, or stenosis, and the Lewis score was used for the quantification of inflammation. The immediate impact of reclassification and outcome data was recorded over a follow-up period of more than one year. Results: Twenty-eight patients with IBD-U were examined using SBCE. Nine patients had small bowel lesions that met the diagnostic criteria for CD, resulting in a reclassification rate of 32.1%. In five of these cases, the treatment was subsequently changed. In the remaining nineteen examinations, no significant findings were observed. There were no complications associated with SBCE. Median follow-up time was 32.5 months (range 12-60). During follow-up, twelve patients were classified as having UC, and seven remained as having an unclassified type; one case of colectomy, for medically refractory UC, was recorded. Conclusions: SBCE is a useful safe tool in the work-up of IBD-U, allowing reclassification in about one third of cases, with subsequent treatment modifications. SBCE may provide a definite diagnosis, enhance the comprehension of the disease's progression, and optimize the short- and long-term management strategy.

Keywords: Crohn’s disease; inflammatory bowel disease type unclassified; small bowel capsule endoscopy; ulcerative colitis.

MeSH terms

Capsule Endoscopy* / methods
Colitis, Ulcerative* / complications
Crohn Disease* / complications
Crohn Disease* / diagnosis
Humans
Inflammatory Bowel Diseases* / complications
Inflammatory Bowel Diseases* / diagnosis
Retrospective Studies

Grants and funding

This research received no external funding.