Long-term follow-up of children with Crohn's disease and small bowel mucosal lesions detected through video capsule endoscopy

J Pediatr Gastroenterol Nutr. 2025 Jan;80(1):124-132. doi: 10.1002/jpn3.12397. Epub 2024 Nov 1.

Abstract

Objectives: We report disease outcomes of pediatric Crohn's disease (CD) affecting the proximal small bowel (SB) and detected through video capsule endoscopy (VCE).

Methods: We undertook a retrospective review of CD patients with VCE performed under age 18 between 2003 and 2017 and having received any biologics. We identified patients from our institutional registry.

Results: Eligible patients (n = 118) had their first VCE performed after a median of 0.1 years after diagnostic endoscopies at a median age of 12.2 years. The proximal SB disease group (Paris classification L4b inclusive) comprised 70 patients with extensive SB lesions in 81% and deep ulcers in 79%. Patients with Paris L1-3 disease with no findings in VCE or disease restricted to the terminal ileum comprised the control group. At first VCE, levels of albumin (34 vs. 37 g/L) and hemoglobin (117 vs. 127 g/L) were lower in SB patients (p < 0.02). After the first VCE, 68% were introduced to biologics, while 10% already received them. Follow-up VCE was performed after a median of 2.4 years (SB group n = 42; controls n = 21). Proximal SB findings had disappeared in 40% of SB patients, and extensive lesions and deep ulcers had decreased to 26% and 29%, respectively (p = 0.001). In the control group, one had progressed to proximal disease. During the clinical follow-up of a median of 4.7 years, one patient with SB underwent surgery for a jejunal stricture.

Conclusions: Proximal SB disease detected through capsule endoscopy abated in most patients with biological medication.

Keywords: TNF‐α blockers; albumin; fecal calprotectin; hemoglobin; pediatric.

MeSH terms

  • Adolescent
  • Capsule Endoscopy* / methods
  • Child
  • Child, Preschool
  • Crohn Disease* / complications
  • Crohn Disease* / diagnostic imaging
  • Crohn Disease* / pathology
  • Female
  • Follow-Up Studies
  • Humans
  • Intestinal Mucosa* / diagnostic imaging
  • Intestinal Mucosa* / pathology
  • Intestine, Small* / diagnostic imaging
  • Intestine, Small* / pathology
  • Male
  • Retrospective Studies

Supplementary concepts

  • Pediatric Crohn's disease