Capsule endoscopy and Crohn's disease.

摘要

The diagnosis of Crohn's disease (CD) remains a challenge. Over the years, we have progressed from single contrast barium studies to enteroclysis to computer-assisted tomography (CT) and magnetic resonance imaging (MRI). Fiber-optic endoscopy has been replaced by video-endoscopy. Capsule endoscopy (CE) has now been added to the list. This noninvasive technology has been shown in several studies to have a diagnostic role, but there are possible additional roles for CE to play in relation to the diagnosis and the management of CD. Firstly, it already has been conceded that CE has a role in the diagnosis of suspected CD. Some insurers will pay for this indication, and there is some data to support this usage. Second, CE may have a role in assessing the extent of disease. There is no prospective data on this indication, but we may unearth additional phenotypes or be able to define those who are more likely to have more aggressive disease when this issue is examined. Third, it may have a role in determiningdisease activity and, hence, may justify a change of management. This concept has already led to the development of a new disease activity index. Last, because there has been a change in the treatment paradigm for CD from symptomatic control to the induction of tissue healing, the use of CE may be appropriate in any pharmaceutical trial before and after the application of new or older therapy to look for tissue healing.