Capsule endoscopy finds undiagnosed Crohn's disease

Oct 16 2007

A small capsule that takes "snapshots" of the small intestine as it moves through the digestive tract helped doctors spot cases of Crohn's disease that had gone undiagnosed for up to 15 years, according to researchers at Wake Forest University Baptist Medical Center.

Reporting this week at the American College of Gastroenterology's meeting in Philadelphia, the researchers said that of 198 video capsule endoscopies that were performed to evaluate unexplained gastrointestinal bleeding, physicians found six cases of Crohn's disease that hadn't been diagnosed previously, despite the patients having colonoscopies and a variety of other imaging tests.

The study is the first to evaluate the prevalence of the Crohn's disease (about 3 percent) among patients having capsule endoscopy to evaluate unexplained bleeding.

“With capsule endoscopy, we were able to diagnose cases that previously were difficult or impossible to diagnose,” said Richard Bloomfeld, M.D., gastroenterologist and senior researcher. “Some of the patients had been having transfusions for years because of anemia from unexplained bleeding.”

The research was presented by Sakeitha Crowder, M.D., a resident in internal medicine.

Capsule endoscopy has become a standard tool to evaluate unexplained bleeding in the stomach and intestines. Patients swallow a small capsule containing a video camera that takes two images per second over eight hours.

“It allows us to see 20 feet of small intestine between the stomach and large intestine – areas that we cannot reach with other tests,” said Bloomfeld. “It's easy, painless and requires no sedation.”

Crohn's disease is a disorder that causes inflammation of the digestive tract. It is generally easy to diagnose with a colonoscopy or through symptoms that include abdominal pain and diarrhea. In some cases, however, the disease affects part of the intestine that cannot be reached with colonoscopy.

The mean age of study patients who were diagnosed with Crohn's disease was 35 years. All were being evaluated for iron deficiency anemia requiring blood transfusions. Only two patients had abdominal pain and diarrhea – the typical symptoms of Crohn's disease. The length of time that patients had anemia until they were successfully diagnosed ranged from 11 months to 15 years. After correct diagnosis, the patients were successfully treated with medications and none required surgery.

“This study suggests the importance of using capsule endoscopy to fully evaluate people with unexplained gastrointestinal bleeding,” said Bloomfeld.

Wake Forest University Baptist Medical Center is an academic health system comprised of North Carolina Baptist Hospital and Wake Forest University Health Sciences, which operates the university's School of Medicine. The system comprises 1,154 acute care, psychiatric, rehabilitation and long-term care beds and is consistently ranked as one of “America's Best Hospitals” by U.S. News & World Report.