Background: Small bowel capsule endoscopy is the most sensitive technique for the detection of lesions in the small intestine. The aims of the study were to assess the prevalence and clinical significance of jejunal lesions detected by small bowel capsule endoscopy in patients with an established Crohn’s disease.
Results: One hundred and eight patients, including 32 patients with ileal disease, 25 patients with colonic disease, and 51 patients with ileocolonic disease, underwent small bowel capsule endoscopy, and findings were analyzed retrospectively. Jejunal lesions were detected in 56% of these patients, of whom 18 (17%) had lesions only in the jejunum. Jejunal lesions were less frequently detected (12% versus 38%, P = 0.001) when location of the disease was limited to the colon at ileocolonoscopy. Conversely, when Crohn’s disease affected the ileum, jejunal lesions were more frequently detected (40% versus 17%, P = 0.007). During a median follow-up time of 24.0 months (interquartile, 8.0–46.2), 50 clinical relapses occurred. The presence of jejunal lesions was the only independent factor associated with an increased risk of relapse (P = 0.02). In nonsmokers and in patients treated by immunosuppressors, the presence of jejunal lesions tended to increase the risk of relapse (P = 0.06 and 0.05, respectively).
Conclusions: Jejunal lesions are detected in more than half of the patients with Crohn’s disease. The prevalence of jejunal lesions is higher when the terminal ileum is involved and associated with an increased risk of further clinical relapse. It may be regarded as a factor of severity.
Article first published online 2 April 2013
*Institut des Maladies de l’Appareil Digestif (IMAD), CHU Nantes, Hôtel Dieu, Nantes, France;
†Université de Nantes, Nantes, France; and
‡INSERM, CIC-04, Nantes, France.
Reprints: Arnaud Bourreille, MD, PhD, Institut des Maladies de l’Appareil Digestif, CHU Nantes, Hôtel Dieu, 1, Place Alexis Ricordeau, 44093 Nantes Cedex, France (e-mail: firstname.lastname@example.org).
The authors did not receive grant support for this work.
A. Bourreille reports receiving consulting or grant support from Given Imaging. S. Sacher-Huvelin and J.-P. Galmiche report receiving consulting fees from Given Imaging.
M. Flamant and C. Trang contributed equally to this work.
Received September 14, 2012
Accepted September 20, 2012