When Crohn's Disease is in Remission, More Patients Complete Capsule Endoscopy Study But Less Lesions are Identified

BACKGROUND AND AIMS: Wireless capsule endoscopy (WCE) is used in Crohn's disease (CD) to define disease extent. We aimed to define WCE detection rate of small bowel ulcerative lesions and completion rate in CD patients. PATIENTS AND METHODS: A total of 102 consecutive CD patients, who successfully passed patency capsule, were matched to 102 controls. WCE was performed in both patients (in acute phase and CD clinical remission) and controls. RESULTS: Eighty-six (84%) controls versus 62 (61%) patients in the acute phase (P = 0.003) and 96 (94%) in remission (P = 0.02) completed WCE study. Gastric passing time was 48 ± 66 min in controls, 66 ± 82 min in CD acute phase (P = 0.03) and 30 ± 21 min in remission (P = 0.07). Small bowel passing time was 276 ± 78 min in controls, 299 ± 78 min in the acute phase of CD (P = 0.04) and 248 ± 89 min in remission (P = 0.01). Mean capsule endoscopy Crohn's disease activity index (CECDAI) score was 14 ± 6 in acute small bowel CD, 12 ± 7 in acute small-large bowel CD (P = 0.08) and 2 ± 2 in both CD types while in remission (P = 1.00). Small bowel ulcerative lesions in the acute phase were more frequently in distal small bowel. Aphthous ulcers were frequent a month after entering clinical remission and tend to disappear gradually later on. No ulcerative lesions were present in deep remission. Patency capsule is rather safe to exclude small bowel obstruction. CONCLUSIONS: (1) A high percentage of patients with active CD do not complete small bowel study with WCE. (2) Small bowel ulcerative lesions in clinical remission were less severe, although at least 6 months are needed in order for them to disappear.