Pan-enteric Capsule Endoscopy to Characterize Crohn's Disease Phenotypes and Predict Clinical Outcomes in Children
Salvatore Oliva1, Silvio Veraldi1,2, Giusy Russo1
1Pediatric Gastroenterology and Liver Unit, Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, Rome, Italy.
Insights
Pan-enteric capsule endoscopy (PCE) helps characterize Crohn's disease (CD) phenotypes in children and adults. Disease extent and severity assessed by PCE predict clinical outcomes differently across age groups.
Area of Science:
- Gastroenterology
- Pediatric Gastroenterology
- Medical Imaging
Background:
- Pan-enteric capsule endoscopy (PCE) is valuable for managing pediatric Crohn's disease (CD).
- Limited data exists on PCE's ability to phenotype CD and predict outcomes in both pediatric and adult populations.
- This study addresses the gap in understanding PCE's role across different age groups in CD management.
Purpose of the Study:
- To evaluate the utility of PCE in characterizing Crohn's disease phenotypes.
- To compare disease characteristics and predict clinical outcomes in pediatric versus adult CD patients.
- To identify factors influencing treatment escalation and relapse based on PCE findings.
Main Methods:
- Prospective, multicenter observational study involving 194 CD patients (>6 years) across 4 Italian centers.
- Patients underwent clinical assessment, biomarker evaluation, and PCE with lesion grading (MCL, MSL, extent).
- Logistic regression analysis identified predictors of negative outcomes in children and adults.
Main Results:
- Children more frequently presented with extensive colonic disease compared to adults.
- Higher Most Common Lesion (MCL) scores correlated with treatment escalation (OR 4.09); >30% disease extent predicted relapse (OR 2.98).
- Disease extent predicted recurrence in children (OR 4.50), while severe lesions predicted escalation in adults (OR 4.31). PCE influenced therapy changes in 79% of procedures.
Conclusions:
- PCE effectively characterizes CD phenotypes by assessing disease severity and extent.
- The predictive importance of disease severity and extent for clinical outcomes varies between pediatric and adult CD patients.
- PCE findings guide therapeutic decisions and outcome prediction in diverse age groups with Crohn's disease.
Background:
Pan-enteric capsule endoscopy (PCE) provides useful information for the management of Crohn's disease (CD), especially in children. No study has evaluated the ability of PCE to characterize CD phenotypes and outcomes in children and adults.
Methods:
In a prospective multicenter observational study, we recruited patients with CD >6 years from 4 centers in Italy. Patients underwent clinical, biomarker assessment and PCE. Lesions were graded using the PCE system. For each segment, the most common lesion (MCL), the most severe lesion (MSL), and the extent of involvement were defined. Disease severity, extent, and clinical outcomes were compared between children and adults. A logistic regression analysis was used to identify predictive factors for negative outcomes in both age groups.
Results:
One hundred ninety-four consecutive patients (adults/children: 144/50) were evaluated for a total of 249 procedures. Children were more likely to have extensive disease, particularly in the colon. Higher MCL scores were independently associated with treatment escalation (odds ratio [OR], 4.09; 95% CI, 1.80-9.25; P = .001), while >30% disease extent was more indicative of clinical and endoscopic relapse (OR, 2.98; 1.26-7.08; P = .013). Disease extent was the only factor associated with endoscopic recurrence in children (OR, 4.50; 95% CI, 1.47-13.77; P = .008), while severe lesions in adults provided a better predictor of treatment escalation (OR, 4.31; 95% CI, 1.52-12.1; P = .006). Postexamination, PCE contributed to a change of therapy in 196/249 (79%) of the procedures.
Conclusions:
PCE allowed the characterization of CD phenotypes in children and adults by assessing disease severity and extent, which are of different importance in predicting clinical outcomes in these age groups.
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