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P168 Isolated terminal ileitis: when capsule endoscopy is key for Crohn’s disease diagnosis

M. FREITAS1,2,3, T. Cúrdia Gonçalves1,2,3, P. Boal Carvalho1,2,3, F. Dias de Castro1,2,3, B. Rosa1,2,3, M.J. Moreira1,2,3, J. Cotter1,2,3

1Hospital da Senhora da Oliveira, Gastroenterology Department, Guimarães, Portugal, 2PT Government Associate Laboratory, ICVS/3B’s, Braga/Guimarães, Portugal, 3University of Minho, Life and Health Sciences Research Institute ICVS- School of Medicine, Braga, Portugal

Background

Terminal ileitis (TI) is a common condition in clinical practice and may be associated with a wide variety of diseases, mostly Crohn’s disease (CD). Data regarding predictors of CD diagnosis in isolated TI are lacking, particularly concerning small bowel capsule endoscopy (SBCE) findings.

Methods

Aim:

To evaluate predictive factors for CD diagnosis in patients with isolated TI detected during ileocolonoscopy, submitted to SBCE.

Results

Retrospective study including consecutive patients undergoing SBCE after diagnosis of TI without colonic mucosal abnormalities on ileocolonoscopy between January 2016 and September 2019. Demographic, clinical, biochemical, endoscopic and imaging data were collected. The diagnosis of CD was based on clinical evaluation, endoscopic, histological, radiological, and/or biochemical investigations.

Conclusion

One hundred and two patients with isolated ileitis on ileocolonoscopy were included. After performing SBCE, 34.3% of the patients had a diagnosis of CD. All CD diagnosed patients had positive SBCE findings. Extraintestinal manifestations (p = 0.003), weight loss (p = 0.01), abnormal imaging (p = 0.04) and positive SBCE findings (p = 0.005) were independently associated with CD diagnosis. Regarding SBCE, presence of proximal small-bowel disease (p = 0.02), diffuse findings (p = 0.002) and presence of moderate to severe inflammatory activity (Lewis Score≥790) (p < 0.001) were independently associated with CD diagnosis.

SBCE is a valuable tool that should be systematically used in patients presenting with isolated TI, since it enabled CD diagnosis in approximately one-third of patients. A diagnosis of CD should be considered when a patient with TI shows extraintestinal manifestations, weight loss, abnormal imaging and positive SBCE findings, especially proximal involvement, diffuse findings and the presence of moderate to severe inflammatory activity.