University Hospitals Case Medical Center, Case Western Reserve University Cleveland, OH, United States
Roma Patel, MD, Sonali Khurana, MD, Jacob Sadik, MD, Abbas Mandviwala, MD, Gerard Isenberg, MD University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, OH
Introduction: The clinical utility of SBCE has been investigated at length regarding its ability to effectively identify and monitor small bowel inflammation for symptomatic IBD patients. However there has been little to no description in the literature of change in treatment and management of patients with Crohn’s disease with regards to negative capsule endoscopies. The aim of this study is to determine how a negative SBCE is being used to change management in symptomatic Crohn’s disease (CD), which has not previously been reported.
Methods: A retrospective cohort chart review was performed on all SBCEs at a single tertiary care center from 2001-2020 in patients 17 years of age or older. Negative SBCE in symptomatic CD patients were identified and defined by absence of active inflammation in the small bowel. Patients were included if they had symptoms characteristic of active CD within 3 months prior to SBCE and follow-up within 12 months of SBCE with documentation of changes in management based on SBCE. Changes in management were defined as escalation (ES), de-escalation (DES), or no change in therapy.
Results: Of the 1506 SBCEs, 216 were performed in symptomatic CD patients. From the 89 negative capsules, 45 met inclusion criteria. Fifteen capsules resulted in DES (33%). Of the capsules resulting in DES with addition of alternative therapies, providers favored anti-diarrheal therapy (33%), antibiotics (20%), tricyclic antidepressants (20%), antispasmodics (26%), antiemetics (6.7%), selective serotonin reuptake inhibitors (6.7%), mixed opioid analgesics 4 (6.7%), barbiturates (6.7%) and psychiatry referral (6.7%). In the DES cohort, 26% of SBCEs resulted in immunotherapy discontinuation or dose reduction.
Discussion: A notable subgroup of symptomatic CD patients with negative SBCE experienced de-escalation in therapy, which would result in significant safety benefits and cost savings for CD management.
Figure: Figure 1: Outline of therapies used for both escalation and de-escalation of Crohn's Disease. Figure 2: Study outline.
Roma Patel indicated no relevant financial relationships.
Sonali Khurana indicated no relevant financial relationships.
Jacob Sadik indicated no relevant financial relationships.
Abbas Mandviwala indicated no relevant financial relationships.
Gerard Isenberg indicated no relevant financial relationships.
Roma Patel, MD, Sonali Khurana, MD, Jacob Sadik, MD, Abbas Mandviwala, MD, Gerard Isenberg, MD. P1465 - Management Changes in Symptomatic Crohn’s Disease Patients Based on Negative Small Bowel Capsule Endoscopy: A Tertiary Care Center Retrospective Study, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.