Einleitung: In der Literatur finden sich nur wenige prospektive Daten zum klinischen Wert der Power-Dopplersonographie bei Morbus Crohn. Der Goldstandard zur Bewertung der Aktivität ist die Ileokoloskopie.

Hintergrund: Die Datenlage zur Wertigkeit der Kapselendoskopie zur Verlaufsbeurteilung mucosaler Läsionen des Dünndarms bei M. Crohn ist spärlich. Ziel unserer Studie war die Beurteilung der Läsionen im Verlauf unter Standarttherapie bei Morbus Crohn (MC).

Background: Wireless capsule endoscopy (WCE) offers endoscopic access to the small bowel and may therefore change diagnostic and therapeutic strategies in small bowel diseases.Aim: The aim of this prospective study was to validate the gain in information and therapeutic impact of WCE in patients with Crohn's disease.Methods: Fifty six consecutive patients with Crohn's disease underwent computed tomography (CT) enteroclysis, and if stenoses <10 mm were excluded, WCE was carried out.Results: In 15 patients (27%), WCE could not be performed due to strictures detected by CT enteroclysis. From the other 41 patients, jejunal or ileal lesions were found in 25 patients by WCE compared with 12 by CT enteroclysis ( p = 0.004). This gain in information was mainly due to detection of small mucosal lesions such as villous denudation, aphthoid ulcerations, or erosions. Both methods were not significantly different in the detection of lesions in the terminal/neoterminal ileum ( WCE 24 patients, CT enteroclysis 20 patients). Therapy was changed due to WCE findings in 10 patients. Consecutively, all of them improved clinically.Conclusions: Capsule endoscopy improves the diagnosis of small bowel Crohn's disease. This may have significant therapeutic impact.

Laryngopharyngeale Reflux (LPR) gilt als Ursache für supraösophageale Symptome (SÖS) bei der gastroösophagealen Refluxkrankheit (GERD). Seine Bedeutung und exakte Diagnose sind umstritten. Ziel unserer Studie war die Validierung der Zweikanal-pH-Metrie als ein Werkzeug zur Diagnose des LPR. Methode: 58 konsekutive Patienten (41,9% männlich, 54[22–79] Jahre) wurden prospektiv evaluiert. Davon wurden 34 aufgrund von gastroösophagealen Refluxbeschwerden (GERD-Gruppe) und 24 weitere zur Diagnostik unklarer laryngealer Symptome mit V.a. GERD untersucht (HNO-Gruppe). Das Screening beinhaltete Ösophagusmanometrie, Zweikanal–24h-pH-Metrie, GERD-Health Related Quality of Life (HRQL)-Fragebogen, einen standardisierten Refluxfragebogen mit Erfassung von SÖS (Husten, Heiserkeit, Asthma) und eine Laryngoskopie. Letztere wurde von einem erfahrenen Phoniater durchgeführt, der gegenüber den weiteren Untersuchungsergebnissen verblindet war. Die Laryngoskopie ergab die Erfassung des Reflux Finding Score (RFS)¹. Ein RFS≥7 wurde als pathologisch gewertet. 16 Patienten mit einem RFS <7 dienten als Kontrollgruppe (CONT). Ergebnisse: Patienten der HNO-Gruppe hatten im Vergleich zu Kontrollen und GERD-Patienten einen signifikant höheren RFS (10,7±3,7 vs. 4,4±3,5 bei GERD p<0,001 vs. 4,2±1,7 bei CONT, p<0,001) und im Vergleich zu GERD-Patienten einen niedrigeren GERD-HRQL (9,3±11,6 vs. 22,1±16,2 p=0,014; CONT: 14,9±11,6; p=0,2) und eine geringere distale Säureexposition (%pH<4: 6,1±4,7 vs. 12,0±8,8, p=0,004 CONT: 9,5±10,4; p=0,72). Alle Patientengruppen unterschieden sich nicht bezüglich der proximalen Säureexposition (1,4±1,6% für HNO vs. 2,0±2,3% für GERD vs. 1,5±1,9% für CONT, p>0,05). Außerdem unterschieden sich Patienten mit SÖS (n=44) bezüglich des proximalen Refluxes nicht von Patienten ohne SÖS (n=11; 1,4±0,9 für Pt. mit SÖS vs. 2,0±2,4 für Pt. ohne SÖS, p=0,939). Es bestand keine signifikante Korrelation zwischen proximaler Refluxzeit, RFS, SÖS oder dem Druck im unteren ösophagealen Sphinkter (Spearman Rho-Test). Schlussfolgerung: Unsere Daten stützen weder die Hypothese, dass laryngophahryngealer Reflux Ursache für laryngeale Symtome ist noch dass der RFS refluxassoziierte Veränderungen misst. Die Zweikanal-pH-Metrie bringt für klinische Fragestellungen keinen Nutzen.

BACKGROUND AND STUDY AIMSAt many centers wireless capsule endoscopy (WCE) without prior radiographic examination to rule out relevant strictures is considered to be contraindicated in suspected obstructive small-bowel disease. However, the accuracy of radiography in this situation has often been questioned. The purpose of this prospective study was to investigate the feasibility and safety of the recently developed patency capsule, and its predictive value regarding the clinical relevance of radiographic small-bowel strictures.PATIENTS AND METHODS22 patients with suspected obstructive small-bowel disease and/or radiological evidence of small-bowel strictures underwent a patency capsule examination. Intact passage, patient experience of pain, and capsule disintegration were correlated with radiographic findings, clinical variables, and outcome.RESULTS13 patients passed an intact capsule without complaints, despite radiographically observed small-bowel stenosis; the subsequent video capsule examination was uneventful in all. In nine patients either intact passage was painful or the capsule disintegrated; in one of these, impaction of an intact capsule led to an ileus and emergency surgery. The type of capsule passage did not correlate with radiographic presence of a stricture, underlying diagnosis, or previous surgery. There was a statistically significant correlation between outcome (surgery performed or recommended) and occurrence of painful capsule passage and disintegration ( P < or = 0.05).CONCLUSIONSPainless egestion of an intact patency capsule indicates safety of WCE. Patients without obstructive symptoms require neither small-bowel radiography nor a patency capsule study prior to WCE. Disintegration of the patency capsule or painful passage seems to be associated with a clinically relevant small-bowel stricture and with a high probability of surgery.

Background and Aims: CARD15 mutations are found in up to 40% of Crohn's disease (CD) patients. Numerous genotype phenotype studies reported an association of these mutations to terminal ileal disease location. However, no informations are available on the impact of CARD15 mutations on mucosal changes within the small intestine estimated by wireless capsule enteroscopy. We therefore hypothesized that CD patients with mutated CARD15 display a different type and pattern of small-bowel lesions compared to patients without mutated CARD15. Methods: We included 27 CD patients (11 male, 16 female, 34.8[16-63]years) in this study. Analysis of small-bowel lesions was performed by wireless capsule enteroscopy after exclusion of significant stenosis (>1 cm in diameter) by CT enteroclysis. Lesions were assessed by a standardized evaluation form, and Crohn specific lesions were assesed for duodenum, jejunum, proximal and terminal ileum, respectively. Genotyping was performed for the three common CARD15 mutations (Arg702Trp, Gly908Arg, 3020insC). Investigators of wireless capsule enteroscopy were blinded to results from genotyping for CARD15 mutations. Results: In total, 12/27 (44%) patients of Crohn's disease patients carried at least one mutant allele within CARD15. In patients positive for CARD15 mutations, analysis by wireless capsule enteroscopy revealed involvment of the duodenum, jejunum, proximal and terminal ileum in 17%, 67%, 58%, and 42%, respectively, whereas patients negative for CARD15 mutations had lesions in 20%, 33%, 33%, and 47%, respectively. There was no statistically significant difference with respect to the extent to the diasease. Moreover, analysis of Crohn-specific lesions such as aphthae, ulcers, cobbelstone pattern, erythema, and stenosis, showed no significant difference in neither location of the small bowel. Conclusions: Wireless capsule examination does not support the hypothesis that CD patients with CARD15 mutations have a different pattern of activity within the small bowel.

Background: Wireless capsule endoscopy (WCE) offers endoscopic access to the small bowel and may therefore change diagnostic and therapeutic strategies in small bowel diseases. Aim of this prospective study was to validate the gain in information and therapeutic impact of WCE in patients with Crohn's disease. Methods: Forty eight consecutive patients with Crohn's disease (n=45) or suspicion of Crohn's disease (n=3) underwent CT enteroclysis, esophagogastroduodenoscopy, ileocolonoscopy, and if stenosis < 10 mm were excluded WCE. Results: In 15 patients (31.3 %) WCE could not be performed due to strictures detected by CT enteroclysis. WCE was superior to CT enteroclysis with respect to the diagnosis of inflammatory activity in the jejunum and in the proximal ileum in the 33 patients in whom all examinations were performed (61% vs. 12% of patients, p=0.0002, 42% vs 24%, p=0.016, respectively), as well as in an intention to “treat” analysis in all 48 patients (48% vs 13% of patients, p=0.0004; 50% vs % 29%, p = 0.0346, respectively). This gain in information was mainly due to the detection of small mucosal lesions (villous denudation, aphthoid ulcerations or erosions) in the jejunum (53% vs 6%, p = 0.0002), and proximal ileum (47% vs 21%, p = 0.027). The therapeutic impact of WCE was 24% overall; 17% in patients with established, 100% in patients with suspected Crohn's disease. The change in treatment led to clinical improvement in all patients. Conclusions: Capsule endoscopy improves diagnosis and staging of patients with Crohn's disease. Furthermore, it has significant therapeutic impact in patients with suspicion of Crohn's disease

BACKGROUND AND STUDY AIMS:It is still difficult to visualize changes in the small intestine. Wireless capsule enteroscopy is a new method that promises to provide new insights into the small intestine. In a prospective study, the diagnostic yield of wireless enteroscopy was therefore compared with computed tomography (CT) enteroclysis.PATIENTS AND METHODS:Twenty-two patients with suspected small-bowel pathology underwent CT enteroclysis and wireless capsule enteroscopy examinations, conducted by two independent blinded investigators. The results of the two investigations (diagnoses and the number, extent, and location of lesions detected) were compared by a third investigator.RESULTS:The patients included in the study had obscure gastrointestinal bleeding (n = 8), Crohn's disease (n = 8), unexplained diarrhea (n = 5), or suspected carcinoid tumor (n = 1). Pathological lesions were detected using capsule enteroscopy in 13 patients (59 %) and using CT enteroclysis in eight (36 %; P = 0.12). In seven patients (one case each of colonic Crohn's disease, diverticulitis, Meckel's diverticulum, carcinoid tumor, mesothelioma, colonic polyps, and irritable bowel syndrome), no pathological changes were found in the small intestine using either method. The diagnosis was established by wireless capsule enteroscopy in four patients with obscure bleeding, whereas CT enteroclysis was positive in only one patient ( P = 0.1). Crohn's disease was found in two patients with unexplained diarrhea. Small-bowel lesions were identified in six patients with known Crohn's disease using capsule enteroscopy or CT enteroclysis. The only side effect of wireless capsule enteroscopy observed was abdominal pain in one patient with Crohn's disease. There were no serious side effects with CT enteroclysis.CONCLUSIONS:Wireless capsule enteroscopy detects more small-bowel lesions than CT enteroclysis in patients with obscure gastrointestinal bleeding and Crohn's disease.