Clin Endosc.  2018 Nov;51(6):570-575. 10.5946/ce.2018.055.

Capsule Endoscopy in Refractory Diarrhea-Predominant Irritable Bowel Syndrome and Functional Abdominal Pain

• Valero M
• Bravo-Velez G
• Oleas R
• Puga-Tejada M
• Soria-Alcívar M
• Escobar HA
• Baquerizo-Burgos J
• Pitanga-Lukashok H
• Robles-Medranda C

• KMID: 2430400
• DOI: http://doi.org/10.5946/ce.2018.055

Abstract

BACKGROUND/AIMS
Capsule endoscopy is a diagnostic method for evaluating the small bowel lumen and can detect undiagnosed lesions. The aim of this study was to evaluate the diagnostic yield and clinical impact of capsule endoscopy in patients with refractory diarrhea-predominant irritable bowel syndrome and functional abdominal pain.
METHODS
This study involved a retrospective analysis of prospectively collected data, maintained in a database. Patients with refractory diarrhea-predominant irritable bowel syndrome and functional abdominal pain within the period of March 2012 to March 2014 were included. Capsule endoscopy was used to detect small bowel pathologies in both groups.
RESULTS
Sixty-five patients (53.8% female) fulfilled the inclusion criteria and had a mean (±standard deviation) age of 50.9±15.9 years. Clinically significant lesions were detected via capsule endoscopy in 32.5% of the patients in the abdominal pain group and 54.5% of the patients in the diarrhea group. Overall, 48% of patients had small bowel pathologies detected during the capsule endoscopy study. Inflammatory lesions and villous atrophy were the most frequent lesions identified in 16.9% and 15.3% of patients in the abdominal pain and the diarrhea groups, respectively.
CONCLUSIONS
Routine use of capsule endoscopy in patients with irritable bowel syndrome should not be recommended. However, in patients with refractory conditions, capsule endoscopy may identify abnormalities.

Keyword

Capsule endoscopy; Irritable bowel syndrome; Refractory

MeSH Terms

Abdominal Pain*
Atrophy
Capsule Endoscopy*
Diarrhea
Humans
Irritable Bowel Syndrome*
Methods
Pathology
Prospective Studies
Retrospective Studies

Figure

• 

  Fig. 1. Flowchart describing the process of population selection. NSAID, nonsteroidal anti-inflammatory agent; D-IBS, diarrhea-predominant irritable bowel syndrome.

• 

  Fig. 2. Capsule endoscopy (CE) findings. (A) Ascariasis found in the small intestine in a patient with persistent abdominal pain, (B) ulcer identified by CE in the terminal ileum. Crohn’s disease was confirmed by histopathology of an enteroscopic sample, (C) sub-mucosal tumor in the upper jejunum, (D) villous atrophy detected by CE in jejunum.

Reference

1. Longstreth GF, Thompson WG, Chey WD, Houghton LA, Mearin F, Spiller RC. Functional bowel disorders. Gastroenterology. 2006; 130:1480–1491.

2. Mearin F, Lacy BE, Chang L, et al. Bowel disorders. Gastroenterology. 2016; Feb. 18. [Epub]. https://doi.org/10.1053/j.gastro.2016.02.031.

3. Palsson OS, Whitehead WE, van Tilburg MAL, et al. Development and validation of the Rome IV diagnostic questionnaire for adults. Gastroenterology. 2016; 150:1481–1491.

4. Yang L, Chen Y, Zhang B, et al. Increased diagnostic yield of capsule endoscopy in patients with chronic abdominal pain. PLoS One. 2014; 9:e87396.

5. Appleyard M, Fireman Z, Glukhovsky A, et al. A randomized trial comparing wireless capsule endoscopy with push enteroscopy for the detection of small-bowel lesions. Gastroenterology. 2000; 119:1431–1438.

6. Costamagna G, Shah SK, Riccioni ME, et al. A prospective trial comparing small bowel radiographs and video capsule endoscopy for suspected small bowel disease. Gastroenterology. 2002; 123:999–1005.

7. Hara AK, Leighton JA, Sharma VK, Fleischer DE. Small bowel: preliminary comparison of capsule endoscopy with barium study and CT. Radiology. 2004; 230:260–265.

8. Goldstein JL, Eisen GM, Lewis B, Gralnek IM, Zlotnick S, Fort JG. Video capsule endoscopy to prospectively assess small bowel injury with celecoxib, naproxen plus omeprazole, and placebo. Clin Gastroenterol Hepatol. 2005; 3:133–141.

9. Graham DY, Opekun AR, Willingham FF, Qureshi WA. Visible small-intestinal mucosal injury in chronic NSAID users. Clin Gastroenterol Hepatol. 2005; 3:55–59.

10. Maiden L, Thjodleifsson B, Theodors A, Gonzalez J, Bjarnason I. A quantitative analysis of NSAID-induced small bowel pathology by capsule enteroscopy. Gastroenterology. 2005; 128:1172–1178.

11. Adler SN, Jacob H. Occult inflammatory small-bowel disease: not so occult anymore. Scand J Gastroenterol. 2005; 40:360–364.

12. Ohlsson B, Bengtsson M, Nielsen J, Toth E. A prospective evaluation of the diagnostic value of video capsule endoscopy in patients initially classified as irritable bowel syndrome. Eur J Intern Med. 2009; 20:48–52.

13. Pennazio M, Spada C, Eliakim R, et al. Small-bowel capsule endoscopy and device-assisted enteroscopy for diagnosis and treatment of small-bowel disorders: European Society of Gastrointestinal Endoscopy (ESGE) clinical guideline. Endoscopy. 2015; 47:352–376.

14. Cobrin GM, Pittman RH, Lewis BS. Increased diagnostic yield of small bowel tumors with capsule endoscopy. Cancer. 2006; 107:22–27.

15. Mata A, Llach J, Castells A, et al. A prospective trial comparing wireless capsule endoscopy and barium contrast series for small-bowel surveillance in hereditary GI polyposis syndromes. Gastrointest Endosc. 2005; 61:721–725.

16. Culliford A, Daly J, Diamond B, Rubin M, Green PH. The value of wireless capsule endoscopy in patients with complicated celiac disease. Gastrointest Endosc. 2005; 62:55–61.

17. Fireman Z, Mahajna E, Broide E, et al. Diagnosing small bowel Crohn’s disease with wireless capsule endoscopy. Gut. 2003; 52:390–392.

18. Nakamura M, Niwa Y, Ohmiya N, et al. Preliminary comparison of capsule endoscopy and double-balloon enteroscopy in patients with suspected small-bowel bleeding. Endoscopy. 2006; 38:59–66.

19. Spada C, Pirozzi GA, Riccioni ME, Iacopini F, Marchese M, Costamagna G. Capsule endoscopy in patients with chronic abdominal pain. Dig Liver Dis. 2006; 38:696–698.

20. Fry LC, Carey EJ, Shiff AD, et al. The yield of capsule endoscopy in patients with abdominal pain or diarrhea. Endoscopy. 2006; 38:498–502.

21. Song HJ, Moon JS, Jeon SR, et al. Diagnostic yield and clinical impact of video capsule endoscopy in patients with chronic diarrhea: a Korean multicenter CAPENTRY study. Gut Liver. 2017; 11:253–260.

22. Xue M, Chen X, Shi L, Si J, Wang L, Chen S. Small-bowel capsule endoscopy in patients with unexplained chronic abdominal pain: a systematic review. Gastrointest Endosc. 2015; 81:186–193.

23. May A, Manner H, Schneider M, Ipsen A, Ell C. Prospective multicenter trial of capsule endoscopy in patients with chronic abdominal pain, diarrhea and other signs and symptoms (CEDAP-Plus Study). Endoscopy. 2007; 39:606–612.

24. Kalla R, McAlindon ME, Sanders DS, Sidhu R. Subtle mucosal changes at capsule endoscopy in diarrhoea predominant irritable bowel syndrome. Med Hypotheses. 2012; 79:423.