Introduction

Small bowel capsule endoscopy (SBCE) is a recommended modality to investigate suspected small bowel Crohn’s disease (CD). The Interational Conference on Capsule Endoscopy (ICCE) set forward criteria to optimize patient selection and diagnostic yield. Capsule candidates should meet one criterion from group A (GI symptoms) along with 1 other criterion from group B/C/D (extraintestinal symptoms/ inflammatory markers /abnormal radiology).

Aims & Methods

The aim of this study is to evaluate the diagnostic performance when ICCE criteria are satisfied in those referred for SBCE with suspected CD. We performed a retrospective single-center study of patients referred for SBCE with suspected CD between March 2021 and March 2024. Demographics, clinical and capsule data were assessed from our hospital’s database and recorded. Patients with incomplete data were excluded. A positive SBCE was defined as a Lewis Score (LS) ≥135. Patients were grouped according to ICCE criteria: ICCE+ were those who satisfied ≥ 2 ICCE criteria and ICCE- were those who did not fulfil criteria. Where available, histopathological results, MDT outcomes and treatment decisions were analyzed to determine CD diagnosis.

Results

A total of 335 of 433 capsules for suspected Crohn’s disease were included (58.5% female, mean age 42 years). In all, 82 capsules (24.5%) had clinically significant enteritis (median LS= 266, range 135-6600). 119 patients (35.5%) satisfied ICCE criteria; ICCE A+B (n=3, 2%), ICCE A+C (n=82, 69%), ICCE A+D (n=19,16%), ICCE x3 (n=15, 13%). Of those, 48 patients (40%) had a positive capsule (average LS = 917.46). As expected ICCE + cases were statistically more likely to have significant enteritis compared with ICCE – cases; 48/119 (40%) versus 34/216 (16%) respectively, OR 3.49, p< 0.0001, 95%CI 2.0892 to 5.8508. Of note the diagnostic yield was similar for ICCE category B,C &D (p=0.6356). On follow up a histological diagnosis of CD was made in 25 (30%) cases and was similar in both the ICCE + and ICCE – groups, 17/ 48 versus 8/34 (p=0.09).

Conclusion

ICCE criteria in our cohort predicted significant enteritis and CD. Each of the secondary ICCE categories performed similarly. Of interest is the significant rate of enteritis in patients not meeting the criteria, with similar rates of confirmed CD to the ICCE + cohort, suggesting these patients still warrant investigation with capsule and that the clinical features and presentation of small bowel CD is varied.

References

Mergener K, Ponchon T, Gralnek I et.al. Literature review and recommendations for clinical application of small bowel capsule endoscopy, based on a panel discussion by international experts. Consensus statements for small bowel capsule endoscopy. 2006/2007, Endoscopy 2007; 39: 895-909.

Clinical Case Summary

We present a case of a 46-year-old female admitted to our clinic with a 6day history of nausea, vomiting around 10-15 times with blood clots, heartburn, regurgitation, retrosternal pain, loss of appetite, dizziness, generalized weakness, jaundiced skin and sclerae. The patient had previously been diagnosed with left-sided ulcerative colitis, currently in remission without medications. She mentioned alcohol abuse of around 300ml cognac per day for the past 2 years.
Physical examination t=36,6 ^oC, BP=70/40 mm Hg. Blood tests showed macrocytic anemia, thrombocytopenia, hypokalemia, elevated values of total bilirubin, especially direct, ALT, AST, GGT, and ALP, creatinine, urea, low albumin level and coagulopathy.
EGDS showed circumferential black discoloration of the esophagus, which bled on contact (Gurvits syndrome or black esophagus) and a coffee grounds resembling sediment in the stomach. PPI therapy was initiated.
An abdominal ultrasound found hepatomegaly, vena portae=11mm. A diagnosis of alcohol-related liver disease was made and corticosteroid therapy was initiated (32mg methylpredinosolone/day). Maddrey’s Discriminant Function was 41.9, and Lille score after 7 days of corticosteroid treatment was 0.021. Steroid therapy was continued, with an increase in serum creatinine levels. A diagnosis of AKI was made, and the patient was started on hemodialysis. Hallucinations started a few days after the initiation of hemodialysis. The differential diagnosis panel included hepatic, uremic, and Wernicke encephalopathies, which were deemed unlikely based on normal serum ammonia levels, unchanged status on hemodialysis, and absence of ataxia, nystagmus and confabulation, respectively. The patient was subsequently transferred to the intensive care unit, where the hallucinations were successfully treated with benzodiazepine therapy. Alcohol withdrawal syndrome was confirmed. A probable diagnosis of pre-renal injury was confirmed, although renal injury could not be ruled out.

Introduction

Functional dyspepsia (FD) is a common yet complex gastrointestinal disorder, characterised by postprandial fullness, early satiety, epigastric pain, and burning. With growing evidence linking diet to inflammation and symptoms, our objective was to review the evidence for the impact of dietary factors on FD symptomatology.

Aims & Methods

A systematic review was conducted to identify dietary components influencing FD symptoms in adults. Databases searched included MEDLINE, EMBASE, PsycINFO, Scopus, and Cochrane, covering January 2000 to December 2024. A total of 14 studies met eligibility criteria, with findings synthesised through narrative analysis.

Results

The search strategy yielded 18,424 articles, of which 14 met the inclusion criteria. Analysis identified seven key dietary components associated with FD: (1) a low FODMAP (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols) diet significantly improved symptoms (p = 0.04), while gluten intake was linked to early satiety (p = 0.03); (2) probiotics or prebiotics provided symptom relief (RR 1.15, p = 0.52), with probiotics alone showing a trend toward improved FD scores (RR 1.35, p = 0.061); (3) capsaicin significantly exacerbated symptoms (p < 0.001), and spicy foods were associated with increased gastric fullness (p = 0.001); (4) both peppermint-caraway oil (p < 0.00001) and cinnamon oil (p < 0.001) demonstrated significant symptom relief; (5) ginseng-based herbal porridge led to a higher rate of epigastric symptom remission by day 90 compared to placebo (45.71% vs. 20.69%, p = 0.036), while the STW 5-II formulation (a nine-herb extract) also yielded significant improvement (p = 0.008); (6) prokinetic agents reduced symptom severity (RR 0.81, p < 0.0001), while amitriptyline outperformed both placebo (40%) and escitalopram (38%), relieving symptoms in 53% of patients—particularly those with ulcer-like FD; and (7) ginger/artichoke capsules improved symptoms within 14 days (p = 0.017), while ginger/perilla tablets offered progressive relief over one to two weeks (p < 0.05 and p < 0.01, respectively). Study quality was assessed using ROBIS, RoB 2.0, and ROBINS-I tools. Of the included studies, three were rated as low risk of bias, eight as moderate, and three as serious. Despite adherence to a standardised PRISMA-based search strategy, variability in outcome reporting limited direct comparability across studies.

Table 1

Conclusion

This review highlights dietary interventions as a promising strategy for managing FD. Our findings show that specific dietary components can be implicated in inducing inflammation and symptoms in FD. Since the symptoms are related to inflammation, we propose using “inflammatory dyspepsia” to represent the true presentation of this form of dyspepsia. Large-scale randomised trials are needed to confirm findings and refine dietary guidelines.

Introduction

Fecal calprotectin (FC) is a key non-invasive biomarker used to monitor inflammatory bowel disease (IBD). Despite its clear clinical value, patient adherence to the test remains suboptimal, mainly due to reluctance related to stool collection. The objective of the ACCALMI study was to compare the acceptability of a new stool collection device, similar to the one used for fecal immunochemical tests (FIT), with a standard stool container, and to evaluate its impact on patient compliance.

Aims & Methods

In this prospective, single-center study, 156 patients with an established diagnosis of IBD and who had been prescribed an FC test as part of their routine care, were randomly assigned to either the standard container group or the alternative device group (Procise Stool Collection Device™), which includes a collection tube with a thin spiral-shaped probe facilitating stool collection. Acceptability was assessed using a 4-category ordinal scale (from "poor" to "very good") and a visual analog scale (VAS, from 0 to 10). Analyses were conducted in both per-protocol and intention-to-treat (ITT) populations, with missing data handled using the maximum bias method. Factors associated with improved FC acceptability, and compliance with FC testing, were analyzed.

Results

The alternative collection device significantly improved acceptability as measured by the ordinal scale (odds ratio [OR] 2.69; p < 0.001). In the alternative group, acceptability ratings were significantly higher with only 1.4% versus 7.0% rating it as ‘poor’, 12.5% versus 46.6% as ‘average’, 66.7% versus 40.8% as ‘good’, and 19.4% versus 5.6% as ‘very good’. Measured using the VAS, the average acceptability was 7.9/10 in the group using the alternative device compared to 6.1/10 in the standard group, with a significant difference of 30.4% (95% CI [19.7 - 44.7%], p < 0.001), although it did not reach the threshold of 30% that was set a priori. The ITT analysis led to the same conclusions. Among the patients who had already undergone FC testing and were randomized to the "alternative device" group, 55% indicated a preference for the alternative device, compared to 7.2% for the conventional device, while 37.7% found them similar. Embarrassment and discomfort associated with the standard container were alleviated by the alternative device. A long home-to-hospital distance (> 50 km) and the use of the alternative device were the only factors associated with better acceptability in the multivariate analysis. Compliance was similar between both groups and remarkably high (92%).

Conclusion

The ACCALMI study demonstrated that the alternative stool collection device, similar to the one used in FIT for colorectal cancer screening, is more accepted by IBD patients than the standard container, thus improving the acceptability of FC testing. These findings support the integration of patient-centered innovations in diagnostic and follow-up testing to improve the monitoring of IBD.

Disclosure

Acknowledgments: Collaboration with Biosynex®.