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Crohn Disease: HELP
Articles by Bruno Rosa
Based on 14 articles published since 2008
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Between 2008 and 2019, Bruno Rosa wrote the following 14 articles about Crohn Disease.
 
+ Citations + Abstracts
1 Guideline Small-bowel capsule endoscopy and device-assisted enteroscopy for diagnosis and treatment of small-bowel disorders: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. 2015

Pennazio, Marco / Spada, Cristiano / Eliakim, Rami / Keuchel, Martin / May, Andrea / Mulder, Chris J / Rondonotti, Emanuele / Adler, Samuel N / Albert, Joerg / Baltes, Peter / Barbaro, Federico / Cellier, Christophe / Charton, Jean Pierre / Delvaux, Michel / Despott, Edward J / Domagk, Dirk / Klein, Amir / McAlindon, Mark / Rosa, Bruno / Rowse, Georgina / Sanders, David S / Saurin, Jean Christophe / Sidhu, Reena / Dumonceau, Jean-Marc / Hassan, Cesare / Gralnek, Ian M. ·Division of Gastroenterology, San Giovanni Battista University Teaching Hospital, Turin, Italy. · Digestive Endoscopy Unit, Catholic University, Rome, Italy. · Department of Gastroenterology, Chaim Sheba Medical Center, Sackler School of Medicine, Tel-Aviv University Tel-Hashomer, Israel. · Klinik für Innere Medizin, Bethesda Krankenhaus Bergedorf, Hamburg, Germany. · Department of Medicine II, Sana Klinikum, Offenbach, Germany. · Department of Gastroenterology and Hepatology, VU University Medical Centre, Amsterdam, The Netherlands. · Gastroenterology Unit, Ospedale Valduce, Como, Italy. · Division of Gastroenterology, Shaare Zedek Medical Center, Jerusalem, Israel. · Department of Medicine I, Johann Wolfgang Goethe University Frankfurt, Frankfurt, Germany. · Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, Service d'Hépato-gastro-entérologie, Paris, France. · Medizinische Klinik, Evangelisches Krankenhaus, Düsseldorf, Germany. · Department of Hepato-Gastroenterology, Nouvel Hôpital Civil, University Hospital of Strasbourg, Strasbourg, France. · Royal Free Unit for Endoscopy and Centre for Gastroenterology, The Royal Free Hospital and University College London, London, UK. · Department of Medicine B, University of Münster, Münster, Germany. · Institute of Gastroenterology and Liver Diseases, Ha'emek Medical Center Afula, Israel, Rappaport Faculty of Medicine, Technion-Israel Institute of Technology Haifa, Israel. · Department of Gastroenterology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK. · Gastroenterology Department, Centro Hospitalar do Alto Ave, Guimarães, Portugal. · Clinical Psychology Unit, Department of Psychology, University of Sheffield. · Centre Hospitalier Lyon Sud, Pierre Bénite, Lyon, France. · Gedyt Endoscopy Center, Buenos Aires, Argentina. ·Endoscopy · Pubmed #25826168.

ABSTRACT: This Guideline is an official statement of the European Society of Gastrointestinal Endoscopy (ESGE). The Guideline was also reviewed and endorsed by the British Society of Gastroenterology (BSG). It addresses the roles of small-bowel capsule endoscopy and device-assisted enteroscopy for diagnosis and treatment of small-bowel disorders. Main recommendations 1 ESGE recommends small-bowel video capsule endoscopy as the first-line investigation in patients with obscure gastrointestinal bleeding (strong recommendation, moderate quality evidence). 2 In patients with overt obscure gastrointestinal bleeding, ESGE recommends performing small-bowel capsule endoscopy as soon as possible after the bleeding episode, optimally within 14 days, in order to maximize the diagnostic yield (strong recommendation, moderate quality evidence). 3 ESGE does not recommend the routine performance of second-look endoscopy prior to small-bowel capsule endoscopy; however whether to perform second-look endoscopy before capsule endoscopy in patients with obscure gastrointestinal bleeding or iron-deficiency anaemia should be decided on a case-by-case basis (strong recommendation, low quality evidence). 4 In patients with positive findings at small-bowel capsule endoscopy, ESGE recommends device-assisted enteroscopy to confirm and possibly treat lesions identified by capsule endoscopy (strong recommendation, high quality evidence). 5 ESGE recommends ileocolonoscopy as the first endoscopic examination for investigating patients with suspected Crohn's disease (strong recommendation, high quality evidence). In patients with suspected Crohn's disease and negative ileocolonoscopy findings, ESGE recommends small-bowel capsule endoscopy as the initial diagnostic modality for investigating the small bowel, in the absence of obstructive symptoms or known stenosis (strong recommendation, moderate quality evidence).ESGE does not recommend routine small-bowel imaging or the use of the PillCam patency capsule prior to capsule endoscopy in these patients (strong recommendation, low quality evidence). In the presence of obstructive symptoms or known stenosis, ESGE recommends that dedicated small bowel cross-sectional imaging modalities such as magnetic resonance enterography/enteroclysis or computed tomography enterography/enteroclysis should be used first (strong recommendation, low quality evidence). 6 In patients with established Crohn's disease, based on ileocolonoscopy findings, ESGE recommends dedicated cross-sectional imaging for small-bowel evaluation since this has the potential to assess extent and location of any Crohn's disease lesions, to identify strictures, and to assess for extraluminal disease (strong recommendation, low quality evidence). In patients with unremarkable or nondiagnostic findings from such cross-sectional imaging of the small bowel, ESGE recommends small-bowel capsule endoscopy as a subsequent investigation, if deemed to influence patient management (strong recommendation, low quality evidence). When capsule endoscopy is indicated, ESGE recommends use of the PillCam patency capsule to confirm functional patency of the small bowel (strong recommendation, low quality evidence). 7 ESGE strongly recommends against the use of small-bowel capsule endoscopy for suspected coeliac disease but suggests that capsule endoscopy could be used in patients unwilling or unable to undergo conventional endoscopy (strong recommendation, low quality evidence).

2 Review Current Clinical Indications for Small Bowel Capsule Endoscopy. 2015

Rosa, Bruno / Cotter, José. ·Gastroenterology Department. Centro Hospitalar do Alto Ave. Guimarães. Portugal. · Gastroenterology Department. Centro Hospitalar do Alto Ave. Guimarães. Portugal. Life and Health Sciences Research Institute. School of Health Sciences. Universidade do Minho. Braga. Portugal. Life and Health Sciences Research Institute/3B's. PT Government Associate Laboratory. Braga/Guimarães. Portugal. ·Acta Med Port · Pubmed #26667868.

ABSTRACT: INTRODUCTION: Small bowel capsule endoscopy is currently the first line diagnostic examination for many diseases affecting the small bowel. This article aims to review and critically address the current indications of small bowel capsule endoscopy in clinical practice. MATERIAL AND METHODS: Bibliographic review of relevant and recent papers indexed in PubMed. RESULTS AND DISCUSSION: Small bowel capsule endoscopy enables a non-invasive full-assessment of the small bowel mucosa, with high diagnostic yield even for subtle lesions. In patients with obscure gastrointestinal bleeding, diagnostic yield is higher when performed early after the onset of bleeding. Endoscopic treatment of angioectasias using balloon-assisted enteroscopy may contribute to reduce rebleeding, while the risk of rebleeding in patients with 'negative' small bowel capsule endoscopy is debatable. Cross-sectional imaging may be more accurate than small bowel capsule endoscopy for the diagnosis of large small bowel tumors. The Smooth Protruding Index on Capsule Endoscopy (SPICE score) may help to differentiate submucosal tumors from innocent bulges. Small bowel capsule endoscopy is also a key diagnostic instrument in patients with suspected Crohn's disease and non-diagnostic ileocolonoscopy; it may also influence prognosis and therapeutic management, by determining disease extent and activity in patients with known Crohn's disease. The role of small bowel capsule endoscopy to investigate possible complications in patients with non-responsive coeliac disease is evolving. CONCLUSIONS: Small bowel capsule endoscopy is a valuable diagnostic instrument for patients with obscure gastrointestinal bleeding and/or suspected small bowel tumors; it may also be a key examination in patients with suspected Crohn's disease, or patients with known Crohn's disease to fully assess disease extension and activity; finally, it may contribute for the diagnosis of complications of non-responsive coeliac disease.

3 Article Utility of video capsule endoscopy for longitudinal monitoring of Crohn's disease activity in the small bowel: a prospective study. 2018

Melmed, Gil Y / Dubinsky, Marla C / Rubin, David T / Fleisher, Mark / Pasha, Shabana F / Sakuraba, Atsushi / Tiongco, Felix / Shafran, Ira / Fernandez-Urien, Ignacio / Rosa, Bruno / Papageorgiou, Neofytos P / Leighton, Jonathan A. ·F Widjaja Inflammatory Bowel and Immunobiology Research Institute, Cedars Sinai Medical Center, Los Angeles, California, USA. · Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Mount Sinai Hospital, New York, New York, USA. · Inflammatory Bowel Disease Center, The University of Chicago Medicine, Chicago, Illinois, USA. · Division of Hepatology and Gastroenterology, Borland-Groover Clinic, Jacksonville, Florida, USA. · Division of Gastroenterology and Hepatology, Mayo Clinic Arizona, Scottsdale, Arizona, USA. · Clinical Research Division, Gastroenterology Associates of Tidewater, Chesapeake, Virginia, USA. · Shafran Gastroenterology Research Center, Winter Park, Florida, USA. · Department of Gastroenterology, Hospital de Navarra, Navarra, Spain. · Department of Gastroenterology, Hospital da Senhora da Oliveira, Guimarães, Portugal. · Department of Gastroenterology, American Medical Center, Nicosia, Cyprus. ·Gastrointest Endosc · Pubmed #30086261.

ABSTRACT: BACKGROUND AND AIMS: This prospective, multicenter study evaluated small-bowel capsule endoscopy (CE) for the longitudinal assessment of mucosal inflammation in subjects with Crohn's disease (CD). METHODS: Subjects with known CD underwent clinical evaluation with ileocolonoscopy and CE at baseline and 6-month follow-up. Small-bowel patency was confirmed before CE at both time points. The Simple Endoscopic Score for CD (SES-CD) was used for ileocolonoscopy, and the Lewis score and the CE CD Endoscopic Index of Severity (CECDEIS) were used for CE. Clinical scoring indices included the Physician Global Assessment (PGA), CD Activity Index (CDAI), and Harvey-Bradshaw Index (HBI). Laboratory markers including C-reactive protein, fecal calprotectin, and erythrocyte sedimentation rate were collected at baseline and follow-up. Correlation between endoscopic scores and clinical parameters were measured using Spearman tests. RESULTS: A total of 74 subjects were enrolled, of whom 53 (72%) completed endoscopic procedures at baseline and 6-month follow-up. The SES-CD ileocolonoscopy score correlated with the Lewis score (P < .001, ρ = .59) and CECDEIS capsule score (P = .002, ρ = .48). None of the 3 endoscopic scores correlated with PGA, CDAI, HBI, C-reactive protein, erythrocyte sedimentation rate, or fecal calprotectin. Approximately 85% of subjects had proximal small-bowel inflammation identified on CE. There were no CE-related adverse events. CONCLUSIONS: There was high correlation between CE and ileocolonoscopy scores for the assessment of mucosal disease activity over time; however, there were no correlations between endoscopic scores and clinical parameters. The use of serial CE for the assessment of small-bowel CD is feasible and valid. (Clinical trial registration number: NCT01942720.).

4 Article Perianal Crohn's disease - association with significant inflammatory activity in proximal small bowel segments. 2018

Xavier, Sofia / Cúrdia Gonçalves, Tiago / Dias de Castro, Francisca / Magalhães, Joana / Rosa, Bruno / Moreira, Maria João / Cotter, José. ·a Gastroenterology Department , Hospital Senhora da Oliveira , Guimarães , Portugal. · b Life and Health Sciences Research Institute (ICVS), School of Medicine , University of Minho , Braga , Portugal. · c ICVS/3B's, PT Government Associate Laboratory , Guimarães/Braga , Portugal. ·Scand J Gastroenterol · Pubmed #29447487.

ABSTRACT: OBJECTIVES: Perianal Crohn's disease (CD) prevalence varies according to the disease location, being particularly frequent in patients with colonic involvement. We aimed to evaluate small bowel involvement and compare small bowel capsule endoscopy findings and inflammatory activity between patients with and without perianal disease. MATERIALS AND METHODS: Retrospective single-center study including 71 patients - all patients with perianal CD (17 patients) who performed a small bowel capsule endoscopy were included, and non-perianal CD patients were randomly selected (54 patients). Clinical and analytical variables at diagnosis were reviewed. Statistical analysis was performed with SPSS v21.0 and a two-tailed p value <.05 was defined as indicating statistical significance. RESULTS: Patients had a median age of 30 ± 16 years with 52.1% females. Perianal disease was present in 23.9%. Patients with perianal disease had significantly more relevant findings (94.1% vs 66.6%, p = .03) and erosions (70.6% vs 42.6%, p = .04), however, no differences were found between the two groups regarding ulcer, villous edema and stenosis detection. Overall, patients with perianal disease had more frequently significant small bowel inflammatory activity, defined as a Lewis Score ≥135 (94.1% vs 64.8%, p = .03), and higher Lewis scores in the first and second tertiles (450 ± 1129 vs 0 ± 169, p = .02 and 675 ± 1941 vs 0 ± 478, p = .04, respectively). No differences were found between the two groups regarding third tertile inflammatory activity assessed with the Lewis Score. CONCLUSION: Patients with perianal CD have significantly higher inflammatory activity in the small bowel, particularly in proximal small bowel segments, when compared with patients without perianal disease.

5 Article Can we rely on inflammatory biomarkers for the diagnosis and monitoring Crohn's disease activity? 2017

Arieira, Cátia / Dias de Castro, Francisca / Rosa, Bruno / Moreira, Maria João / Firmino-Machado, João / Cotter, José. ·Gastrenterologia, Hospital da Senhora da Oliveira- Guimarães, Portugal. · Gastrenterologia, Hospital da Senhora da Oliveira -Guimarães, Portugal. · Porto Ocidental, Departamento Saúde Pública, Portugal. ·Rev Esp Enferm Dig · Pubmed #28950707.

ABSTRACT: BACKGROUND: Small bowel capsule endoscopy (SBCE) is a very important tool in the diagnosis and monitoring of Crohn's disease (CD). The Lewis score (LS) and Capsule Endoscopy Crohn's Disease Activity Index (CECDAI) are used to quantify and standardize inflammatory activity observed in the SBCE. AIM: To evaluate the correlation between the LS and CECDAI scores and inflammation biomarkers (C-reactive protein [CRP] and erythrocyte sedimentation rate [ESR]). A secondary goal was to define thresholds for CECDAI based on thresholds already established for LS. METHODS: This was a retrospective study of 110 patients with suspect or known CD, with involvement of small bowel. Linear regression was used to calculate thresholds of CECDAI corresponding to the thresholds already established for LS. A Pearson correlation (r) was used to calculate the correlation between the LS and CECDAI scores and biomarker levels. Only patients with exclusive involvement of the small bowel were selected (n = 78). RESULTS: A moderate correlation was found between the endoscopic scores (r = 0.59, p < 0.001). CECDAI scores of 5.57 and 7.53 corresponded to scores of 135 and 790 in LS, respectively. There was a statistically significant correlation between CRP and the LS (r = 0.28, p = 0.014) and CECDAI (r = 0.29, p = 0.009). There was also a significant correlation between ESR and CECDAI (r = 0.29, p = 0.019), but not with LS. CONCLUSION: There is a moderate correlation between the two scores. This study allowed the calculation of thresholds for CECDAI based on those defined for LS. We found a weak correlation between SBCE endoscopic activity and inflammatory biomarkers.

6 Article Comparing diagnostic yield of a novel pan-enteric video capsule endoscope with ileocolonoscopy in patients with active Crohn's disease: a feasibility study. 2017

Leighton, Jonathan A / Helper, Debra J / Gralnek, Ian M / Dotan, Iris / Fernandez-Urien, Ignacio / Lahat, Adi / Malik, Pramod / Mullin, Gerard E / Rosa, Bruno. ·Mayo Clinic Arizona, Scottsdale, Arizona, USA. · Indiana University School of Medicine, Indianapolis, Indiana, USA. · Institute of Gastroenterology and Liver Diseases, Ha'Emek Medical Center, Afula, Israel. · IBD Center, Department of Gastroenterology and Liver Diseases, Tel Aviv Sourasky Medical Center, and the Sackler Faculty of Medicine, Tel Aviv, Israel. · Hospital de Navarra, Navarra, Spain. · Department of Gastroenterology, Sheba Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. · Gastrointestinal and Liver Specialists of Tidewater, Suffolk, Virginia, USA. · The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA. · Gastroenterology Department, Centro Hospitalar do Alto Ave, Guimarães, Portugal. ·Gastrointest Endosc · Pubmed #27658907.

ABSTRACT: BACKGROUND AND AIMS: Crohn's disease (CD) is typically diagnosed with ileocolonoscopy (IC); however, when inflammation is localized solely in the small bowel, visualization of the entire small-bowel mucosa can be challenging. The aim of this study was to compare the diagnostic yield of a pan-enteric video capsule endoscope (small-bowel colon [SBC] capsule) versus IC in patients with active CD. METHODS: This was a prospective, multicenter study. Patients with known active CD and proven bowel luminal patency underwent a standardized colon cleansing protocol followed by ingestion of the capsule. After passage of the capsule, IC was performed and recorded. Lesions indicative of active CD were assessed. RESULTS: One hundred fourteen subjects were screened; 66 subjects completed both endoscopic procedures. The per-subject diagnostic yield rate for active CD lesions was 83.3% for SBC and 69.7% for IC (yield difference, 13.6%; 95% confidence interval [CI], 2.6%-24.7%); 65% of subjects had active CD lesions identified by both modalities. Of the 12 subjects who were positive for active CD by SBC only, 5 subjects were found to have active CD lesions in the terminal ileum. Three subjects were positive for active CD by IC only. Three hundred fifty-five classifying bowel segments were analyzed; the per-segment diagnostic yield rate was 40.6% for SBC and 32.7% for IC (yield difference 7.9%; 95% CI, 3.3%-12.4%). CONCLUSION: This preliminary study shows that the diagnostic yields for SBC might be higher than IC; however, the magnitude of difference between the two is difficult to estimate. Further study is needed to confirm these findings.

7 Article Lewis Score--Prognostic Value in Patients with Isolated Small Bowel Crohn's Disease. 2015

Dias de Castro, F / Boal Carvalho, Pedro / Monteiro, Sara / Rosa, Bruno / Firmino-Machado, João / Moreira, Maria João / Cotter, José. ·Gastroenterology Department, Centro Hospitalar do Alto Ave, Guimarães, Portugal franciscacastro@chaa.min-saude.pt. · Gastroenterology Department, Centro Hospitalar do Alto Ave, Guimarães, Portugal. · Unidade de Saúde Pública, ACES Porto Ocidental, Porto, Portugal. · Gastroenterology Department, Centro Hospitalar do Alto Ave, Guimarães, Portugal Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, 4710-057 Braga, Portugal. ICVS/3B's, PT Government Associate Laboratory, 4710-057 Braga/Guimarães, Portugal. ·J Crohns Colitis · Pubmed #26377028.

ABSTRACT: BACKGROUND AND AIMS: Small bowel capsule endoscopy (SBCE) allows mapping of small bowel inflammation in Crohn's disease (CD). We aimed to assess the prognostic value of the severity of inflammatory lesions, quantified by the Lewis score (LS), in patients with isolated small bowel CD. METHODS: A retrospective study was performed in which 53 patients with isolated small bowel CD were submitted to SBCE at the time of diagnosis. The Lewis score was calculated and patients had at least 12 months of follow-up after diagnosis. As adverse events we defined disease flare requiring systemic corticosteroid therapy, hospitalization and/or surgery during follow-up. We compared the incidence of adverse events in 2 patient subgroups, i.e. those with moderate or severe inflammatory activity (LS ≥790) and those with mild inflammatory activity (135 ≤ LS < 790). RESULTS: The LS was ≥790 in 22 patients (41.5%), while 58.5% presented with LS between 135 and 790. Patients with a higher LS were more frequently smokers (p = 0.01), males (p = 0017) and under immunosuppressive therapy (p = 0.004). In multivariate analysis, moderate to severe disease at SBCE was independently associated with corticosteroid therapy during follow-up, with a relative risk (RR) of 5 (p = 0.011; 95% confidence interval [CI] 1.5-17.8), and for hospitalization, with an RR of 13.7 (p = 0 .028; 95% CI 1.3-141.9). CONCLUSION: In patients with moderate to severe inflammatory activity there were higher prevalences of corticosteroid therapy demand and hospitalization during follow-up. Thus, stratifying the degree of small bowel inflammatory activity with SBCE and LS calculation at the time of diagnosis provided relevant prognostic value in patients with isolated small bowel CD.

8 Article Capsule Endoscopy: Diagnostic Accuracy of Lewis Score in Patients with Suspected Crohn's Disease. 2015

Monteiro, Sara / Boal Carvalho, Pedro / Dias de Castro, Francisca / Magalhães, Joana / Machado, Firmino / Moreira, Maria J / Rosa, Bruno / Cotter, José. ·*Department of Gastroenterology, Alto Ave Hospital Center, Guimarães, Portugal; †Department of Public Health Unit, ACES Porto Ocidental, Alto Ave Hospital Center, Guimarães, Portugal; ‡Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal; and §ICVS/3B's, PT Government Associate Laboratory, Braga/Guimarães, Portugal. ·Inflamm Bowel Dis · Pubmed #26197449.

ABSTRACT: BACKGROUND: The Lewis Score (LS) aims to standardize the method of quantification of small bowel inflammatory activity detected by the small bowel capsule endoscopy (SBCE). The aim of this study was to evaluate the diagnostic accuracy of the LS in patients with suspected CD undergoing SBCE. METHODS: We performed a retrospective study including patients who underwent SBCE for suspected CD between September 2006 and February 2013. Patients were grouped according to the criteria of the International Conference on Capsule Endoscopy for the definition of suspected CD. Inflammatory activity on SBCE was objectively assessed by determining the LS. RESULTS: Ninety-five patients were included. Group 1: 37 patients not fulfilling International Conference on Capsule Endoscopy criteria; Group 2: 58 patients with ≥ 2 International Conference on Capsule Endoscopy criteria. The diagnosis of CD was established in 38 patients (40%): 8 (21.6%) from group 1 and 30 from group 2 (51.7%) (P = 0.003). Among those patients, 34 had LS ≥ 135 (73.9%) and 4 had LS <135 (8.2%) at SBCE (P < 0.001). The LS ≥ 135 had an overall diagnostic accuracy of 83.2% with a sensitivity, specificity, positive predictive value, and negative predictive value for the diagnosis of CD of 89.5%, 78.9%, 73.9%, and 91.8%, respectively. CONCLUSIONS: The application of LS ≥ 135 as the cutoff value for the presence of significant inflammatory activity in patients undergoing SBCE for suspected CD may be useful to establish the diagnosis of CD. In patients with LS < 135, the probability of having CD confirmed on follow-up is low.

9 Article PillCam COLON 2 in Crohn's disease: A new concept of pan-enteric mucosal healing assessment. 2015

Boal Carvalho, Pedro / Rosa, Bruno / Dias de Castro, Francisca / Moreira, Maria João / Cotter, José. ·Pedro Boal Carvalho, Bruno Rosa, Francisca Dias de Castro, Maria João Moreira, José Cotter, Life and Health Sciences Research Institute, School of Health Sciences, University of Minho, 4710-057 Braga, Portugal. ·World J Gastroenterol · Pubmed #26109810.

ABSTRACT: AIM: To evaluate mucosal healing in patients with small bowel plus colonic Crohn's disease (CD) with a single non-invasive examination, by using PillCam COLON 2 (PCC2). METHODS: Patients with non-stricturing nonpenetrating small bowel plus colonic CD in sustained corticosteroid-free remission were included. At diagnosis, patients had undergone ileocolonoscopy to identify active CD lesions, such as ulcers and erosions, and small bowel capsule endoscopy to assess the Lewis Score (LS). After ≥ 1 year of follow-up, patients underwent entire gastrointestinal tract evaluation with PCC2. The primary endpoint was assessment of CD mucosal healing, defined as no active colonic CD lesions and LS < 135. RESULTS: Twelve patients were included (7 male; mean age: 32 years), and mean follow-up was 38 mo. The majority of patients (83.3%) received immunosuppressive therapy. Three patients (25%) achieved mucosal healing in both the small bowel and the colon, while disease activity was limited to either the small bowel or the colon in 5 patients (42%). It was possible to observe the entire gastrointestinal tract in 10 of the 12 patients (83%) who underwent PCC2. CONCLUSION: Only three patients in sustained corticosteroid-free clinical remission achieved mucosal healing in both the small bowel and the colon, highlighting the limitations of clinical assessment when stratifying disease activity, and the need for pan-enteric endoscopy to guide therapeutic modification.

10 Article Validation of the Lewis score for the evaluation of small-bowel Crohn's disease activity. 2015

Cotter, José / Dias de Castro, Francisca / Magalhães, Joana / Moreira, Maria João / Rosa, Bruno. ·Gastroenterology Department, Centro Hospitalar do Alto Ave, Guimarães, Portugal. ·Endoscopy · Pubmed #25412092.

ABSTRACT: BACKGROUND AND STUDY AIMS: The Lewis score was developed to measure mucosal inflammatory activity as detected by small-bowel capsule endoscopy (SBCE). The aim of the current study was to validate the Lewis score by assessing interobserver correlation and level of agreement in a clinical setting. PATIENTS AND METHODS: This was a retrospective, single-center, double-blind study including patients with isolated small-bowel Crohn's disease who underwent SBCE. The Lewis score was calculated using a software application, based on the characteristics of villous edema, ulcers, and stenoses. The Lewis score was independently calculated by one of three investigators and by a central reader (gold standard). Interobserver agreement was assessed using intraclass correlation (ICC) coefficient and Bland - Altman plots. RESULTS: A total of 70 patients were consecutively included (mean age 33.9 ± 11.7 years). The mean Lewis score was 1265 and 1320 for investigators and the central reader, respectively. There was a high correlation, both for scores obtained for each tertile (first tertile r = 0.659 - 0.950, second tertile r = 0.756 - 0.906, third tertile r = 0.750 - 0.939), and for the global score (r = 0.745 - 0.928) (P < 0.0001). Interobserver agreement was almost perfect between the investigators and the central reader (first tertile ICC = 0.788 - 0.971, second tertile ICC = 0.824 - 0.943, third tertile ICC = 0.857 - 0.968, global score ICC = 0.852 - 0.960; P < 0.0001). The inflammatory activity was classified as normal (score < 135) in 2.9 % vs. 2.9 %, mild (score ≥ 135 - < 790) in 51.4 % vs. 55.7 %, and moderate to severe (score ≥ 790) in 45.8 % vs. 41.4 % of patients, respectively (P < 0.001). CONCLUSION: A strong interobserver agreement was demonstrated for the determination of the Lewis score in a practical clinical setting, validating this score for the reporting of small-bowel inflammatory activity. The Lewis score might be used for diagnosing, staging, follow-up, and therapeutic assessment of patients with isolated small-bowel Crohn's disease.

11 Article Tailoring Crohn's disease treatment: the impact of small bowel capsule endoscopy. 2014

Cotter, José / Dias de Castro, Francisca / Moreira, Maria João / Rosa, Bruno. ·Gastroenterology Department, Centro Hospitalar do Alto Ave, Guimarães, Portugal; Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, 4710-057 Braga, Portugal; ICVS/3B's, PT Government Associate Laboratory, 4710-057 Guimarães, Braga, Portugal. Electronic address: jcotter@chaa.min-saude.pt. · Gastroenterology Department, Centro Hospitalar do Alto Ave, Guimarães, Portugal. Electronic address: franciscacastro@chaa.min-saude.pt. · Gastroenterology Department, Centro Hospitalar do Alto Ave, Guimarães, Portugal. Electronic address: mj.moreira@netcabo.pt. · Gastroenterology Department, Centro Hospitalar do Alto Ave, Guimarães, Portugal. Electronic address: brunorosa@chaa.min-saude.pt. ·J Crohns Colitis · Pubmed #24631311.

ABSTRACT: BACKGROUND AND AIMS: Small bowel capsule endoscopy (SBCE) may detect proximal small bowel lesions that have been previously missed by ileocolonoscopy and small bowel imaging in patients with known ileal and/or colonic Crohn's disease (CD). We aimed to evaluate whether the therapeutic management is influenced by SBCE findings. METHODS: Retrospective single center study. Inclusion of consecutive patients with known non-stricturing and non-penetrating ileal and/or colonic CD, submitted to SBCE to evaluate disease extension and activity, with ≥ 1 year follow-up. Lesions were classified with the Lewis score (LS) as non-significant (LS<135), mild (135≤LS≤790), or moderate-to-severe (LS>790). Therapeutic changes were assessed three months after SBCE. RESULTS: Fifty consecutive patients (35±13 years, 52% females) were included. At ileocolonoscopy, disease location was ileal (L1) in 60%, colonic (L2) in 10% and ileocolonic (L3) in 30% of the patients. In 33 patients (66%) SBCE detected significant proximal lesions previously missed by other modalities. The proportion of patients on thiopurines and/or biologics before SBCE was 2/50 (4%); this was significantly higher three months after SBCE, 15/50 (30%), p=0.023. Treatment with thiopurines and/or biologics was started more often in patients with proximal small bowel lesions [13/33 (39%) vs. 1/17 (6%), p=0.011, relative risk (RR) 6.5], particularly when severe (6%, 36% and 45% of patients with non-significant, mild and moderate-to-severe inflammation, respectively). CONCLUSIONS: SBCE diagnoses previously undetected lesions and it influences therapeutic management of CD, triggering an earlier introduction of immunomodulators and/or biological therapy.

12 Article Lewis Score: a useful clinical tool for patients with suspected Crohn's Disease submitted to capsule endoscopy. 2012

Rosa, Bruno / Moreira, Maria João / Rebelo, Ana / Cotter, José. ·Gastroenterology Department, Alto Ave Hospital Center, Guimarães, Portugal. bruno.joel.rosa@gmail.com ·J Crohns Colitis · Pubmed #22398099.

ABSTRACT: BACKGROUND/AIMS: The Lewis Score (LS) can assess inflammatory activity on small bowel capsule endoscopy (SBCE). We aimed to evaluate the LS usefulness in the setting of suspected Crohn's Disease (CD). METHODS: Retrospective single-center study including 56 patients undergoing SBCE for suspected CD. Patients were divided into three groups, according to clinical presentation: Group 1 (28 patients): suspected CD not supported by the International Conference on Capsule Endoscopy (ICCE) criteria; Group 2 (19 patients): suspected CD based on two ICCE criteria; Group 3 (9 patients): patients fulfilling three or more criteria. Inflammatory activity was assessed with the LS. The diagnosis of CD required a minimum follow-up of 6 months after SBCE, basing on clinical evaluation, endoscopic, histological, radiological, and/or biochemical investigations. RESULTS: SBCE detected significant inflammatory activity (LS≥135) in 23 patients (41.1%), being 5 patients from Group 1 (17.8%), 11 from Group 2 (57.9%) and 7 from Group 3 (77.8%) (p<0.05). CD was diagnosed in 23 patients (41.1%): six patients from Group 1 (21.4%), 10 from Group 2 (52.6%) and 7 from Group 3 (77.8%) (p<0.05). CD was diagnosed in 82.6% of patients with significant inflammatory activity on CE (LS≥135), but in only 12.1% of those having a LS<135 (p<0.05). The LS Positive Predictive Value, Negative Predictive Value, Sensitivity and Specificity were 82.6%, 87.9%, 82.6% and 87.9%, respectively. CONCLUSIONS: The LS may be a valuable diagnostic tool in the setting of suspected CD. Patients not fulfilling the ICCE criteria have lower LS and fewer are diagnosed with CD during follow-up.

13 Minor Mucosal healing in Crohn's disease - are we reaching as far as possible with capsule endoscopy? 2014

Carvalho, Pedro Boal / Rosa, Bruno / Cotter, Jose. ·Centro Hospitalar do Alto Ave, Portugal. Electronic address: Pedroboalcarvalho@chaa.min-saude.pt. · Centro Hospitalar do Alto Ave, Portugal. ·J Crohns Colitis · Pubmed #25023448.

ABSTRACT: -- No abstract --

14 Minor On the usefulness of small bowel capsule endoscopy in Crohn's disease. 2011

Rosa, Bruno / Moreira, Maria João / Rebelo, Ana / Cotter, José. · ·J Crohns Colitis · Pubmed #21939930.

ABSTRACT: -- No abstract --