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Crohn Disease: HELP
Articles by Bruno Rosa
Based on 22 articles published since 2010
(Why 22 articles?)
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Between 2010 and 2020, Bruno Rosa wrote the following 22 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 Guideline European evidence based consensus for endoscopy in inflammatory bowel disease. 2013

Annese, Vito / Daperno, Marco / Rutter, Matthew D / Amiot, Aurelien / Bossuyt, Peter / East, James / Ferrante, Marc / Götz, Martin / Katsanos, Konstantinos H / Kießlich, Ralf / Ordás, Ingrid / Repici, Alessandro / Rosa, Bruno / Sebastian, Shaji / Kucharzik, Torsten / Eliakim, Rami / Anonymous1380774. ·Dept. Gastroenterology, University Hospital Careggi, Largo Brambilla 3, 50139 Florence, Italy. Electronic address: annesev@aou-careggi.toscana.it. ·J Crohns Colitis · Pubmed #24184171.

ABSTRACT: -- No abstract --

3 Review Endoscopic Scores for Evaluation of Crohn's Disease Activity at Small Bowel Capsule Endoscopy: General Principles and Current Applications. 2016

Rosa, Bruno / Pinho, Rolando / de Ferro, Susana Mão / Almeida, Nuno / Cotter, José / Saraiva, Miguel Mascarenhas. ·Gastroenterology Department, Centro Hospitalar do Alto Ave, Guimarães, Portugal. · Gastroenterology Department, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal. · Gastroenterology Center, ManopH, Instituto CUF, Porto, Portugal. · Gastroenterology Department, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal. · Faculdade de Medicina, Universidade de Coimbra, Coimbra, Portugal. · Gastroenterology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal. · Instituto de Investigação em Ciências da Vida e Saúde (ICVS), Escola de Ciências da Saúde, Universidade do Minho, Braga, Portugal. · Laboratório Associado ICVS/3B's, Braga, Portugal. · ManopH - Laboratório de Endoscopia e Motilidade Digestiva, Porto, Portugal. ·GE Port J Gastroenterol · Pubmed #28868428.

ABSTRACT: The small bowel is affected in the vast majority of patients with Crohn's Disease (CD). Small bowel capsule endoscopy (SBCE) has a very high sensitivity for the detection of CD-related pathology, including early mucosal lesions and/or those located in the proximal segments of the small bowel, which is a major advantage when compared with other small bowel imaging modalities. The recent guidelines of European Society of Gastrointestinal Endoscopy (ESGE) and European Crohn's and Colitis Organisation (ECCO) advocate the use of validated endoscopic scoring indices for the classification of inflammatory activity in patients with CD undergoing SBCE, such as the Lewis Score or the Capsule Endoscopy Crohn's Disease Activity Index (CECDAI). These scores aim to standardize the description of lesions and capsule endoscopy reports, contributing to increase inter-observer agreement and enabling a stratification of the severity of the disease. On behalf of the

4 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.

5 Article Simplify to improve in capsule endoscopy - TOP 100 is a swift and reliable evaluation tool for the small bowel inflammatory activity in Crohn's disease. 2020

Freitas, Marta / Arieira, Cátia / Carvalho, Pedro Boal / Rosa, Bruno / Moreira, Maria João / Cotter, José. ·Gastroenterology Department, Hospital da Senhora da Oliveira, Guimarães, Portugal. · Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal. · ICVS/3B's, PT Government Associate Laboratory, Braga/Guimarães, Portugal. ·Scand J Gastroenterol · Pubmed #32228199.

ABSTRACT:

6 Article Nomenclature and semantic descriptions of ulcerative and inflammatory lesions seen in Crohn's disease in small bowel capsule endoscopy: An international Delphi consensus statement. 2020

Leenhardt, Romain / Buisson, Anthony / Bourreille, Arnaud / Marteau, Philippe / Koulaouzidis, Anastasios / Li, Cynthia / Keuchel, Martin / Rondonotti, Emmanuele / Toth, Ervin / Plevris, John N / Eliakim, Rami / Rosa, Bruno / Triantafyllou, Konstantinos / Elli, Luca / Wurm Johansson, Gabriele / Panter, Simon / Ellul, Pierre / Pérez-Cuadrado Robles, Enrique / McNamara, Deirdre / Beaumont, Hanneke / Spada, Cristiano / Cavallaro, Flaminia / Cholet, Franck / Fernandez-Urien Sainz, Ignacio / Kopylov, Uri / McAlindon, Mark E / Németh, Artur / Tontini, Gian Eugenio / Yung, Diana E / Niv, Yaron / Rahmi, Gabriel / Saurin, Jean-Christophe / Dray, Xavier. ·Sorbonne Université, Endoscopy Unit, Hôpital Saint-Antoine, AP-HP, Paris, France. · Dept. of Gastroenterology, CHU Estaing Clermont-Ferrand, Clermont-ferrand, France. · Institut des Maladies de l'Appareil Digestif (IMAD), Dept of Gastroenterology, CHU Nantes, University of Nantes, Nantes, France. · Centre For Liver & Digestive Disorders, The Royal Infirmary of Edinburgh, Edinburgh, United Kingdom. · College of Arts & Sciences, Drexel University, Philadelphia, USA. · Klinik für Innere Medizin, Bethesda Krankenhaus Bergedorf, Hamburg, Germany. · Gastroenterology Unit, Valduce Hospital, Como, Italy. · Department of Gastroenterology, Skåne University Hospital, Lund University, Malmö, Sweden. · Dept. of Gastroenterology, Sheba Medical Center, Ramat Gan, and Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel. · Departamento de Gastroenterologia, Universidade do Minho, Hospital Senhora da Oliveira, Guimarães, Portugal. · Hepatogastroenterology Unit, Second Department of Internal Medicine - Propaedeutic Research Institute and Diabetes Center, National and Kapodistrian University of Athens, Medical School, Attikon University General Hospital, Athens, Greece. · Center for Prevention and Diagnosis of Celiac Disease, Fondazione IRCCS Ca Granda, Milano, Italy. · Gastroenterology, South Tyneside Hospital, South Shields, United Kingdom. · Department of Medicine, Mater Dei Hospital, Msida, Malta. · Department of Gastroenterology, Cliniques Universitaires Saint-Luc, Bruxelles, Belgium. · Department of Gastroenterology and Digestive Endoscopy, Georges-Pompidou European hospital, Paris, France. · Trinity Academic Gastroenterology Group, Departement of Clinical Medicine, Tallaght Hospital, Trinity College Dublin, Ireland. · Department of Gastroenterology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands. · Digestive Endoscopy Unit and Gastroenterology, Fondazione Poliambulanza, Brescia, Italia; Digestive Endoscopy Unit, Università Cattolica del Sacro Cuore, Roma, Italia. · Gastroenterology and Endoscopy Unit, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy. · Endoscopy unit, CHU La Cavale Blanche, Brest, France. · Gastroenterology, Hospital de Navarra, Pamplona, Spain. · Dept. of Gastroenterology, Royal Hallamshire Hospital, Sheffield, United Kingdom. · Department of Pathophysiology and Transplantation, University of Milan - Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy. · Rabin Medical Center, Dept. of Gastroenterology, Petach Tikva, Israel, and Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel. · Gastroenterology and Endoscopy Unit, Edouard Herriot Hospital, Lyon, France. ·United European Gastroenterol J · Pubmed #32213061.

ABSTRACT: BACKGROUND: In the medical literature, the nomenclature and descriptions (ND) of small bowel (SB) ulcerative and inflammatory (U-I) lesions in capsule endoscopy (CE) are scarce and inconsistent. Inter-observer variability in interpreting these findings remains a major limitation in the assessment of the severity of mucosal lesions, which can impact negatively on clinical care, training and research on SB-CE. OBJECTIVE: Focusing on SB-CE in Crohn's disease (CD), our aim is to establish a consensus on the ND of U-I lesions. METHODS: An international panel of experienced SB-CE readers was formed during the 2016 United European Gastroenterology Week meeting. A core group of five CE and inflammatory bowel disease (IBD) experts established an Internet-based, three-round Delphi consensus but did not participate in the voting process. The core group built illustrated questionnaires, including SB-CE still frames of U-I lesions from patients with documented CD. Twenty-seven other experts were asked to rate and comment on the different proposals for the ND of the most frequent SB U-I lesions. For each round, we used a 6-point rating scale (varying from 'strongly disagree' to 'strongly agree'). The consensus was reached when at least 80 % of the voting members scored the statement within the 'agree' or 'strongly agree' categories. RESULTS: A 100% participation rate was obtained for all the rounds. Consensual ND were reached for the following seven U-I lesions: CONCLUSION: Considering the most frequent SB U-I lesions seen in CE in CD, a consensual ND was reached by the international group of experts. These descriptions and names are useful not only for daily practice and medical education, but also for medical research.

7 Article CECDAIic - a new useful tool in pan-intestinal evaluation of Crohn's disease patients in the era of mucosal healing. 2019

Arieira, Cátia / Magalhães, Rui / Dias de Castro, Francisca / Boal Carvalho, Pedro / Rosa, Bruno / Moreira, Maria João / Cotter, José. ·Gastroenterology Department, Hospital da Senhora da Oliveira, Guimarães, Portugal. · Life and Health Sciences Research Institute, School of Medicine, University of Minho, Braga/Guimarães, Portugal. · ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal. ·Scand J Gastroenterol · Pubmed #31646914.

ABSTRACT:

8 Article How should we select suspected Crohn's disease patients for capsule enteroscopy? 2019

de Sousa Magalhães, Rui / Rosa, Bruno / Marques, Margarida / Boal Carvalho, Pedro / Cardoso, Hélder / Machado, Firmino / Macedo, Guilherme / Cotter, José. ·Gastrsoenterology Department, Hospital Senhora da Oliveira - Guimarães , Guimarães , Portugal. · Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho , Braga , Portugal. · ICVS/3B's, PT Government Associate Laboratory , Guimarães/Braga , Portugal. · Gastroenterology Department, Hospital de São João - Porto , Porto , Portugal. · Western Oporto Public Health Unit, Northern Regional Health Administration , Porto , Portugal. ·Scand J Gastroenterol · Pubmed #31378118.

ABSTRACT:

9 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.).

10 Article Fecal Calprotectin as a Selection Tool for Small Bowel Capsule Endoscopy in Suspected Crohn's Disease. 2018

Monteiro, Sara / Barbosa, Mara / Cúrdia Gonçalves, Tiago / Boal Carvalho, Pedro / Moreira, Maria João / Rosa, Bruno / Cotter, José. ·Department of Gastroenterology, Hospital da Senhora da Oliveira-Guimarães, Portugal; Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga/Guimarães, Portugal; and ICVS/3B's, PT Government Associate Laboratory, Braga/Guimarães, Portugal. ·Inflamm Bowel Dis · Pubmed #29722829.

ABSTRACT: BACKGROUND: Small bowel capsule endoscopy (SBCE) is a firstline examination in patients with suspected Crohn's disease (CD) after negative ileocolonoscopy. Fecal calprotectin (FC) is a noninvasive marker of intestinal inflammation. The aim of this study was to evaluate the predictive value of FC in inflammatory activity detected by SBCE in patients with suspected CD. METHODS: This is a retrospective study including patients who underwent SBCE for suspected CD between March 2015 and October 2016. FC was measured within 1 week of SBCE. Inflammatory activity at SBCE was considered significant when the Lewis score (LS) was ≥135. FC correlation with LS was assessed using the Spearman correlation. The diagnostic accuracy of FC for significant inflammatory activity at SBCE was calculated by the area under the receiver operating characteristic curve (AUC). RESULTS: Seventy-five patients were included: 52 females (69.3%), with a mean age of 37 years. SBCE detected significant inflammatory activity (LS ≥ 135) in 42 patients (56%), and FC was positively correlated to LS (rank correlation = 0.56; P < 0.001). The AUC of FC was 0.854 for significant inflammatory activity (LS ≥ 135). For values of FC ≥100 µg/g, an LS ≥135 was found in 33 of 37 patients (89.2%, P < 0.001), corresponding to a sensitivity, specificity, positive predictive value, and negative predictive value of 78.6%, 87.9%, 89.2%, and 76.3%, respectively. CONCLUSIONS: FC has shown a good ability to predict significant inflammatory activity in SBCE in patients with suspected CD. Thus, FC proved to be a useful tool to select patients with suspected CD for SBCE.

11 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.

12 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.

13 Article Essential role of small bowel capsule endoscopy in reclassification of colonic inflammatory bowel disease type unclassified. 2017

Monteiro, Sara / Dias de Castro, Francisca / Boal Carvalho, Pedro / Rosa, Bruno / Moreira, Maria João / Pinho, Rolando / Saraiva, Miguel Mascarenhas / Cotter, José. ·Sara Monteiro, Francisca Dias de Castro, Pedro Boal Carvalho, Bruno Rosa, Maria João Moreira, José Cotter, Department of Gastroenterology, Hospital da Senhora da Oliveira-Guimarães, Rua dos Cutileiros, Creixomil, 4835-044 Guimarães, Portugal. ·World J Gastrointest Endosc · Pubmed #28101306.

ABSTRACT: AIM: To evaluate the role of small bowel capsule endoscopy (SBCE) on the reclassification of colonic inflammatory bowel disease type unclassified (IBDU). METHODS: We performed a multicenter, retrospective study including patients with IBDU undergoing SBCE, between 2002 and 2014. SBCE studies were reviewed and the inflammatory activity was evaluated by determining the Lewis score (LS). Inflammatory activity was considered significant and consistent with Crohn's disease (CD) when the LS ≥ 135. The definitive diagnosis during follow-up (minimum 12 mo following SBCE) was based on the combination of clinical, analytical, imaging, endoscopic and histological elements. RESULTS: Thirty-six patients were included, 21 females (58%) with mean age at diagnosis of 33 ± 13 (15-64) years. The mean follow-up time after the SBCE was 52 ± 41 (12-156) mo. The SBCE revealed findings consistent with significant inflammatory activity in the small bowel (LS ≥ 135) in 9 patients (25%); in all of them the diagnosis of CD was confirmed during follow-up. In 27 patients (75%), the SBCE revealed no significant inflammatory activity (LS < 135); among these patients, the diagnosis of Ulcerative Colitis (UC) was established in 16 cases (59.3%), CD in 1 case (3.7%) and 10 patients (37%) maintained a diagnosis of IBDU during follow-up. A LS ≥ 135 at SBCE had a sensitivity = 90%, specificity = 100%, positive predictive value = 100% and negative predictive value = 94% for the diagnosis of CD. CONCLUSION: SBCE proved to be fundamental in the reclassification of patients with IBDU. Absence of significant inflammatory activity in the small intestine allowed exclusion of CD in 94% of cases.

14 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.

15 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.

16 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.

17 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.

18 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.

19 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.

20 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.

21 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 --

22 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 --