• computed tomography enterography
• enteroscopy
• intestinal ultrasound
• small bowel Crohn’s disease

• Crohn’s disease
• L4
• Stricture
• Upper gastrointestinal tract

• Humans
• Crohn Disease/complications
• Crohn Disease/epidemiology
• Crohn Disease/diagnosis
• Retrospective Studies
• Male
• Female
• Adult
• Constriction, Pathologic
• Middle Aged
• Upper Gastrointestinal Tract/pathology
• Endoscopy, Gastrointestinal
• Young Adult
• Risk Factors

• Bowel stenosis
• Crohn’s disease
• Strictureplasty

• Crohn Disease/surgery
• Humans
• Male
• Female
• Retrospective Studies
• Intestine, Small/surgery
• Intestine, Small/diagnostic imaging
• Intestine, Small/pathology
• Adult
• Magnetic Resonance Imaging
• Treatment Outcome
• Constriction, Pathologic/etiology
• Constriction, Pathologic/surgery
• Time Factors
• Digestive System Surgical Procedures/methods
• Young Adult
• Leukocyte L1 Antigen Complex/analysis
• Middle Aged
• Recurrence
• Organ Sparing Treatments/methods
• Follow-Up Studies
• Feces/chemistry

• BIRD Università degli Studi di Padova

• Crohn's disease
• prevalence
• prognosis
• systematic review
• upper gastrointestinal tract

• Abdominal surgery
• Complication
• Crohn’s disease
• EGD involvement
• Prognosis

The early recognition of malnutrition is essential for improving the prognosis of patients with Crohn's disease (CD). The Global Leadership Initiative on Malnutrition (GLIM) criteria represent a new consensus for the diagnosis of malnutrition but need to be validated in CD. The aims were to explore the related factors of malnutrition in CD and explore whether GLIM-positive patients who did not meet the Nutritional Risk Screening 2002 (NRS 2002) would benefit from nutritional treatment.

This study retrospectively enrolled patients with CD at the Gastroenterology Department of Xiangya Hospital Central South University between March 2020 and March 2021. After bioelectrical impedance analysis, all patients underwent nutritional screening and diagnosis using the NRS 2002 and GLIM criteria, respectively. Multivariable analysis was performed to evaluate risk factors related to malnutrition in patients with CD. A multivariable Cox hazard model was used to assess the association between nutritional therapy and prognostic outcomes.

Of the 118 patients included, fifty were classified as having a high malnutrition risk according to the NRS 2002, while 76 were diagnosed with malnutrition by the GLIM criteria. Multivariate analysis showed that a high malnutrition risk was independently associated with the L4 phenotype [odds ratio (OR) (95% confidence interval (CI)) = 4.718 (1.108, 20.10), p = 0.036] and Crohn's Disease Activity Index (CDAI) [OR (95% CI) = 1.018 (1.007, 1.029), p = 0.002] based on the NRS 2002. The age at onset [OR (95% CI) = 0.828 (0.699, 0.980), p = 0.028] and CDAI [OR (95% CI) = 1.111 (1.034, 1.195), p = 0.004] were regarded as independent risk factors related to malnutrition, as determined by the GLIM criteria. Among 26 GLIM+/NRS− patients, significantly more patients who received nutritional support achieved 6-week remission than patients who did not (100 vs. 71.4%, p < 0.05). The 6-week remission risk in patients treated with nutrition therapy was more than 4-fold higher than those without nutritional therapy.

The GLIM criteria could diagnose more malnourished patients with CD who are not positively screened by the NRS 2002, among whom nutritional support therapy would be beneficial for disease remission. The new criteria should be more appropriate for assessing the nutritional status of patients with CD.

• Crohn's disease
• GLIM
• NRS 2002
• nutrition therapy
• nutritional assessment

• Crohn's disease
• Epidemiology
• Montreal classification
• Upper gastrointestinal Crohn's disease

• Female
• Humans
• Male
• Crohn Disease/classification
• Crohn Disease/epidemiology
• Disease Progression
• Phenotype
• Prevalence
• Risk Factors
• Sex Factors
• Upper Gastrointestinal Tract/pathology

• Adult-onset
• Crohn’s disease
• Intestinal resection
• Paediatric onset
• Perianal disease

In pediatric Crohn’s disease (CD) patients, it is important to define the disease phenotype at diagnosis for stratifying risk. In this retrospective study, we aimed to assess the disease phenotype compared to EUROKIDS registry and analyze disease outcome of pediatric CD patients according to upper gastrointestinal (GI) tract involvement. A total of 312 patients were included. The median age at diagnosis was 13.7 years and 232 patients (74.4%) were identified to have upper GI involvement at diagnosis. In Korean pediatric CD patients, there were significant differences in male predominance (72.8% vs. 59.2, p < 0.001), proportion of upper GI involvement (74.4% vs. 46.2%, p < 0.001), and perianal disease (62.1% vs. 8.2%, p < 0.001) compared to data in the EUROKIDS registry. Younger age (OR 2.594, p = 0.0139) and ileal involvement (OR 2.293, p = 0.0176) at diagnosis were associated with upper GI involvement. There were no significant differences in disease outcomes between patients with and without upper GI tract involvement. This study revealed that upper GI involvement is more prevalent in Korean patients with pediatric Crohn’s disease than in European patients, and the disease outcome did not appear to differ according to upper GI tract involvement.

The clinical features of upper gastrointestinal (L4) Crohn’s disease (CD) and its subtypes, along with the associated and nutritional status, remain poorly described. Our aim was to evaluate the clinical characteristics of L4 CD phenotype and its subtypes at diagnosis, and their relationship with the nutritional status.

A retrospective study was conducted on 869 CD patients diagnosed between 2013 and 2019, and the association between the clinical characteristics and nutritional status of L4 patients was determined using Random forest importance ranking and logistic regression.

The majority of the patients (59.72%) presented L4 lesions, of which 335, 158 and 26 had proximal ileal, jejunal and esophago-gastroduodenal (EGD) lesions respectively. L4 patients were predominantly male (OR 2.07), smoker (OR 1.80), and had higher body weight and BMI, longer disease course, and stricturing disease (OR 1.88). Furthermore, the serum albumin level, body weight and disease course showed higher MDG in the random forest importance ranking test for L4 CD and L4-proximal ileal types. According to logistic regression, body weight (OR 1.054), disease course (OR 1.010), stricturing behavior (OR 4.998) and tomato intolerance (OR 1.313) were the independent risk factors for L4. In addition, body weight (OR 1.042) and stricturing behavior (OR 3.152) were the relevant factors for proximal ileal subtype, and stricturing behavior (OR 4.206) and perianal disease (OR 0.339) for jejunal subtype.

L4 disease has a higher incidence rate compared to the non-L4 CD, and mainly affects males, and those with prolonged disease course, stricturing behavior, higher weight, BMI, albumin levels and food intolerance (FI).

• Crohn’s disease (CD)
• features
• food intolerance (FI)
• nutrition
• upper gastrointestinal tract

• Clinical feature
• Crohn’s disease
• Prognosis
• Upper gastrointestinal tract phenotype

• Inflammatory bowel disease
• Monitoring
• Mucosal healing
• Post-operative recurrence
• Prognosis
• Treat-to-target
• Wireless capsule endoscopy

• Capsule Endoscopy
• Clinical Protocols
• Constriction, Pathologic/diagnostic imaging
• Constriction, Pathologic/etiology
• Constriction, Pathologic/pathology
• Crohn Disease/complications
• Crohn Disease/diagnostic imaging
• Crohn Disease/therapy
• Humans
• Ileum/diagnostic imaging
• Ileum/pathology
• Intestinal Mucosa/diagnostic imaging
• Intestinal Mucosa/pathology
• Jejunum/diagnostic imaging
• Jejunum/pathology
• Prognosis
• Recurrence
• Reproducibility of Results
• Treatment Outcome

Magnetic resonance enterography (MRE) and wireless capsule endoscopy (WCE) are equally accepted modalities for noninvasive screening of small bowel involvement (SBI) in children with Crohn’s disease (CD) and indeterminate colitis (IC) albeit there is a paucity of data comparing the two and thereby guiding the clinician in selecting the ideal diagnostic approach. Therefore, the goal of this study is to provide additional evidence for capsule endoscopy role in the evaluation of established Crohn’s disease exacerbation compared to MRE in relation to Pediatric Crohn's Disease Activity Index (PCDAI), and histological indices.

To prospectively compare the findings of MRE and WCE and their agreement with PCDAI or histology in children with CD or IC.

Consecutive patients diagnosed with CD and IC were screened for inclusion. After informed consent, patient’s demographic and clinical data was abstracted. The current pediatric disease activity index (PCDAI) and endoscopic findings were included. Patients underwent MRE and WCE including preprocedural patency capsule within a maximum of 7 d of each other. Pathological presence of active small bowel disease in ileal and duodenal biopsies were collected if the endoscopy was performed within 2 mo of the WCE study. Patients who failed to pass the PC were excluded from the study. WCE was read by two different experienced gastroenterologists (Attard TM and Colombo JM) blinded to each other's findings and to the findings on MRE (Mardis NJ). Agreement between WCE reviewers, WCE and MRE findings and concordance between positive PCDAI and SBI based on MRE compared with WCE was computed.

Forty-five patients were included in the study, 18 withdrew and 27 (20 males and 20 CD), mean age (standard deviation) 13.46 (2.4) years, completed the study protocol. There were no instances of capsule retention. Concordance between gastroenterologist reviewers was excellent for the diagnosis of small intestinal CD with good correlation between the two Lewis scores (r = 0.875, P < 0.001). Concordance between WCE and MRE was poor (69%). In CD patients, when both MRE and WCE were compared using PCDAI > 10 as the standard reference reflecting active small intestinal CD, the sensitivity of MRE and WCE were 100% and 83% respectively and the specificity of MRE and WCE were 57.14% and 78.6%, respectively. If the histology in ileum or/and duodenum was used as the reference for active small bowel involvement, WCE had a higher specificity as compared to MRE (83.3% vs 50%). In patients with Crohn’s disease, those with a positive PCDAI (> 10) were more likely to have a positive WCE as compared to those with a negative PCDAI (83% vs 21%; P = 0.018).

We suggest that MRE and WCE have a complementary role in the assessment of SBI in CD. WCE detected SBI with a much higher specificity while MRE had a higher sensitivity.

• Crohn’s disease
• Wireless capsule endoscopy
• Inflammatory bowel disease
• Magnetic resonance enterography
• Small bowel involvement
• Small bowel disease
• Indeterminate colitis
• Pediatric
• Children

• Adolescent
• Capsule Endoscopy
• Child
• Duodenum/diagnostic imaging
• Duodenum/pathology
• Female
• Humans
• Ileum/diagnostic imaging
• Ileum/pathology
• Inflammatory Bowel Diseases/diagnosis
• Inflammatory Bowel Diseases/diagnostic imaging
• Inflammatory Bowel Diseases/pathology
• Magnetic Resonance Imaging
• Male
• Prospective Studies
• Sensitivity and Specificity
• Severity of Illness Index
• United States