Search

Objective: To explore the diagnostic value of different serological markers and the correlation with disease phenotype in inflammatory bowel disease (IBD). Methods: The clinical data of 445 IBD patients in Peking Union Medical College Hospital from June 2010 to December 2020 were retrospectively collected, including 223 cases of ulcerative colitis (UC) [111 males, 112 females, with a median age of 46(20,79) years] and 222 cases of Crohn's disease (CD) [147 males, 75 females, with a median age of 39 (19, 72) years]. The positive rates of serum anti-neutrophil cytoplasmic antibodies (ANCA), anti-Saccharomyces cerevisiae antibodies (ASCA), goblet cell autoantibodies (GAB) and pancreatic autoantibodies (PAB) in the two groups were analyzed. The sensitivity, specificity, positive predictive value and negative predictive value of UC and CD were calculated. Logistic regression was performed to analyze the relationship between different combinations of antibodies and disease phenotype. Results: The positive rates of ASCA and PAB in CD patients were 34.7% (77/222) and 38.3% (85/222), respectively, which were higher than those in UC patients [10.3% (23/223) and 4.5% (10/223), P <0.001]. The positive rate of ANCA in UC patients was 50.2% (112/223), which was higher than that in CD patients [5.4% (12/222), P <0.001]. The positive rates of serum GAB in CD and UC patients were 21.6% (48/222) and 28.3% (63/223), respectively, with no significant difference ( P =0.760). In patients with CD, the sensitivity of mono-marker ASCA (+), dual-marker ASCA (+) ANCA (-), quadruple-marker ASCA (+) ANCA (-) PAB (+) GAB (-) in diagnosing CD was 34.7%, 32.9%, 20.7%, the specificity was 89.7%, 95.5%, 100.0%, the positive predictive value was 77.0%, 90.1%, 100.0%, and the negative predictive value was 58.0%, 58.7%, 55.9%, respectively. In patients with UC, the sensitivity of mono-marker ANCA (+), dual-marker ANCA (+) ASCA (-), quadruple-marker ANCA (+) ASCA (-) PAB (-) GAB (+) in diagnosing UC was 50.2%, 40.4%, 24.2%, the specificity was 94.6%, 95.5%, 100.0%, the positive predictive value was 90.3%, 90.0%, 100.0%, and the negative predictive value was 65.4%, 61.4%, 56.8%, respectively. Mono-marker ASCA (+) ( OR =3.39, 95% CI : 1.59-7.21), dual-marker ASCA (+) ANCA (-) ( OR =2.87, 95% CI : 1.34-6.14), triple-marker ASCA (+) ANCA (-) GAB (-) ( OR =3.09, 95% CI : 1.31-7.31) and quadruple-marker ASCA (+) ANCA (-) PAB (+) GAB (-) ( OR =3.15, 95% CI : 1.56-8.03) were associated with stenosis and/or penetrating type CD. The mono-marker ANCA (+) ( OR =2.69, 95% CI : 1.42-5.12) and dual-marker ANCA (+) ASCA (-) ( OR =2.11, 95% CI : 1.03-4.16) were associated with extensive colonic lesions in UC. Conclusion: Based on ASCA or ANCA, the combination with PAB or GAB, is conducive to IBD diagnosis, and is associated with stenosis and/or penetrating type of CD and extensive type of UC.

Objective: To evaluate the short-term efficacy and safety of vedolizumab in patients with inflammatory bowel disease (IBD). Methods: Patients with moderate and severe active IBD at the first use of vedolizumab from May 1 to October 31, 2021 were retrospectively enrolled. Then the clinical characteristics, and the efficacy and safety of vedolizumab were evaluated. Meanwhile, the clinical response rate, biological response rate and endoscopic response rate were calculated. Multivariate analysis was used to evaluate the independent influencing factors of short-term clinical efficacy and safety. Results: A total of 78 patients (44 males and 34 females) with IBD were enrolled, with a mean age of (40.5±11.9) years. The clinical remission rate, clinical response rate, biological remission rate, biological response rate and endoscopic remission rate was 60.3% (47/78), 85.9% (67/78), 70.5% (55/78), 43.6% (34/78) and 47.0% (31/66) respectively after 14 weeks of treatment. Body mass index (BMI) ≥ 18.5 kg/m 2 ( HR =5.04, 95% CI : 1.50-16.91, P =0.009) and biological remission at 6 weeks of treatment ( HR =15.22, 95% CI : 3.16-73.38, P =0.001) were predictors of endoscopic remission at 14 weeks of treatment. Adverse reactions occurred in 57 patients, with an incidence of 73.1%. The main manifestations were liver and kidney damage (37.2%) and infection (26.9%). Conclusions: More than half of patients with moderate and severe active IBD can achieve clinical remission after 14 weeks of vedolizumab treatment. Baseline BMI level and biological remission at 6 weeks of treatment are predictors of mucosal healing at 14 weeks. The incidence of adverse reactions is not low, although serious adverse reactions are rare in short-term treatment.

Objective: To investigate the prevalence of Crohn's disease (CD) among urban employees in 24 provinces (municipalities and autonomous regions) in China in 2013. Method: The crude annual prevalence of CD among urban employees with medical insurance in 2013 was estimated by using the basic medical insurance database of 24 provinces (municipalities and autonomous regions), as well as the prevalence by sex, age and region. The age-standardized rate based on the 2010 census was also estimated. Results: The crude prevalence of CD among urban employees in 2013 was 3.2/100 000(95 %CI :3.1/100 000-3.3/100 000) , and the sex-specific rate was 3.5/100 000 (95 %CI :3.3/100 000-3.6/100 000) and 3.0/100 000 (95% CI: 2.8/100 000-3.1/100 000) for male and female, respectively. The crude prevalence in different regions indicated that the highest crude prevalence was in the eastern region [5.6/100 000 (95% CI: 5.4/100 000-5.8/100 000) ]. Conclusion: The prevalence of CD in China is still lower than that of the western countries, with difference varied in terms of age, gender and region.

Objective: To summarize the extraintestinal manifestations and intestinal complications in children with Crohn's disease (CD)., Methods: The clinical data of 54 children who were diagnosed with CD in Peking Union Medical College Hospital from January 2008 to December 2018 were collected for retrospective analysis of extraintestinal manifestations and intestinal complications. According to the location of the lesion, the children were divided into ileocolonic group (30 cases), colonic group (6 cases), and ileal group (18 cases)., Results: In the 54 children, the mean age at diagnosis was 14.5±2.7 years, and the median duration from disease onset to definite diagnosis was 20 months (range: 1-36 months). Twenty-four patients (44%) had extraintestinal manifestations, with the two most common manifestations being growth retardation (11 cases, 20%) and oral mucosal ulcer (10 cases, 19%), followed by arthritis (2 cases, 4%), erythema nodosum (2 cases, 4%), and cholecystitis (2 cases, 4%). There were no significant differences in the incidence of extraintestinal manifestations among the three groups (P=0.792). The most common intestinal complications were anal fistula/perianal abscess (13 cases, 24%), followed by intestinal fistula (5 cases, 9%) and intestinal obstruction (4 cases, 7%). There was a significant difference in the incidence of intestinal complications among the three groups (P=0.0406). No intestinal complications were reported in the colonic group., Conclusions: Extraintestinal manifestations and intestinal complications are common in children with CD. Perianal examinations should be performed in children with suspected CD. Intestinal complications are less common in children with colonic CD, which may be associated with relatively mild disease condition.

Objective: To investigate the correlations of serum total 25-hydroxyvitamin D (T-25 (OH) D) levels with serum cytokine levels including interleukin-6 (IL-6), interleukin-8 (IL-8) and tumor necrosis factor α (TNF-α) and Crohn's disease activity index (CDAI) in patients with Crohn's disease (CD). Methods: A total of 60 patients with CD admitted in Peking Union Medical College Hospital from April 2014 to March 2019 who completed the tests for serum T-25 (OH) D and cytokines (IL-6, IL-8 and/or TNF-α) were retrospectively enrolled. Clinical data were collected for analysis. Results: Among 60 CD patients, there were 46 male patients, and the age was (34±13) years. There were 16 patients (26.7%) in remission and 44 cases (73.3%) in active status. The T-25(OH)D level was (16.0±7.7)μg/L. The prevalence of vitamin D sufficiency, insufficiency and deficiency was 26.7%, 40.0% and 33.3%, respectively. Correlation analysis showed that serum T-25 (OH) D level was negatively correlated with CDAI ( r= -0.363, P= 0.004), IL-6 level ( r= -0.360, P= 0.007), hsCRP level( r= -0.272, P= 0.043) and ESR level( r= -0.293, P= 0.024), while positively correlated with serum Alb level( r= 0.372, P= 0.003)、Hb( r= 0.330, P= 0.010) and BMI( r= 0.276, P= 0.033).Twenty-three cases (52.3%) of active CD patients accompanied with infection had a lower level of serum T-25 (OH) D than those without infection [(12.55±7.17) vs (17.41±6.49)μg/L, P= 0.023]. Conclusion: Serum T-25 (OH) D level was negatively correlated with CDAI, serum IL-6 level and inflammatory markers in patients with CD, and it was lower in active CD patients with infection than those without infection.

Background: Colorectal cancer (CRC) has become one of the major life-threatening complications in patients with inflammatory bowel disease (IBD), which includes ulcerative colitis (UC) and Crohn's disease (CD). This study aimed to explore the clinical-pathologic similarities and differences in the IBD-associated CRC (IBD-CRC) between patients in China and Canada., Methods: Data of 78 patients with IBD-CRC retrospectively retrieved from two representative medical institutions in Beijing (China) and Calgary (Canada) over the same past 13 years, including 25 (22 UC-associated and three CD-associated) from Beijing group and 53 (32 UC-associated and 21 CD-associated) from Calgary group, were compared with regards to their clinical and pathologic characteristics., Results: Several known features of IBD-CRC were seen in both groups, including long duration and large extent of colitis, active inflammation background, multifocal lesions, and advanced tumor-node-metastasis stage. Beijing group showed a significantly higher percentage of UC (88.0% vs. 60.4%, P = 0.018), younger age at diagnosis of CRC (48.6 ± 12.8 years vs. 61.6 ± 14.7 years, P < 0.001), lower ratio of mucinous adenocarcinoma (7.1% vs. 42.4%, P = 0.001) compared with Calgary group. None of the Beijing group had concurrent primary sclerosing cholangitis, while 5.7% of Calgary group did. Surveillance colonoscopy favored the detection rate of precancerous lesions (41.4% vs.17.0%, P = 0.002)., Conclusions: As compared with patients from the Calgary group, the IBD-CRC patients in Beijing group were younger, less CD-associated and had less mucinous features, otherwise they were similar in many common features.

To assess the quality and readability of patient-education information on Crohn's disease on the internet in China., Methods: Baidu and Sogou were chosen as search engines, and the top 58 webpages on Crohn's disease meeting the inclusion criteria were evaluated. After the data were screened, the quality of information was assessed by two specialists using a simplified DISCERN system. Different levels of official Chinese-teaching materials were used to build a readability model to predict the readability of these information., Results: Altogether 13 pieces of information were included in this study, all of which were derived from commercial webpages. The simplified DISCERN system found an excellent consistency in the Chinese literature, and Spearman's coefficient was 0.685, 0.556 and 0.607, respectively (P < 0.001), for publication reliability, treatment options and the total score. Most of the information lacked clear sources and conflicts of interest statements. The corresponding DISCERN scores were all below 2. In terms of treatment options, many webpages did not provide adequate information about the prognosis, possible side effects of treatment and risks of developing cancer. The scores of treatment-related DISCERN items were all below 2 as well. The webpages did not show enough readability. Altogether 84.6% of the information exceeded the middle-school readability level, and 69.2% exceeded the high-school level., Conclusions: The quality of patient-education information on Crohn's disease on the internet in China is worrisome, with poor readability, which should be addressed by the academic community., (© 2019 Chinese Medical Association Shanghai Branch, Chinese Society of Gastroenterology, Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine and John Wiley & Sons Australia, Ltd.)

This is a complicated and difficult case. The onset symptom of a 62-year-old male was recurrent intestinal obstruction. Ileocecal and ileocolic operation was done twice. Massive gastrointestinal bleeding occurred due to giant fistula of descending duodenum, which connected to ileocolic anastomosis. After consultation by multidisciplinary team, jejunal-feeding tube was placed to provide enteral nutrition. With general condition improving, duodenal fistula repair and involved bowel resection were performed. Postoperative pathology confirmed Crohn's disease. The patient was treated with thalidomide and recovered well during follow-up.

Objective: To evaluate the diagnostic value of capsular endoscopy in patients with obscure gastrointestinal bleeding (OGIB) in different age groups, and assess its effectiveness and safety. Methods: A total of 216 patients who were diagnosed with OGIB between March 2005 and March 2016 at Department of Gastroenterology of Peking Union Medical College Hospital were retrospectively reviewed. They were assigned into three groups: young adults, middle-aged and elderly. The demographic characteristics, clinical manifestations, working performance as well as endoscopic features in each group were collected and analyzed. Results: The detection rate and diagnosis rate of the young adults and middle-aged group were 98.53% vs 98.51% ( P =0.992), 92.65% vs 91.04% ( P =0.734), while those between the young adults and the elderly group were 98.53% vs 91.14% ( P =0.109), 92.65% vs 87.34% ( P =0.289), and 98.51% vs 91.14% ( P =0.113) and 91.04% vs 87.34 ( P =0.475) between the middle-aged and elderly group. No significant difference existed in either detection rates nor diagnostic rates between the different age groups. The distribution of the small intestinal lesions varied between the different age groups. The top three common lesions in young adults were vascular malformation, small intestine ulcer and Crohn's disease, while in the middle-aged group vascular malformation, non-specific enteritis and small intestine ulcer were the most common. Patients in elderly group were most likely to have vascular malformation, small intestine ulcer and erosion. Conclusions: For patients of any age with OGIB, capsule endoscopy is a safe, effective and comfortable examination which can be widely used in clinical practice.

Objective: The aim of this study was to explore the long-term risk of infection in patients with Crohn's disease (CD) on infliximab (IFX) therapy., Methods: All CD patients treated with IFX were recruited from January 2008 to December 2015. Their characteristics and infectious events during IFX therapy were prospectively collected, and the risk of infection was evaluated using Cox regression., Results: Seventy CD patients receiving IFX were consecutively recruited. During a median of 15 months, 15 patients experienced 17 infectious events which occurred within a median of 21 weeks after the initiation of IFX therapy. Of 17 infectious events, eight were viral infections, six were bacterial infections, and the others were fungal infections. IFX was discontinued in 6 (40.0%) out of 15 cases due to infections. Compared with those without infections, patients with infectious events were more likely of Montreal B1 (inflammatory) behavior, with concomitant use of systemic corticosteroids when infliximab was started but less mucosal healing when infections occurred (P < 0.05). By Cox hazard ratio (HR) analysis, patients with B1 behavior had a higher risk of developing infections than those with B3 (fistulizing) behavior (HR 4.897, P = 0.010). Successful corticosteroid withdrawal (HR 0.275, P = 0.035) or mucosal healing (HR 0.155, P = 0.002) were associated with a lower risk of infections., Conclusions: Long-term use of IFX in CD patients has a high risk of infections. Failure in mucosal healing and increased concomitant use of systemic corticosteroids are independent risk factors of infections during IFX therapy., (© 2017 Chinese Medical Association Shanghai Branch, Chinese Society of Gastroenterology, Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine and John Wiley & Sons Australia, Ltd.)

Objective: Azathioprine (AZA) is widely used to treat Crohn's disease (CD) with a recommended dose of 2-2.5 mg/kg per day for Westerners. Asian patients are suggested to take a lower dose. However, many clinicians reported poor efficacy with a reduced dose. This study aimed to explore a efficient and safe dose of AZA providing the best efficacy for Chinese CD patients., Methods: Fifty patients with active CD were enrolled and randomized into two groups (n = 25 each). All other treatments were the same except that group A received 1 mg/kg per day and group B took 2 mg/kg per day of AZA. Complete remission (CR) rate and response rate at weeks 12, 24 and 48 were assessed by using intent-to-treat (ITT) and per-protocol (PP) analyses. Adverse events and recurrence rate were also evaluated., Results: At week 48, CR rate and response rate in group B (ITT: 50.0% and 59.1%; PP: 57.9% and 68.4%) were significantly higher than those in group A (ITT: 13.0% and 17.4%; PP: 16.7% and 22.2%) (P < 0.05). Nine adverse events occurred, including pancreatitis (n = 1), arthritis (n = 2) and myelosuppression (n = 6). There was no significant difference in adverse events between the two groups. However, recurrence rate was significantly higher in group A than in group B (P = 0.042)., Conclusion: AZA 2 mg/kg per day is more appropriate than 1 mg/kg per day for Chinese CD patients with a high efficacy, a low recurrence rate and not increased adverse events., (© 2016 Chinese Medical Association Shanghai Branch, Chinese Society of Gastroenterology, Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine and John Wiley & Sons Australia, Ltd.)

Objective: This meta-analysis assessed the value of interferon-γ release assays (IGRAs) in the differential diagnosis of intestinal tuberculosis (ITB) from Crohn's disease (CD)., Methods: Systematic search without language restriction was conducted in the main computerized databases until June 2015. Studies that have evaluated the performance of IGRAs (QuantiFERON-TB Gold or T-SPOT.TB) in distinguishing ITB from CD were eligible. Main outcome measures included sensitivity and specificity. Area under the curve (AUC) of the summary receiver operating characteristic (sROC) curve was used to evaluate the accuracy of IGRAs., Results: Twelve studies (all from Asia) were finally included. The pooled sensitivity and specificity of IGRAs for the differential diagnosis of ITB from CD were 82.8% (95%CI 78.4%-86.6%) and 86.7% (95%CI 83.2%-89.6%) respectively. The positive likelihood ratio (PLR) and negative likelihood ratio (NLR) were 6.870 (95%CI 5.345-8.830) and 0.171 (95%CI 0.105-0.279). The diagnostic odds ratio was 44.030 (95%CI 27.964-69.325). And the AUC of sROC was 0.939., Conclusions: IGRAs have a high sensitivity and specificity for the diagnosis of ITB, and specificity is consistent from study to study. IGRAs may be considered as a supplementary method in the differential diagnosis of ITB from CD.

Background: The distinction between intestinal Behηet's disease (BD) and Crohn's disease (CD) is always challenging due to many overlapping clinical features. We conducted a retrospective study to reveal valuable strategies for the differential diagnosis between intestinal BD and CD in Chinese patients based on their clinical and colonoscopic features., Methods: Thirty-five intestinal BD patients and 106 CD patients hospitalized from January 1983 to January 2010, who had ulcerative lesions in the terminal ileum or colon under colonoscopy and no history of gastrointestinal operation except appendectomy before admission, were enrolled. Univariate and multivariate logistic regression analyses were conducted to find discriminating predictors among demographic data, clinical manifestations, and colonoscopic findings., Results: Based on univariate analysis, massive gastrointestinal hemorrhage, fever, and extraintestinal systemic manifestations were more common in intestinal BD patients (P = 0.022, 0.048 and 0.001, respectively), while diarrhea, intestinal obstruction, and perianal lesions were more common in CD patients (P = 0.002, 0.010, and 0.027 respectively). Based on colonoscopy, focal involvement, ileocecal valve deformity, solitary ulcers, large ulcers (ulcer size > 2 cm), and circumferential ulcers were more common in intestinal BD patients (P = 0.003, 0.003, 0.014, 0,013, and 0.003, respectively), while segmental involvement, longitudinal ulcers, a cobblestone or nodular appearance, and pseudo-polyps were more common in CD patients (P = 0.003, 0.008, 0.023, and 0.002, respectively). Based on multivariate logistic regression analysis, diarrhea, extraintestinal manifestations, ulcer distribution, size, and type, and pseudo-polyps were independent discriminating predictors between the two groups (P = 0.048, 0.008, 0.006, 0.021, 0.002, and 0.041, respectively). The discriminating algorithm composed of the above independent predictors had the highest area under the curve of 0.987 for distinguishing between the two diseases., Conclusions: Extraintestinal systemic manifestations and the characteristic colonoscopic features, such as ulcer distribution, size and type, helped to distinguish intestinal BD from CD.

Objective: To investigate the safety of thalidomide in the treatment of immune-related bowel diseases for providing clinical reference., Methods: Thirty-five patients with immune-related bowel diseases (31 Crohn's disease, 2 ulcerative colitis and 2 Behcet's disease) treated with thalidomide were enrolled in this study. The incidence, type, severity, duration of thalidomide related adverse drug reaction (ADR) and the dose-effect relationship of neurotoxicity were analyzed., Results: All the patients were treated with a mean dose of thalidomide (109.29 ± 30.37) mg/d for (18.8 ± 12.4) months, and 33 occurred ADR. The three most frequent ADR were numbness [51.4% (18/35) ], somnolence [48.6% (17/35) ] and dermatitis [37.1% (13/35) ]. The median time to development of these three ADR were 6.50, 0.25, and 1.00 months, respectively. Severe ADR leading to withdrawal accounted for 20.0% (7/35), including reasons of peripheral neuritis (3/7), dermatitis (2/7) and myelosuppression (2/7). The incidence of peripheral neuritis was not significantly related to the maximal and initial dose of thalidomide (P > 0.05)., Conclusions: Although the incidence of ADR was relatively high during the treatment of thalidomide, most of them were mild and well tolerated. Thalidomide can be safely used in patients with immune-related bowel diseases under close monitoring.

Aim: Intestinal tuberculosis (ITB) and Crohn's disease (CD) have overlapping clinical, radiographic, endoscopic and histologic features, which makes the distinction between these two disease entities a great challenge in tuberculosis-endemic countries. The aim of the study was to investigate the value of in vitro interferonγ release assay (T-SPOT.TB) in differentiating ITB from CD., Methods: From June 2008 to February 2010, a total of 93 consecutive patients with undetermined ITB or CD were prospectively recruited. Clinical, endoscopic, histologic and therapeutic responses were longitudinally monitored at follow-up evaluation until the final definite diagnosis has been reached., Results: After a median of 6 months' follow-up (interquartile range [IQR], 3.0 to 7.5 months), definitive diagnosis was achieved in 84 of the 93 patients (90%), with 19 having ITB and 65 having CD. On univariate analysis, a long duration of illness, chronic diarrhea, and anemia were significantly more common in CD (P<0.05). While night sweat, ascites, pulmonary lesions, circumferential ulcer on endoscopy, ileo-cecal valve involvement and epithelioid granulomas were significantly more common in ITB (P<0.05). On multivariate analysis, T-SPOT.TB (Hazard ratio 7.0, 95% confidence interval [CI] 1.9-25.7) was found to be a good predictor for ITB diagnosis. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) of T-SPOT.TB were 84.2%, 75.4%, 50.0%, and 94.2%, respectively., Conclusions: When differentiating ITB and CD in tuberculosis-endemic regions, T-SPOT.TB blood test may be a helpful and practical diagnostic tool for its high NPV to rule out ITB., (Crown Copyright © 2012. Published by Elsevier B.V. All rights reserved.)

Objective: To investigate the diagnostic value of capsule endoscopy (CE), CT enterography (CTE), ileocolonoscopy and small bowel follow through (SBFT) for small bowel Crohn's disease (CD)., Methods: Fifty-seven consecutive patients with CD underwent ileocolonoscopy, CTE, CE, and SBFT. It included the presence of the following symptoms and signs: abdominal pain, weight loss, diarrhea, fever and positive fecal occult blood test. The location and the characteristics of intestinal and extra-intestinal lesions detected by four techniques were compared. The proportions of patients with positive findings using each examination were compared., Results: Of the 57 patients, 50 underwent ileocolonoscopy, terminal ileum lesion was found in 33 patients (66.00%), the remaining 17 (34.0%) were normal; among 34 patients who had CTE, 29 of small bowel lesion were found (85.29%); CE were performed in 27 patients, due to prolonged gastric transit one time, the capsule did not reach the cecum in one patient during battery lifetime. CE showed small bowel lesion in 26 patients (96.30%); SBFT was performed in 39 patients and 26 of small bowel lesion were detected (66.67%). CE had the highest diagnostic yield for CD and ileocolonoscopy had the lowest, and there were statistically significant difference among the 4 examinations (P = 0.006). The combined positive rates of two methods were: CE + CTE 92.86% (13/14), SBFT + CTE 90.91% (20/22), CE + ileocolonoscopy 95.65% (22/23), CE + SBFT 100% (17/17), ileocolonoscopy + CTE 89.66% (26/29), ileocolonoscopy + SBFT 77.78% (28/36), but there were no significant differences between each two examinations., Conclusion: CE, CTE have a higher yield in depicting mild to moderate finding of CD than SBFT. CE is better for assessing early mucosal disease, whereas CTE is better for detecting transmural and extraluminal abnormalities. Most important, CE plus CTE may depict nonobstructive CD of the small bowel when conventional techniques such as ileocolonoscopy or SBFT have negative or inconclusive finding. CE provides us explanations for the symptoms of patients, decision to follow up or therapy.

Objective: To investigate the therapeutic effect of immunodepressant on Crohn's disease (CD)., Methods: 105 patients with CD were collected from 1983 to 2006 in Peking Union Medical College Hospital. All of their clinical manifestations and therapeutic results were analyzed retrospectively., Results: (1) The application of immunodepressant was significantly increased after the year of 2000 (34.7% vs 3.0%, P = 0.000). (2) The application of immunodepressant and the clinical features of these patients were as follows: 1) The number of patients with moderate to severe CD were more than that with mild CD in those using immunodepressant (28.9% vs 0). 2) The use of immunodepressant was not related with the diseased site of CD, because there were no difference among the groups with lesion in small intestine (20.0%), colon (27.3%) and ileocolon (27.1%), P =0.726. 3) The serum albumin level of CD patients using immunodepressant was significantly lower than that of those not using (31.9 g/L vs 35.1 g/L, P = 0.047). 4) The use of immunodepressant did not decrease the incidence of operative treatment (38.5% vs 50.0%, P= 0.320). (3) The rate of remission in 19 CD patients using azathioprine is 68.4% (13/19) and the percentage of neutrophil in the group with relief was lower than that without relief (0.76 vs 0.65, P = 0.032)., Conclusions: Immunodepressant is playing more important role in the treatment of CD. The patients with moderate and severe CD with as well as lower serum albumin should be treated with immunodepressant as early as possible. Whether immunodepressant is necessary or not is not decided by the diseased site. CD patients with higher percentage of neutrophil have less therapeutic effect than those with lower.