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Crohn’s Disease Diagnosed Only by Capsule Endoscopy Shows Milder Disease Course
Published online: July 24, 2025


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Clinical characteristics and long-term disease course in patients with Crohn’s disease as diagnosed by video capsule endoscopy: a multicenter retrospective matched case-control study
Intest Res. 2025;23(3):290-301

Video capsule endoscopy (VCE) is rarely used as a primary diagnostic tool for Crohn’s disease (CD), particularly in patients who show no abnormalities on ileocolonoscopy or cross-sectional imaging such as CT or MR enterography. This multicenter study, conducted at three tertiary hospitals between 2007 and 2022, evaluated the clinical features and long-term outcomes of patients diagnosed with CD based solely on VCE findings. Among 3,752 CD patients, only 24 (0.6%) were identified through VCE alone, highlighting the rarity of this diagnostic pathway.
These patients demonstrated distinct clinical characteristics compared to matched controls who were diagnosed using conventional methods. Specifically, they had significantly different disease locations and behavior at diagnosis, along with milder disease activity and lower levels of inflammatory markers such as C-reactive protein (CRP) and fecal calprotectin. Over a 10-year follow-up period, the VCE-diagnosed group experienced more favorable outcomes, including lower cumulative rates of disease complications, biologics use, hospitalizations, and surgical interventions. These findings suggest that although rare, Crohn’s disease cases detected only by VCE represent a clinically unique subgroup with a less aggressive disease course.

  1. Very low prevalence: Only 0.6% of Crohn’s disease cases were diagnosed solely using video capsule endoscopy findings.
  2. Milder initial disease: These patients had significantly lower disease activity and inflammatory markers (CRP, fecal calprotectin) at diagnosis.
  3. Better long-term outcomes: Over a 10-year follow-up, they experienced fewer complications, less need for biologic therapy, and lower rates of hospitalization and surgery.

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