'Camera Pill' Promising For Diagnosing Small Bowel Disease

Pairing Pill With CT Scan A Plus

< January 7, 2004 > -- An ingestible video camera that produces digital images of the small intestine can "see" areas other diagnostic techniques cannot, and aided researchers in the diagnosis of small bowel disease, according to a study reported in the medical journal Radiology.

Capsule endoscopy (CE) displays the small bowel's entire length (as long as 25 feet) as the intestine's involuntary muscles push this "camera pill" forward.

CE heralds an important step forward in the diagnosis of small bowel disorders, demonstrating more abnormalities than standard small bowel imaging techniques, the researchers say.

But its greater promise may lie in conjunction with computed tomography (CT). CE does a good job of indicating the presence of abnormalities, but does not tell their location, the authors say.

Images Created as Camera Travels

The video capsule - the size of a large vitamin pill - is swallowed by a patient after an eight-hour fast.

The CE transmits a continuous stream of digital images to a small data recorder worn around the patient's waist. The CE passes through the digestive tract without interfering with normal activites. The physician downloads the data and analyzes the images at a workstation.

"As the camera tumbles through the intestine, you don't know exactly where the mass is located," says lead author Dr. Amy K. Hara, diagnostic radiologist at Mayo Clinic in Scottsdale, Ariz.

"CT, by contrast, provides a very good global view of the body, and specialized parameters can be employed to localize lesions," Dr. Hara says.

Among those who may benefit from CE are individuals with Crohn's disease, a form of inflammatory bowel disease that occurs most often in the lower portion of the small intestine and is marked by diarrhea, abdominal pain, and bleeding.

Unlike standard endoscopy, CE (also known as wireless endoscopy) can examine the entire small intestine. Endoscopy, which uses a fiberoptic scope, reaches only the upper and very lower portion of the small intestine.

CE also demonstrated more tumors, ulcers, vascular malformations, and other small bowel abnormalities than ingested barium exams or CT, the current diagnostic standards for small intestine disorders.

Experts say CE does not replace a standard upper gastrointestinal study (barium swallow) used to detect diseases of the esophagus or stomach, or colonoscopy used to detect colorectal cancer. CE may not be recommended for persons with a history of prior gastrointestinal surgery or bowel obstruction.

Finding Missing Information

The Mayo study reviewed data on the first 52 patients to undergo CE at the clinic following a barium study or CT for unexplained gastrointestinal bleeding, inflammatory bowel disease, or chronic abdominal pain.

Forty patients received a barium study and CE. Of those, CE helped radiologists detect abnormalities in 22 patients (55 percent), while barium studies yielded abnormal results in only 1 patient (3 percent).

Nineteen patients underwent CT examination as well as CE. Of those, CE helped radiologists detect abnormalities in 12 patients (63 percent), while CT yielded abnormal results in 4 patients (21 percent).

"We wanted to see what we were missing or not missing with standard radiology techniques," says Dr. Hara. "The information we are gaining from CE will allow us to improve our use of CT for better diagnoses and determine when to pair the two technologies."

The CE technology, developed by Given Imaging Ltd., was approved in 2001 by the US Food and Drug Administration (FDA) for use along with - not as a replacement for - other endoscopic and radiological evaluations of the small bowel.

An earlier study by researchers at Baylor College of Medicine showed the success of CE for finding damage to the small bowel from non-steroidal anti-inflammatory drugs (NSAIDs).

Studies, such as Dr. Hara's, are continuing to look at the effectiveness of the technology and the ways it may complement standard technologies.

Always consult your physician for more information.

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What Is Crohn's Disease?

Crohn's disease is an inflammatory bowel disease that is a chronic condition and may recur at various times over a lifetime. It usually involves the small intestine, most often the lower part called the ileum.

However, in some cases, both the small and large intestine are affected. Sometimes, inflammation may also affect the entire digestive tract, including the mouth, esophagus, stomach, duodenum, appendix, or anus.

Crohn's disease is also called ileitis or enteritis.

Crohn's disease affects males and females equally. It appears to run in some families, with about 20 percent of people with Crohn's disease having a blood relative with some form of inflammatory bowel disease.

The following are the most common symptoms of Crohn's disease:

Some people have long periods of remission, sometimes for years, when they are free of symptoms. There is no way to predict when a remission may occur or when symptoms will return.

People who have experienced chronic abdominal pain, diarrhea, fever, weight loss, and anemia may be examined for signs of Crohn's disease.

In addition to a complete medical history and physical examination, diagnostic procedures for Crohn's disease may include the following:

blood tests - a test to determine if there is anemia resulting from blood loss, or if there is an increased number of white blood cells, suggesting an inflammatory process)

stool culture - checks for the presence of abnormal bacteria in the digestive tract that may cause diarrhea and other problems. A small sample of stool is collected and sent to a lab.

esophagogastroduodenoscopy (Also called EGD or upper endoscopy.)
An EGD (upper endoscopy) is a procedure that allows the physician to examine the inside of the esophagus, stomach, and duodenum. A thin, flexible, lighted tube, called an endoscope, is guided into the mouth and throat, then into the esophagus, stomach, and duodenum. The endoscope allows the physician to view the inside of this area of the body.

biopsy - a procedure performed to remove tissue or cells from the lining of the colon for examination under a microscope.

upper GI (gastrointestinal) series (Also called barium swallow.) - a diagnostic test that examines the organs of the upper part of the digestive system: the esophagus, stomach, and duodenum (the first section of the small intestine). A fluid called barium is swallowed. X-rays are then taken to evaluate the digestive organs.

lower GI (gastrointestinal) series (Also called barium enema.) - a procedure that examines the rectum, the large intestine, and the lower part of the small intestine. A fluid called barium is given into the rectum as an enema. An x-ray of the abdomen shows strictures (narrowed areas), obstructions (blockages), and other problems.

colonoscopy - a procedure that allows the physician to view the entire length of the large intestine, and can often help identify abnormal growths, inflamed tissue, ulcers, and bleeding. It involves inserting a colonoscope, a long, flexible, lighted tube, in through the rectum up into the colon. The colonoscope allows the physician to see the lining of the colon, remove tissue for further examination, and possibly treat some problems that are discovered.

Always consult your physician for more information.