Given Imaging has presented data from six studies at Digestive Disease Week 2003, in Orlando, FL, which further support using capsule endoscopy for the diagnosis and evaluation of patients with suspected Crohn's disease. These studies show that capsule endoscopy is a useful tool in the diagnosis of Crohn's disease, avoids radiation associated with small bowel follow through procedures and provides a higher diagnostic yield. Until capsule endoscopy, physicians have used a variety of procedures for diagnosis including endoscopy and barium X-ray.

"We are learning from clinical trials that many patients with assumed active disease may in fact not have active inflammation as determined by objective measures. Capsule endoscopy findings in these patients may prove very valuable in guiding day-to-day therapy. It may also prove a very valuable tool in patients after surgery for Crohn's disease as a predictive tool as to which patients require preventative medical therapy," said Dr Asher Kornbluth, of the Henry D Janowitz Division of Gastroenterology, Department of Medicine, The Mount Sinai Medical Center.

potential gene-gene interactions in Crohn's disease
Gut 2003;52:541-546
K Negoro, D P B McGovern, Y Kinouchi, S Takahashi, N J Lench, T Shimosegawa, A Carey, L R Cardon, D P Jewell and D A van Heel

Background and aims: Genetic variation in the chromosome 5q31 cytokine cluster (IBD5 risk haplotype) has been associated with Crohn's disease (CD) in a Canadian population. We studied the IBD5 risk haplotype in both British and Japanese cohorts. Disease associations have also been reported for CARD15/NOD2 and TNF variants. Complex interactions between susceptibility loci have been shown in animal models, and we tested for potential gene-gene interactions between the three CD associated loci.

Methods: Family based association analyses were performed in 457 British families (252 ulcerative colitis, 282 CD trios) genotyped for the IBD5 haplotype, common CARD15, and TNF-857 variants. To test for possible epistatic interactions between variants, transmission disequilibrium test analyses were further stratified by genotype at other loci, and novel log linear analyses were performed using the haplotype relative risk model. Case control association analyses were performed in 178 Japanese CD patients and 156 healthy controls genotyped for the IBD5 haplotype.

Results: The IBD5 haplotype was associated with CD (p=0.007), but not with UC, in the British Caucasian population. The CARD15 variants and IBD5 haplotype showed additive main effects, and in particular no evidence for epistatic interactions was found. Variants from the IBD5 haplotype were extremely rare in the Japanese.

Conclusions: The IBD5 risk haplotype is associated with British CD. Genetic variants predisposing to CD show heterogeneity and population specific differences.