Development and validation of a scoring index to predict the presence of lesions in capsule endoscopy in patients with suspected Crohn's disease of the small bowel: a Spanish multicenter study.

BACKGROUND: Capsule endoscopy (CE) is the first-line investigation in cases of suspected Crohn's disease (CD) of the small bowel, but the factors associated with a higher diagnostic yield remain unclear. OBJECTIVE: Our aim is to develop and validate a scoring index to assess the risk of the patients in this setting on the basis of biomarkers. PATIENTS AND METHODS: Data on fecal calprotectin, C-reactive protein, and other biomarkers from a population of 124 patients with suspected CD of the small bowel studied by CE and included in a PhD study were used to build a scoring index. This was first used on this population (internal validation process) and after that on a different set of patients from a multicenter study (external validation process). RESULTS: An index was designed in which every biomarker is assigned a score. Three risk groups have been established (low, intermediate, and high). In the internal validation analysis (124 individuals), patients had a 10, 46.5, and 81% probability of showing inflammatory lesions in CE in the low-risk, intermediate-risk, and high-risk groups, respectively. In the external validation analysis, including 410 patients from 12 Spanish hospitals, this probability was 15.8, 49.7, and 80.6% for the low-risk, intermediate-risk, and high-risk groups, respectively. CONCLUSION: Results from the internal validation process show that the scoring index is coherent, and results from the external validation process confirm its reliability. This index can be a useful tool for selecting patients before CE studies in cases of suspected CD of the small bowel.

La hipoplasia del esmalte en la esclerosis tuberosa / Enamel hypoplasia in the tuberous sclerosis

La hipoplasia del esmalte dental es un signo constante y patognomónico en los pacientes con ET. El defecto consiste en pequeñas cavidades que miden en promedio 80 micras y afecta exclusivamente el esmalte sin dañar la dentina. Se estudiaron las características morfológicas de dientes retenidos en tres pacientes con ET, los resultados mostraron variabilidad en la forma y el tamaño de las cavidades hipoplásicas siendo de constitución cilíndrica y cónica y el tamaño varió entre 50 a 500 micras y no se afectó la dentina. La identificación clínica y el reconocimiento morfológico de la hipoplasia del esmalte en dientes deciduos y permanentes es de gran valor para el diagnósico temprano cuando aún no se han manifestado otras anomalías del complejo de ET.