Background: Little is known about the accuracy of capsule endoscopy (CE) in evaluation of small-bowel Crohn’s disease. Methods: Symptomatic eligible patients had ileocolonoscopy and biopsies from the terminal ileum, followed by small-bowel radiologic studies before CE. Endoscopic, radiologic, CE, and histologic findings were compared. Histology (terminal ileum biopsy specimens or a tissue sample after small-bowel resection) served as a criterion standard. Results: Fifty-four patients were enrolled; 15 of the 54 patients were excluded from data analysis (critical small-bowel strictures,14, identified on radiology; incomplete CE, 1). Data were analyzed for 39 patients. All patients had histologic evaluation of the small bowel. Final diagnosis of active small-intestine Crohn’s disease was made in 29/39 patients (74.4% ). When calculated, CE yielded a sensitivity and a specificity of 89.6% and 100.0% , respectively, and a positive predictive value and a negative predictive value of 100.0% and 76.9% , respectively,whereas small-bowel series were 27.6% /100.0% and 100.0% /32.3% . Conclusions: CE is more accurate in detecting small-bowel inflammatory changes suggestive of Crohn’ s disease than conventional studies. CE, combined with ileocolonoscopy,may be proposed as a first-line investigation of the small intestine in cases of uncomplicated known or suspected Crohn’s disease. Methods: Symptomatic eligible patients had ileocolonoscopy and biopsies from the terminal ileum, followed by small-bowel radiologic studies before CE. Endoscopic, radiologic , CE, and histologic findings were compared. Histology (terminal ileum biopsy specimens or a tissue sample after small-bowel resection) served as a criterion standard. Results: Fifty-four patients were enrolled; 15 of the 54 patients were excluded from data analysis All patients had histologic evaluation of the small bowel. Final diagnosis of active small-intestine Crohn’s disease was made in 29 / 39 patients (74.4%). When calculated, CE yielded a sensitivity and a specificity of 89.6% and 100.0%, respectively, and a positive predictive value and a negative predictive value of 100.0% and 76.9%, respectively, small-bowel series were 27.6% /100.0% and 100.0% /32.3%. Conclusions: CE is more accurate in detecting small-bowel inflammatory changes suggestive of Crohn’s disease than conventional studies. CE, combined with ileocolonoscopy, may be proposed as a first-line investigation of the small intestine in cases of uncomplicated known or suspected Crohn’s disease.