Capsule endoscopy in nonresponsive celiac disease.

Abstract

BACKGROUND:

Nonresponsive celiac disease (CD) is defined by persistent or recurrent symptoms, common after treatment with a gluten-free diet (GFD).

OBJECTIVE:

To evaluate the utility of capsule endoscopy (CE) in nonresponsive CD.

DESIGN:

Case-control study.

SETTING:

Tertiary-care center.

PATIENTS:

Forty-two consecutive patients with nonresponsive CD and 84 age- and sex-matched CD-free controls who underwent CE were included. In addition, capsules taken after treatment with a GFD were retrospectively evaluated in 30 patients with uncomplicated CD.

INTERVENTION:

CE.

MAIN OUTCOME MEASUREMENTS:

Diagnostic accuracy of CE for the detection of mucosal abnormalities in nonresponsive CD.

RESULTS:

Macroscopic features of villous atrophy were detected in 13 of 42 patients (31%) with nonresponsive CD compared with none among 84 CD-free controls and 14 of 30 patients (47%) with uncomplicated CD. Among nonresponsive CD cases, the overall sensitivity and specificity of CE for the detection of any degree of villous atrophy as graded by histology were 56% and 85%, respectively. Single or multiple erosions/ulcerations of the gut were observed in 19% of nonresponsive CD patients, 18% of CD-free controls, and 31% of patients with uncomplicated CD (P = .35). The presence of erosions/ulcerations was associated with increased aspirin/nonsteroidal anti-inflammatory drug use in nonresponsive CD (P =.05). Two severe complications (ulcerative jejunitis and adenocarcinoma) were detected by CE in nonresponsive CD.

LIMITATIONS:

Single-center, retrospective study.

CONCLUSIONS:

Mucosal abnormalities were observed by CE in patients with both nonresponsive CD and uncomplicated CD. CE can detect severe complications in patients with nonresponsive CD.

• Authors: David S Atlas, Alberto Rubio-Tapia, Carol T Van Dyke, Brian D Lahr, Joseph A Murray
• Journal: Gastrointestinal endoscopy (Gastrointest Endosc) Vol. 74 Issue 6 Pg. 1315-22 (Dec 2011) ISSN: 1097-6779 [Electronic] United States
• PMID: 21835400 (Publication Type: Comparative Study, Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2011 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.

Topics

• Capsule Endoscopy (methods)
• Celiac Disease (diagnosis, diet therapy)
• Diagnosis, Differential
• Diet, Gluten-Free (methods)
• Female
• Humans
• Intestinal Mucosa (pathology)
• Male
• Middle Aged
• Prognosis
• Retrospective Studies
• Sensitivity and Specificity
• Treatment Failure