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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.

journal_name

Gastrointest Endosc

journal_title

Gastrointestinal endoscopy

authors

Atlas DS,Rubio-Tapia A,Van Dyke CT,Lahr BD,Murray JA

doi

10.1016/j.gie.2011.05.049

subject

Has Abstract

pub_date

2011-12-01 00:00:00

pages

1315-22

issue

6

eissn

0016-5107

issn

1097-6779

pii

S0016-5107(11)01777-9

journal_volume

74

pub_type

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