Capsule endoscopy in nonresponsive celiac disease

Gastrointestinal Endoscopy, 08/16/2011

Atlas DS et al. – Mucosal abnormalities were observed by capsule endoscopy(CE) in patients with both nonresponsive celiac disease(CD) and uncomplicated CD. CE can detect severe complications in patients with nonresponsive CD.

Methods

  • Case-control study was done at Tertiary-care center.
  • 42 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.
  • Diagnostic accuracy of CE for the detection of mucosal abnormalities in nonresponsive CD was measured.

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).
  • 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.

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