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Diagnostic yield of capsule endoscopy in refractory celiac disease

The latest issue of American Journal of Gastroenterology reports on the diagnostic yield of capsule endoscopy in refractory celiac disease

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Capsule endoscopy (CE) allows for the assessment of the small bowel in numerous intestinal diseases, including celiac disease (CD).

The main advantage of CE is the complete visualization of the intestinal mucosal surface.

Dr Maximilien Barret and colleagues from Paris, France investigated whether CE can predict the severity of CD and detect complications.

The team retrospectively studied the medical files of 9 patients with symptomatic CD, 11 patients with refractory celiac disease type I (RCDI) and 18 patients with refractory celiac disease type II (RCDII), and 45 patients without CD who were investigated both CE and upper endoscopy or enteroscopy.

The type of CD was diagnosed on the basis of a centralized histological review, flow cytometry analysis of intraepithelial lymphocytes, and the analysis of T-cell receptor rearrangement by multiplex polymerase chain reaction.

The researchers found that a total of 47 CEs from the 38 celiac patients and 47 CEs from the 45 nonceliac patients were retrospectively reviewed.

45 nonceliac patients were retrospectively reviewed
American Journal of Gastroenterology

Villous atrophy, numerous, or distally located ulcers were more frequent in celiac patients than in controls.

Among celiac patients, CE was of acceptable quality in 96% of cases and was complete in 62% of cases.

The concordance of CE with histology for villous atrophy was better than that of optic endoscopy. 

Extensive mucosal damage on CE was associated with low serum albumin and the RCDII form.

The research team detected 3 cases of overt lymphoma by CE during the follow-up.

Dr Barret's team conclude, "CE findings have a satisfactory concordance with histology and nutritional status in patients with symptomatic or refractory CD."

"Moreover, CE may predict the type of RCD and allows for the early detection of overt lymphoma."

Am J Gastroenterol 2012: 107: 1546-53
12 October 2012

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