Background
There have been limited studies evaluating capsule endoscopy (CE) in equivocal celiac
disease (CD).
Objective
To determine the role CE may have in equivocal CD cases, compared with patients with
biopsy-proven and serology-proven CD who have persisting symptoms.
Design
Prospective cohort study.
Setting
University hospital.
Patients
A total of 62 patients with equivocal CD and 69 patients with nonresponsive CD.
Intervention
CE.
Main Outcome Measurements
Diagnostic yield of CE in equivocal cases and accuracy of mucosal abnormality detection
in patients with nonresponsive CD.
Results
Equivocal cases (n = 62) were divided into two subgroups: group A (antibody-negative
villous atrophy, n = 32) and group B (Marsh 1-2 changes, n = 30). In group A, CE secured
a diagnosis of CD or Crohn's disease in 28% (9/32), significantly higher than the
diagnostic yield in group B (7%; P = .044). In patients with CD with persisting symptoms, significant CE findings were
identified in 12% (8/69), including 2 cases of enteropathy-associated lymphoma, 4
type 1 refractory disease cases, 1 polypoidal mass histologically confirmed to be
a fibroepithelial polyp, and 1 case of ulcerative jejunitis. This outcome was significantly
lower than the diagnostic yield of CE in antibody-negative villous atrophy (P = .048).
Limitations
Single center.
Conclusion
There have been no previous reports systematically evaluating equivocal CD by using
CE. The diagnostic yield of CE in patients with antibody-negative villous atrophy
is better than that of CE in patients with CD with persisting symptoms. We advocate
the use of CE in equivocal cases, particularly in patients with antibody-negative
villous atrophy.
Abbreviations:
CE (capsule endoscopy), CD (celiac disease), EMA (endomysial antibodies), HLA (human leukocyte antigen), tTG (tissue transglutaminase)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: December 03, 2012
Accepted:
September 20,
2012
Received:
June 25,
2012
Footnotes
DISCLOSURE: All authors disclosed no financial relationships relevant to this publication.
Identification
Copyright
© 2013 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.
ScienceDirect
Access this article on ScienceDirectLinked Article
- Endoscopic diagnosis of celiac disease: what is the role of capsule endoscopy?Gastrointestinal EndoscopyVol. 78Issue 2
- PreviewI read with great interest the recent article by Kurien and colleagues.1 They found that video capsule endoscopy (VCE) may be a useful tool in the diagnosis of celiac disease (CD) in equivocal cases, especially in antibody-negative villous atrophy. These results are of interest for clinicians, but they need to be translated from bench to bedside.
- Full-Text
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