Author(s): Atlas DS, RubioTapia A, Van Dyke CT, Lahr BD, Murray JA
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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. Copyright © 2011 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.
This article was published in Gastrointest Endosc
and referenced in Journal of Gastrointestinal & Digestive System