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Gastrointest Endosc. 2013 Feb;77(2):227-32. doi: 10.1016/j.gie.2012.09.031. Epub 2012 Nov 30.

Capsule endoscopy in adult celiac disease: a potential role in equivocal cases of celiac disease?

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1
Department of Gastroenterology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, South Yorkshire, United Kingdom.

Abstract

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.

PMID:
23200728
DOI:
10.1016/j.gie.2012.09.031
[Indexed for MEDLINE]
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