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  • Scott Adams
    Scott Adams

    Is Small-Bowel Capsule Endoscopy Useful in Cases of Equivocal Celiac Disease?

    Reviewed and edited by a celiac disease expert.

    What's the relationship between positive SBCE and celiac disease?

    Is Small-Bowel Capsule Endoscopy Useful in Cases of Equivocal Celiac Disease? - A patient is prepared for an endoscopy. Image: CC BY-SA 4.0--Peggy.poon
    Caption: A patient is prepared for an endoscopy. Image: CC BY-SA 4.0--Peggy.poon

    Celiac.com 05/07/2020 - Seronegative villous atrophy (SNVA), raised intraepithelial lymphocytes (IELs) and crypt hyperplasia on duodenal histology can be caused by celiac disease or by drugs or infections.

    A team of researchers recently set out to assess the role of small-bowel capsule endoscopy (SBCE) in these patients and to determine SBCE findings at diagnosis can predict disease outcome.



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    The research team included Stefania Chetcuti Zammit, Annalisa Schiepatti, Imran Aziz, Matthew Kurien, David S. Sanders, and Reena Sidhu. They are variously affiliated with the Academic Unit of Gastroenterology, Royal Hallamshire Hospital, Sheffield, UK, and the Academic Unit of Gastroenterology, Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield Medical School, Sheffield.

    The team assessed 177 patients with SNVA, IELs +/-crypt hyperplasia on duodenal histology. These patients all had an equivocal diagnosis of celiac disease.

    About one in three patients had a positive SBCE. Most patients had disease affecting the proximal third of the small bowel. All patients in the SNVA-celiac disease group who later developed poor outcomes had a positive SBCE. 

    These patients also showed much more widespread small bowel disease than those with no adverse incidents. More-extensive small bowel disease on SBCE was associated with a higher SNVA-related deaths in patients with SNVA-UO and SNVA-celiac disease. 

    Interestingly, severity of gut damage did not correlate with mortality, meaning that it's possible to recover and become healthy.

    Overall, the team found that positive SBCE at diagnosis corresponds to a worse celiac disease outcome. Crucially, widespread disease in these patients is associated with poor survival rates. Spotting and aggressively treating patients with extensive disease at diagnosis can improve outcomes for many of these patients.

    Read more at: Gastrointestinal Endoscopy

    Edited by Scott Adams



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  • About Me

    Scott Adams

    Scott Adams was diagnosed with celiac disease in 1994, and, due to the nearly total lack of information available at that time, was forced to become an expert on the disease in order to recover. In 1995 he launched the site that later became Celiac.com to help as many people as possible with celiac disease get diagnosed so they can begin to live happy, healthy gluten-free lives.  He is co-author of the book Cereal Killers, and founder and publisher of the (formerly paper) newsletter Journal of Gluten Sensitivity. In 1998 he founded The Gluten-Free Mall which he sold in 2014. Celiac.com does not sell any products, and is 100% advertiser supported.


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    Jefferson Adams
    Celiac.com 01/02/2012 - To properly diagnose celiac disease doctors must observe classic histological changes to small bowel mucosa. Success rates can vary among clinics and practitioners. A clinical team recently compared biopsy interpretation between different pathology practice types.
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    Journal of Clinical Pathology (2011). doi:10.1136/jclinpath-2011-200372


    Jefferson Adams
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    Jefferson Adams
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    Read more in the Eur J Gastroenterol Hepatol 31: 1496–1501


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