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Video Capsule Enteroscopy Shows Promise in Diagnosing Celiac Disease 10/30/2007 - A recent study published in the August issue of American Journal of Gastroenterology suggest that villous atrophy in suspected cases of celiac disease can be reliably detected by video capsule enteroscopy (VCE).

Reliable diagnosis presently demands the identification of tell-tale lesions in the mucosa of the small bowel. Accomplishing such identification requires an endoscopy of the upper gastrointestinal tract, and multiple duodenal biopsies.

A team of Italian researchers evaluated the effectiveness of Video Capsule Enteroscopy against the standard endoscopy of the upper GI with biopsies of the second portion of the duodenum in patients suspected of having celiac disease. The research team included Emanuele Rondonotti, M.D.; Cristiano Spada, M.D.; David Cave, M.D.; Marco Pennazio, M.D.; Maria E. Riccioni, M.D.; Italo De Vitis, M.D.; David Schneider, M.D.; Tatiana Sprujevnik, M.D.; Federica Villa, M.D.; Jennifer Langelier, M.D.; Arrigo Arrigoni, M.D.; Guido Costamagna, M.D.; Roberto de Franchis, M.D.

The research team tested a total of 43 patients. In 41 patients, VCE reached the ileocecal valve during the reading time. 32 patients were found to exhibit diagnostic histology. Of those, 28 were diagnosed with celiac disease using capsule enteroscopy, for a total sensitivity of 87.5%.

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Overall, for diagnosing celiac disease, VCE was shown to be 90.9% specific, 96.5% predictive, 71.4% negative predictive, with positive and negative likelihood ratios of 9.6% and 0.14% respectively. Four patients showed normal VCE findings, but were still diagnosed with celiac disease. Of these patients, three had Marsh grade III lesions, and one had Marsh grade I lesions.

The ability of VCE to offer high-quality images of small bowel mucosa including high-resolution of the individual villi led the team to conclude the VCE may offer an effective alternative to duodenal biopsy among some patients.

As VCE is also far less invasive than the endoscopy/biopsy approach, it may also generate greater patient acceptance. Also, unlike conventional endoscopy/biopsy, VCE offers exploration of the entire small intestine, and may lead to the discovery of damaged villi beyond those areas accessible via endoscopy.

Because of the small number of the test subjects, the results, though encouraging, invite a larger and more comprehensive study before VCE becomes an acceptable alternative to conventional endoscopy/biopsy method for diagnosing celiac disease.

American Journal of Gastroenterology 2007; 102(8): 1624-1631 welcomes your comments below (registration is NOT required).

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11 Responses:

Pat Alford
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said this on
31 Oct 2007 6:00:00 PM PST
Appreciate you updating the celiac community with latest findings, but significant error in this summary -- the sensitivity of VCE in this study is 87.5%, not 28%. That is, the VCE technique picked up 28 of 32 histology-proven celiacs.

This correction was added--Scott Adams.

Barbara Bonavoglia
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said this on
01 Nov 2007 6:53:03 AM PST
Very encouraging to know there might me a less invasive test for celiac disease. Many are fearful when they hear tge word 'biopsy.' I question whether this could ever replace a colonoscopy as well!

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said this on
01 Nov 2007 7:30:05 AM PST
Great article! Just wish they would of had this when they tried to diagnose me and my husband. We both have symptoms and both tested negative but have a son with celiac sprue--and we both have dermatitis herpetaformis--explain that one !

France-Marie Louvet, ND
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said this on
01 Nov 2007 11:05:14 AM PST
That is very good. Now on the practical side, who is practicing VCE in the U.S.? Are health insurance companies willing to re-reimburse for it, and since I guess a lot won't, how much does it cost for the patient?
There are many more effective, less invasive methods of health screening available in Europe, and this since many years. However, since the U.S. health care system is based in profit first, we never have access to it.
Thank you for giving practical information that everybody could use.

shirley gulla
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said this on
01 Nov 2007 3:07:28 PM PST
I was diagnosed with celiac disease in August of 2006. My Doctor did the upper endoscopy and also the capsule endoscopy. Given a choice I would have preferred only the capsule endoscopy rather than be put out for the regular endoscopy.

Evelyn Schindler
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said this on
02 Nov 2007 5:19:25 PM PST
I completely agree with this article.
My celiac disease was diagnosed this way nearly 2 years ago.

Barbara Coots
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said this on
05 Nov 2007 5:29:53 PM PST
Does it pick up damage like scar tissue? I've not had the endoscopy the Dr. said that this was not necessary because the colonoscopy was negative Thanks

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said this on
07 Nov 2007 7:09:40 AM PST
Any non-invasive procedure is the way to go, however, like comment #4, you won't see it being done in the US. When I was diagnosed it took me 3 months to get in to see a GI doctor. My physician told me to stop eating gluten (I was so sick that my body was shutting down). I listened to my physician and felt better by the time I went to see the GI doctor. He wanted to do all sorts of tests, most I didn't allow because I was already gluten free. I changed doctors because it was obvious he was only interested in the profit. Until that changes in the US it won't matter what new tests they come up with, the doctors and the insurance companies will only do what profits them best!

Maryann Sivertson
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said this on
07 Nov 2007 9:11:55 PM PST
I was diagnosed in '99 via colonoscopy. I would not like to have had to do the endoscopy. I try my best to stay gluten free but find I am unable to do so completely. I thank gluten free website for all the help I have found there.

tina ellis
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said this on
10 Nov 2007 11:18:15 AM PST
I love this article. My Doctor had recommended this procedure for me. The problem lies with the insurance company. My insurance denied this procedure, which to me meant no procedures to do the night before and less cost compared to an endoscopy, colonoscopy, outpatient room, etc., the cost and time seemed less, the pros of this procedure are excellent. The cons to the other procedures speak for themselves. I would have gone through the capsule endoscopy over the endoscopy, and colonoscopy any day. But the insurance claims that it is not FDA approved. I tried fighting the issue with them and of course they won. The insurance company spent hundreds of thousand dollars more than the capsule endoscopy, go figure, these insurance companies need to wake up. I have to have the endoscopy and colonoscopy done every year, It makes me unhappy to know that the capsule endoscopy would be so much better for me to have than the others. Time and the thought of the night before the colonoscopy just drains me and I feel so miserable afterwards. so please, please tell me why insurance companies have the say over this wonderful procedure vs. the old fashion ones. It is less than having many other tests and procedures. I just don't understand them.

Dorothy Burton
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said this on
01 Dec 2007 4:25:54 PM PST
With my husband being new to this , I find this article and others very helpful.
Thank you

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