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Can Capsule Endoscopy Help to Diagnose Cases of Equivocal Celiac Disease in Adults?

Celiac.com 04/01/2013 - There haven't been many studies that evaluate the usefulness of capsule endoscopy in equivocal celiac disease. A team of researchers recently set out to conduct an evaluation of capsule endoscopy in adult celiac disease, and to assess its potential role in equivocal cases of celiac disease compared with patients with biopsy-proven and serology-proven celiac disease who have persisting symptoms.

Photo: CC-- Capt. KodakThe research team included M. Kurien, K.E. Evans, I. Aziz, R. Sidhu, K. Drew, T.L. Rogers, M.E. McAlindon, and D.S.Sanders. They are affiliated with the Department of Gastroenterology at Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust in Sheffield, South Yorkshire, United Kingdom.

To determine the use of capsule endoscopy in patients with equivocal celiac disease, compared to patients with biopsy-proven and serology-proven celiac disease who have ongoing symptoms.

To do this, the team conduced a prospective cohort study of 62 patients with equivocal celiac disease and 69 patients with non-responsive celiac disease.

They measured outcome according to the diagnostic yield of capsule endoscopy in equivocal cases and accuracy of mucosal abnormality detection in patients with non-responsive celiac disease.

They found that the 62 cases of equivocal celiac disease could be divided into two subgroups: group A, with 32 cases of antibody-negative villous atrophy, and group B with 30 cases of Marsh 1-2 changes.

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In group A, using capsule endoscopy, the team was able to diagnose celiac disease or Crohn's disease in 9 of 32 patients (28%), compared with just 2 of the 30 patients in group B (7%; P = .044).

In patients with persistent celiac disease symptoms, the team made
significant capsule endoscopy findings in 8 of 69 patients (12%), including 2 cases of enteropathy-associated lymphoma, 4 cases of type 1 refractory celiac disease, 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 capsule endoscopy in antibody-negative villous atrophy (P = .048).

It is important to remember that this study was restricted to a single clinic. That said, this is the first time that researchers have used capsule endoscopy to systematically evaluate equivocal celiac disease.

Because the diagnostic rates for capsule endoscopy in patients with antibody-negative villous atrophy are better than that of capsule endoscopy in patients with celiac disease with persisting symptoms, the researchers are encouraging the use of capsule endoscopy in equivocal cases, especially in cases where patients antibody-negative villous atrophy.

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1 Response:

 
Donna
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said this on
08 Apr 2013 11:52:02 PM PDT
Thank you for the information. Since bring diagnosed with Crohn's disease, every bit of detail is paramount and interesting.




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@jddh So...did the restricted diet you were going to implement work (FODMAP or Whole Foods)? I recall that you were mis-diagnosed at one point with refractory celiac disease, but it was later determined that you were getting trace amounts of gluten in your diet. If you are not catching colds, I assume that you have healed from the damages of celiac disease? I hope so!!! ?

Peter is correct. You do have a positive so that warrants further investigation. Here is a link supporting our comments: http://www.cureceliacdisease.org/faq/are-raised-dgp-igg-levels-an-early-sign-of-celiac-disease/ http://www.mayomedicallaboratories.com/it-mmfiles/Celiac_Disease_Diagnostic_Testing_Algorithm.pdf Does she have celiac disease? You will never know for sure without an endoscopy. Even then, there is a chance the biopsies are negative, but keep in mind that she might just be starting to develop celiac disease or that the damage was not captured (the small intestine is the size of a tennis court if spread out). Personally, I tested negative on all but the DGP IgA, yet I had moderate to severe intestinal damage. The celiac blood tests are good, but they do not catch all celiacs, some celiacs can even test negative to ALL the blood tests. Consider yourself fortunate that your doctor ordered several of the tests and not just the screening TTG IgA (very good, keeps cost down, but does not catch all). The DGP is the preferred test in small children. I do not know why it caught me because I am old, but it did! Confusing, isn't it? I wish there was an easier way to diagnose, but we have to work with what we have available to us.

Thank you for your reply, though it's not necessarily what I wanted to hear, it is what I was thinking.

Gluten-free. ... But the last few decades have seen a rise in the incidence of celiac disease, an illness that causes harm to the small intestine when ... View the full article

you're lucky you dont catch colds. im the opposite i catch everything very easily and get alot sicker than whoever i caught it from and take much longer to get better.