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Showing results for tags 'endoscopy'.
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Hi everyone! i have just been told I have to have an endoscopy and colonoscopy, not because of any gastro symptoms but because of non iron anaemia. These tests seem a bit invasive and maybe a little premature ? I do have the coeliac gene but apparently so do 33% of the population. Why would it be so important for me to go straight to this? Any help to understand/convince me appreciated
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Hi everyone! Brand new here !! Still trying to figure out how this all works So, a few months ago I started feeling absolutely terrible. Muscle Pains, palpitations and tingling sensations, as well skin sensitivity and rosacea. I did not notice at the time that it was related to food until I had a few "poisonings" that I thought came from shellfish. I have always suffered from severe C but never D. Anyways.. I was incredibly sick for about 3 months and I got tested for everything under the sun: even lyme disease, toxoplasmosis etc. Then I got a brain scan that showed I had T2 non specific white matter lesions that could be consistent with MS ( which of course scared me A LOT) These were seen by 3 neurologists who thankfully ruled out MS, but also did not give me a reason for them. Interestingly enough, I got a 23 and me test kit as a gift for Christmas, and when it came back, it showed I had a variant in the HLA-DQA1 which increased my chances of developing celiac. When I saw that it was like a light bulb came on immediately !! . I just knew that it had to be related to gluten at that point. So, I went to at least 3 doctors who completely dismissed me ( one said those tests were not accurate at all , another said my symptoms were psycosomatic and refered me to a psychiatrist.. ) until finally I had one doctor send me for testing. Upon finding my ttg A elevated and the EMA positive, she refered me to a gastroenterologist to get more tests. This gastroenterologist sees my husband for his Chron's Disease and he is very good for that, but when I showed him my ttgA result and the EMA, he said he did not believe I had Celiac because I did not have D, only C, which put his celiac's expertise in question IMHO. ANyways, he repeated all the tests, and added more including genetic testing. Below are the results. He now says he is sure I have celiac but won't give me the diagnosis unless I get a biopsy to confirm. I asked, "so what else could the tests mean?" and he said, " I'm sure you have celiac, but I need the bipsy before I impose this lifelong diet on you " My insurance is not very good and it will cost me over $1000 to have this done, which is steep for me at the moment. I know that it is a personal choice and I am not looking for any medical advice, but I want to know people's opinions on wether you guys think it is really necessary. All my tests seem to point to Celiac's direction and makes me wonder if maybe I should look for another doctor, or just start on the gluten-free diet, ( I've tried to lower my gluten consumption but still kept eating it to prepare for the endoscopy" ) Or wether I should get it done to establish a baseline. I worry that the exam will be a false positve, seeing how unacurate they can be, and also lowering gluten could maybe alter it ? Finally, if anyone knows a Dr in the Miami / Fort Lauderdale area that specializes in Celiac I would reallly appreciate it Sooo sorry this got soo long, but i appreciate any advice TEST RESULTS: TISSUE TRANSGLUTAMINASE IgA - 9 Ref: <4 TISSUE TRANSGLUTAMINASE IgG - 15 Ref: <6 GLIADIN (DEAMIDATED) IgA - 21 Ref: <20 GLIADIN (DEAMIDATED) IgG - 38 Ref: <20 ENDOMYSIAL ANTIBODY SCR AMD (IGA) W/REFL TO TITER Positive ENDOMYSIAL ANTIBODY AMD TITER - 1:5 Ref: <1:5 IMMUNOGLOBULIN A: 135 Ref: 81-463 HLA TYPING FOR CELAIC DISEASE: •HLA DQ2: POSITIVE •HLA DQ8: NEGATIVE •HLA VARIANTS DETECTED: HLA DQA1 : 02 HLA DQA1 : 05 HLA DQB1 : 0202 HLA DQB1 : 0301
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Can someone please tell me about my results attached? My Doctor was a little vague. 1. Gastric, The section show Amtrak mucosa with faveolar hyperplasia, interstitial oedema and smooth muscle proliferation in the laminate proprietary. Inflammatory cells are spares. The gastric body mucosa is normal. No helicobacter can be seen. Bile reflux and NSAIDS can give this pattern of gastritis. There is no evidence of intestinal meta plasma, dysplasia or malignancy. 2. Duodenial the sections show small intestinal mucosa with normal billows architecture. There is no significant inflammation. No granulomas or parasitis are seen. There is no evidence of malignancy. thoughts?
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Looking for advice and also to help those undergoing testing. I went to my general practitioner back in August with nausea, bloating, diarrhea, migraines, sluggishness, and a feeling of general unwellness. I was eating a gluten diet at the time. My doc ordered the dual antigen screen- it came back positive for celiac. He set up an appointment for me with a specialist. I called the specialist and they could get me in 8 weeks later. I asked the specialist if I went gluten free is this would affect any testing. They said “no” that I was in a gluten diet for so long I would be fine. However, 8 weeks later, the blood test showed no celiac- my results were normal after 8 weeks on a gluten free diet. I felt great, for me the turnaround was almost immediate- in a week or 2 I felt amazing. But that didn’t help with getting accurate results (mostly wanted to rule out another autoimmune disorder). I then went on gluten for 7 weeks (I ate a lot of gluten- like at least a bagel a day and much more on some days- I wasn’t messing around, I wanted an accurate diagnosis)and repeated the blood test at 7 weeks. It came back a very weak positive for deamidated gliadin abs iGg. I then underwent a endoscopy because the doc said that number, although positive, was not high enough to go off of. The endoscopy came back normal- however, the doc noted that higher levels of antibodies were found but not in the “abnormal range.” So, they were present, just not in crazy levels. I then kept eating gluten- I should note my doctors SUCK (could do a whole other post just on this- I have been my own doctor pretty much). I just took another blood test at 3 months eating gluten. My levels are now SUPER high for deamidated Gliadin abs IgG. The doc is confident I have celiac. Question is- my doc is so bad, I wanted to check here to make sure that it indicates celiac. I also wanted to help others as I know there’s lots of conflicting information on how long to do a gluten Challenge. For me, it took 3 months. My gut tells me I am early stage celiac- I don’t have full blown damage yet, but if I keep eating it I am sure it will do some damage. Just wanted to highlight this as if your case isn’t super bad yet, you may have to eat gluten longer- everyone is different. Any advice on my results would be awesome!
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1st of all my GI is AMAZING. Not only is he a great doc, but he also is just a great guy. We had a great time, LOL!! The findings were: 1) Hiatal hernia 2) Duodenal tissue looked normal, but he took 10 biopsies to be sure. 3) I may have Eosinophilic Esophagitis, which is an chronic allergic/immune response to a certain food (we don't know what it would be), leading to a buildup of the white blood cells eosiniophils. The evidence was from rings in my esophagus that shouldn't be there. Biopsies were taken to evaluate for that. So now I wait. Only I would add another possibility onto my crazy health situation, LOL!!! He was baffled by my positive TTG celiac blood test, if the biopsy comes back negative. But at least they can see that there is SOMETHING going on in there, and that my body is reacting to something. Now we just to see if it's gluten, or if it's something else. He did recommend a 2 week trial of a gluten free diet to see if it helped alleviate any symptoms.
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My endoscopy is this afternoon. I'm a little anxious because I just want to get it over with. I honestly think there's a high probability of it coming back negative, but it drives me crazy that I won't know for like a week or two, especially with the holiday. Should they tell me how many samples they took? Anything I should make sure to ask, etc.?
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Hi, I have an endoscopy scheduled on Thursday to confirm celiac. I have a positive tTG IGA test but negative EMA. I know they'll take some biopsies and those will take 1-2 weeks to come back, but can they see the damage by sight too? Is it also possible to see absolutely no damage, but then the biopsies come back showing damage? I'm just going crazy over here not knowing, LOL.
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Celiac.com 11/30/2017 - Talk about handling a celiac disease diagnosis in style. This past summer, "Us" star Mandy Moore showed us how its done, when she documented the process of working with her doctor to determine if she had celiac disease. She even posted a photo of her endoscopy visit for her Instagram followers. Moore captioned the post: "Grog city. Just had an upper endoscopy to officially see whether or not I have celiac (only way to officially diagnose)…things are looking 👌)." Later, and also on Instagram, she revealed that she had been diagnosed with celiac disease. "Well, this definitely takes the (now gluten free cake) for bummer news," she wrote on her Instagram story at the time. "Any celiac sufferers out there with any helpful tips??" Maybe consider looking at Celic.com for helpful tips and information on living with celiac disease and eating gluten-free? Later, she posted another message, thanking her fans for sharing their knowledge with her, adding that there were "so many lovely humans out there. My heart is full." Moore seems to be embracing the realities of a gluten-free diet. Later, in an Instagram post celebrating her engagement to Taylor Goldsmith, Moore thanked her friends and family for their support, and noted that she planned to "enjoy some delightful gluten-free tea sandwiches (and 🥂) like ladies do." Best of luck to Mandy Moore in dealing with her new found celiac disease diagnosis.
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Hi, I just got the blood test for celiac done and the results came back positive. My mother and aunt both are diagnosed with celiac so it is likely I have it too. My doctor said the endoscopy will take a while to get (on the order of months) and that I should start a gluten free diet immediately, then go back on gluten for the six weeks prior to test. But I heard that the reaction to gluten was worse for celiacs when they followed a gluten free diet for a while and then reintroduced it. I have a lot of symptoms that are likely caused by celiac, but I've been dealing with them for a year or so, so another few months isn't a huge deal, although of course I would rather avoid them. So if it better if I stay on a gluten diet for the next few months until the endoscopy instead of eliminating gluten and then reintroducing it? My other question is if I stay on a gluten diet from now until the endoscopy, will consuming less gluten (1 meal a day instead of 3) cause less damage and symptoms? In other words, is the severity of the symptoms and damage dependent on the amount ingested or is it the same no matter how much is ingested if I'm eating it regularly? And if I do reduce the amount, should I increase it again in the six weeks prior to the test?
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I recently found out I have the DQ8 hetero gene. Because my life was being affected so drastically, I discontinues eating gluten and have started to feel myself. about 90% of my symptoms have resolved during the past 2 weeks of eating gluten-free. Now, I need to decide whether I should continue with a gluten challenge and test for antibodies and do the endoscopy/biopsy. I am one that would be unsettled not knowing whether or not I have Celiac. Does anyone have advice on whether or not I should do a gluten challenge and do further testing to pursue a diagnosis?
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Hello, I am a young man dealing with some Thyroid issues, along with some general digestive issues. A long time ago I was tested for Celiac disease via blood and was told I had it, but then had an endoscopy to confirm, and actually I got the results back, but I could never really decipher what they meant, so i just assumed I had it to be safe. I'm taking a much larger role in the control of my health now, and I deem it necessary to be less assumptive and to make sure I have concrete facts now. Under "Clinical History" Abdominal pain/bowel issues/Wt loss. R/O Celiac. Findings: Mild gastritis. EGD. Not sure what to make of that. Under "Final Pathologic Diagnosis" A. Duodenum Biopsy; Mature benign small bowel mucosa with a normal villous architecture. B. Stomach Biopsy; mild chronic gastritis, Helicobacter Immunoperoxidase stain is negative for Helicobacter organisms(Controls appropriate.) c. Esophagus Biopsy, Chronic Esophagitis with Rare Eosinophils. ------- If anyone can decipher and elaborate on any of this, I would appreciate it? Do I have Celiac disease? Anything else anyone notice to be relevant? Thank you!
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Hello everyone! My son is 6 years old and he is very small. He is the lower 5% of his age group for height and weight. He will be 7 years old on November 2nd and he only weighs 41pounds. I don't think he has gained weight in 2-3 years. He is a picky eater...very picky! He does not even like ice cream. He was diagnosed with hypothyroidism, which explains his short stature. He has been on synthroid for 6 months and is doing great. I do not know if he has hashimotos as he has not been tested for that. His endocrinologist did a celiac blood panel despite no digivestive issues (only poor appetite) or family history of celiac. His labwork is the following... DUAL AG SCREEN 31 (ABNORMAL normal is 0-19) TISSUE TRANSGLUTAMINASE IGA 0 TISSUE TRANSGLUTAMINASE IGG 1 IGA IMMUNOGLOBULIN ASSAY 65 DEAMIDATED GLIADIN IGA 62 (ABNORMAL normal is 0-19) DEAMIDATED GLIADIN IGG 3 ENDOMYSIAL ANTIBODY IGA <1:10 He only had two abnormal labs. Endocrinology told us to go to GI and GI did a scope on Monday. We are still waiting on biopsy results. The GI doctor said the scope looked great visually, but biopsy will be the final answer. What do y'all think? Can someone have celiac with mostly negative blood work? How accurate is the blood Work? What are the chances of this biopsy being positive? I feel like I have been waiting a lifetime for these results. Doctor said if biopsy is negitive, we should repeat blood work in two years.
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Celiac.com 05/02/2016 - Even with endoscopies, physicians can still miss some cases of celiac disease. A team of researchers recently set out to determine if I-Scan, or virtual chromo-endoscopy, could improve sensitivity of endoscopy to detect markers of villous atrophy in patients with celiac disease. The research team included Hugo A. Penny, Peter D. Mooney, Mitchell Burden, Nisha Patel, Alexander J. Johnston, Simon H. Wong, Julian Teare, and David S. Sanders. They are variously affiliated with Royal Hallamshire Hospital in Sheffield, UK, and with St Mary's Hospital in London, UK. For their study, the team assessed patients from two UK hospitals in 3 groups. For Group 1, they used standard high definition, white light endoscopy (WLE). For Group 2, they used WLE plus I-Scan. For Group 3, they used a non-high definition control group. They recruited an initial group of 758 patients. That group was 62% female, with an average age of 52. They recorded the presence of endoscopic markers, and took at least 4 duodenal biopsies from all patients. They also made concurrent blood tests, and compared observations with patient histology. The patient breakdown was as follows: Group 1: 230; Group 2: 228; Group 3: 300. The team made 135 new diagnoses of celiac disease, with 21 cases in Group 1, 24 in Group 2, and 89 in Group 3. The sensitivity for detection of endoscopic markers of villous atrophy was significantly higher in both Group 1 at 85.7% and Group 2 at 75%, compared to non-high definition controls at 41.6%. There was no significant difference between high definition only and I-Scan groups. In non-high definition endoscopy, they found that missed diagnosis was mainly due to lesser degrees of villous atrophy (p = 0.019) and low tTG titre (p = 0.007). From their data, the team concluded that high definition endoscopy with or without I-Scan increases the detection of celiac disease during routine endoscopy. Source: Digestive and Liver Disease.
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Celiac.com 03/02/2015 - Officials at UCLA Ronald Reagan Medical Center have warned 179 people that a fairly routine endoscopy procedure may have left them exposed to a drug-resistant 'super-bug' that infected seven patients, and may have contributed to two deaths. The possible exposures occurred at the UCLA Ronald Reagan Medical Center, between October and January, in patients who underwent a procedure in which a specialized endoscope is inserted down the throat to diagnose and treat pancreatic and bile duct diseases. Officials said in an official statement that hospital staff had been sterilizing the scopes according to the manufacturer's standards, but was now using "a decontamination process that goes above and beyond manufacturer and national standards." Meanwhile, hospitals across the United States have reported exposures from the same type of medical equipment in recent years, and the U.S. Food and Drug Administration (FDA) has said it was working with other government agencies and manufacturers of the scopes to minimize risks to patients. The FDA says recent medical publications and adverse event reports associated multidrug-resistant bacterial infections in patients who have undergone ERCP with reprocessed duodenoscopes, "even when manufacturer reprocessing instructions are followed correctly." The multidrug-resistant bacterial infections include carbapenem-resistant Enterobacteriaceae (CRE) such as Klebsiella species and Escherichia coli. The FDA says that from January 2013 through December 2014, they received 75 medical device reports involving about 135 patients related to possible microbial transmission from reprocessed duodenoscopes. "It is possible that not all cases have been reported to the FDA," the agency says. Given the fact that celiac disease diagnosis and follow up care require the use of endoscopy, this news is particularly disturbing to those in the celiac community. Source: Medscape.com.
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Celiac.com 08/20/2015 - Celiac disease is frequently mis-diagnosed. Even when patients received endoscopy, celiac disease is often missed or not detected. A team of researchers recently assessed the accuracy of finger prick-based point-of-care tests in the detection of celiac disease, and developed an algorithm for diagnosis. The research team included PD Mooney, SH Wong, AJ Johnston, M Kurien, A Avgerinos, and DS Sanders. They are variously affiliated with the Royal Hallamshire Hospital, Sheffield, United Kingdom and the University of Sheffield, Sheffield, United Kingdom. Their team conducted a prospective study of two groups of celiac disease patients evaluated at the Royal Hallamshire Hospital in Sheffield UK from March 2013 through February 2014. In group one, the team evaluated 55 patients at high risk for celiac disease, and who tested positive for endomysial antibody, using the Biocard test (BHR Pharmaceuticals, Nuneaton, UK) and the Celiac Quick Test (Biohit Healthcare UK, Ellesmere Port, UK), which measure antibodies to tissue transglutaminase (anti-tTG), and the Simtomax test (Tillotts Pharma, Rheinfelden, Switzerland), which measures deamidated gliadin peptide antibodies (DGP). Group 2 included 508 consecutive patients who received an endoscopy for any reason, received the DGP test, and also were evaluated using a diagnostic algorithm that incorporated results from the DGP test and data on symptoms. For both groups, point-of-care tests were administered at the time of endoscopy, and the results compared against results from histologic analyses of duodenal biopsy specimens from all patients. In group 1, the DGP test identified patients with celiac disease with 94.4% sensitivity, the Celiac Quick Test identified patients with 77.8% sensitivity (P = .03 vs the DGP test), while the Biocard test identified patients with 72.2% sensitivity (P = .008 vs the DGP test). In group 2, the DGP test identified patients with celiac disease with 92.7% sensitivity (95% confidence interval, 83.0-97.3), 85.2% specificity (95% confidence interval, 81.5-88.3), a positive predictive value of 49.2% (95% confidence interval, 40.3-58.2), and a negative predictive value of 98.7% (95% confidence interval, 96.8-99.5). Measurement of serum anti-tTG identified patients with celiac disease with 91.2% sensitivity (95% confidence interval, 81.1-96.4), 87.5% specificity (95% confidence interval, 84.0-90.4), a positive predictive value of 53.0% (95% confidence interval, 43.6-62.2), and a negative predictive value of 98.5% (95% confidence interval, 96.5-99.4). The algorithm identified patients with celiac disease with 98.5% sensitivity, and has the potential to reduce duodenal biopsies by 35%. In this prospective study, the test for DGP identified celiac patients with comparable sensitivity and specificity as standard serologic analysis of anti-tTG. Conducting the DGP test before endoscopy might increase the accuracy of the diagnosis of celiac disease. These results look promising, but further study is needed, in lower-prevalence populations, to more accurately determine the potential benefits of the DGP test in celiac screening. Source: Clin Gastroenterol Hepatol. 2015 Jul;13(7):1278-1284.e1. doi: 10.1016/j.cgh.2015.01.010. Epub 2015 Jan 26.
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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. The 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. 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. Source: Gastrointest Endosc. 2013 Feb;77(2):227-32. doi: 10.1016/j.gie.2012.09.031.
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Celiac.com 01/02/2013 - Doctors use capsule endoscopy to assess the small bowel in a number of intestinal diseases, including celiac disease. The main advantage of capsule endoscopy is that it allows for complete visualization of the intestinal mucosal surface. A team of researchers recently set out to investigate whether capsule endoscopy can predict the severity of celiac disease, and detect celiac disease complications. The research team included M. Barret, G. Malamut, G. Rahmi, E. Samaha, J. Edery, V. Verkarre, E. Macintyre, E. Lenain, G. Chatellier, N. Cerf-Bensussan, and C. Cellier. They are affiliated with the Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, Service d'Hépato-gastro-entérologie, and the Université Paris Descartes, Sorbonne Paris Cité, Faculté de médecine, both in Paris, France. For their study, the team reviewed medical files for nine patients with symptomatic celiac disease, eleven patients with refractory celiac disease type I (RCDI), 18 patients with refractory celiac disease type II (RCDII), and 45 patients without celiac disease who received both capsule endoscopy and upper endoscopy or enteroscopy. To properly diagnose the type of celiac disease in the patients, the researchers used a centralized histological review, flow cytometry analysis of intraepithelial lymphocytes, and the analysis of T-cell receptor rearrangement by multiplex polymerase chain reaction. A total of 47 capsule endoscopies were administered for the 38 celiac patients: ten for the patients with symptomatic celiac disease; eleven for patients with RCDI; and 26 for RCDII patients. Another 47 capsule endoscopies were administered for the 45 non-celiac patients were retrospectively reviewed. They found that patients with celiac disease had more villous atrophy, and more numerous, or distally located ulcers than the control subjects. They also found that, in celiac disease patients, capsule endoscopy was of acceptable quality in 96% of cases and was complete in 62% of cases. Moreover, the concordance of capsule endoscopy with histology for villous atrophy was better than that of optic endoscopy (κ coefficient =0.45 vs. 0.24, P<0.001). Extensive mucosal damage on capsule endocscopy was associated with low serum albumin (P=0.003) and the RCDII form (P=0.02). The also detected three cases of overt lymphoma by capsule endoscopy during the follow-up. Overall, the results show that capsule endoscopy provides a sufficient match with histology and nutritional status in patients with symptomatic or refractory celiac disease. Lastly, capsule endoscopy may predict the type of RCD and enable the early detection of overt lymphoma. Source: Am J Gastroenterol. 2012 Oct;107(10):1546-53. doi: 10.1038/ajg.2012.199. Epub 2012 Sep 11.
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Celiac.com 12/10/2012 - In celiac disease, doctors use video capsule endoscopy (VCE) mainly to follow-up on stubborn cases, and to diagnose adenocarcinoma, lymphoma or refractory celiac disease. However, some doctors are suggesting that VCE could replace standard esophagogastroduodenoscopy (EGD) and biopsy in certain circumstances. A team of researchers recently evaluated the use of VCE to diagnose celiac disease in place of esophagogastroduodenoscopy (EGD) and biopsy under certain circumstances. The research team included Matthew S. Chang, Moshe Rubin, Suzanne K Lewis, and Peter H. Green. They are variously affiliated with the Celiac Disease Center, Division of Digestive and Liver Diseases of the Department of Medicine at Columbia University College of Physicians and Surgeons in New York, and with the Division of Gastroenterology and Hepatology of the Department of Medicine at New York Hospital Queens, Weill Cornell Medical College in Flushing, New York. For their study, the team evaluated eight patients with suspected celiac disease who were diagnosed by VCE. Of the eight patients, four underwent EGD and biopsy, with negative biopsy results. Two patients declined the procedure, and two showed contradictory results due to hemophilia and von Willebrand disease. Using VCE, the team found that all patients showed mucosal scalloping, mucosal mosaicism and reduced folds in either the duodenum or jejunum. After treatment with a gluten-free diet, seven patients who participated in follow-up showed improvement in either their blood tests, or their presenting clinical symptoms. From this small study, the team concludes that VCE and the observation of the classic mucosal changes of villous atrophy may replace biopsy as the mode of diagnosis for celiac disease in patients who either decline EGD, or show contradictory results, or in suspect patients with negative duodenal biopsy. They encourage further study to determine the role and cost of using VCE to diagnose celiac disease. Source: BMC Gastroenterolohy. 2012;12(90)
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Endoscopy Complications Quadruple Rate Reported by Doctors
Jefferson Adams posted an article in Additional Concerns
Celiac.com 11/09/2010 - Each year in the United States, millions of people undergo gastrointestinal (GI) endoscopic procedures. Generally, the procedures have been regarded as safe, with a physician-reported complication rate for endoscopies of just 7%. However, most systems, including the gastroenterology department at Beth Israel, maintain a voluntary, paper-based physician reporting system wherein each gastroenterologist submits a monthly log describing any known complications. To get a better idea of actual numbers based on Emergency Room (ER) visits within two weeks of an endoscopy, Daniel A. Leffler, MD, of Beth Israel Deaconess Medical Center in Boston, set out with a research team to conduct a more in-depth review. Their review of electronic medical records (EMR) showed that complications after endoscopy may be more common than previously thought. Dr. Leffler and his colleagues reviewed over 400 emergency department (ED) visits logged in one hospital's EMR system within two weeks of an endoscopic procedure. They found that nearly one-third of those visits were related to the previous endoscopy. Overall, they looked at records for follow-up visits for 6,383 esophagogastroduodenoscopies and 11,632 colonoscopies. The medical center's electronic reporting system showed 419 ED visits within two weeks of these procedures. The review team determined 32%, or 134 of these visits, to be directly related to the endoscopic procedure. Yet only about 7% of these were reported using the standard physician reporting system, the researchers said (P<0.001). The team also found that 29% of 266 subsequent hospitalizations were directly related to the patients' endoscopic procedure. Most of the ER visits were a result of abdominal pain (47%), gastrointestinal tract bleeding (12%), or chest pain (11%). By looking at actual electronic admission data, rather than relying on the more cumbersome physician reporting data, the research team found "a 1% incidence of related hospital visits within 14 days of outpatient endoscopy, 2- to 3-fold higher than recent estimates." This is important not just from a patient wellness perspective, but from a financial one. According to Medicare standardized rates, the average costs of endoscopic-related complications is $1403 per ED visit, and $10123 per hospitalization. Over the full screening and surveillance program, such complications added an extra $48 to each exam. The team's own words reinforce their conclusions: "Although the overall rate of severe complications, including perforation, myocardial infarction, and death remained low, the true range of adverse events is much greater than typically appreciated." Moreover, "standard physician reporting greatly underestimated the burden of medical care related to endoscopic procedures and unexpected hospital utilization," Leffler and colleagues wrote. With so many cases of celiac disease relying on biopsy via endoscopy, these numbers might be especially interesting to people with celiac disease, in addition to anyone else facing endoscopy in the future. Source: Arch Intern Med 2010; 170(19): 1752-1757- 2 comments
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Celiac.com 07/02/2010 - Serological screening of healthy volunteers from around the world estimates that the prevalence for celiac disease is approximately 0.5%- 1% of the total population. However, a recent meta-analysis denotes that the actual ratio of known or undiagnosed celiac cases is closer to 1 in 7 people. Due to knowledge of celiac, acute clinical suspicion, and increased endoscopy accessibility some areas have reported celiac prevalence as high as 5.2%; suggesting that there is a considerable gap in effectively detecting new cases of celiac disease. Researchers further investigated the statistics on celiac disease prevalence by evaluating the incidence of celiac disease among “adult out-patients biopsied during upper endoscopy with typical and atypical symptoms”. One hundred and fifty out-patients including 94 women and 56 men with a median age of 45, were enrolled for the study between January 2007 and December 2008. There is no current standard classification for endoscopic lesions found from celiac disease. As such, this study used a method of classification where-as patients were labeled as; normal, mild, moderate, or severe. To detect villous atrophy, biopsy's were taken from patients that were only presenting endoscopic appearances, which are indicative of celiac disease. Results which had t-TGA levels greater than 24 U/mL were considered positive for celiac disease. Patients were also positively diagnosed as celiac if they exhibited some degree of histological abnormality. Of the hundred and fifty subjects studied, twelve were diagnosed positively for celiac disease, and nine of them were women. The most commonly exhibited gastrointestinal pathology diagnosed in the study, was gatroduodenitis peptic ulcer. All of the subjects that had biopsy proven t-TGA, had positive antibodies, and the values of t-TGA increased depending on the intensity of the mucosal lesions. Additionally, all subjects were assessed for the existence of gastrointestinal and extra-intestinal symptoms. Typical gastrointestinal symptoms of celiac include diarrhea, anemia and weight loss, as evident in 58.32% of the subjects studied, while atypical symptoms were present in 25% of the test subjects. 41.66% of the subjects had iron deficiency anemia(IDA), 8.33% had osteopenia, 16.66% had hypocalcaemiaia and hypomagnesaemia. Additionally, extra-intestinal symptoms associated with gastrointestinal manifestations were found in 16.66% of the subjects that had astenia, and in 41.55% of the subjects with weight loss. Almost every celiac case observed demonstrated symptoms that progressively increased in severity. No differences were observed among patients in the control group, and in the celiac patients with regard to gastrointestinal problems and discomforts. However, IDA was observed most frequently in patients with celiac disease than in the control group. All patients that were diagnosed were recommended to strictly adhere to a gluten-free diet. One person refused to comply with the diet, but the other 90% followed the diet for one year. Of the patients following a gluten-free diet, a total histological response was observed. Severity of mucosal lesions decreased in 70% of the subjects, and all subjects were asymptomatic after one year on a gluten-free diet. The final incidence of celiac disease in the study was 6%. Screening studies such as these, demonstrate that the prevalence of celiac disease is increasing. When duodenal biopsy was preformed in patients during routine upper gastrointestinal endoscopy, the incidence of celiac disease was observed at rates as high as 12%. Additionally, when clinical presentations of symptoms like diarrhea, anemia, and weight loss are used as screening criteria for celiac, increased rates of celiac disease diagnosis' were evident. Strict adherence to a completely gluten-free diet is still the only cure for celiac disease. Increased doctor and patient awareness of celiac, as well as an increase in celiac screening (especially for patients with typical celiac symptoms or atypical symptoms untreated by standard methods) is still needed to avoid more cases of undiagnosed celiac disease, and to eliminate unnecessary suffering for those misdiagnosed or undiagnosed. Source: Journal of Experimental Medical & Surgical Research, Year XVII · Nr.1/2010 · Pag.23 -27
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Celiac.com 06/23/2010 - A team of researchers evaluated the possibility of diagnosing celiac disease using quantitative analysis of videocapsule endoscopy images. The team included Edward J. Ciaccioa, Christina A. Tennysonb, Suzanne K. Lewisb, Suneet, Krishnareddy, Govind Bhagat, and Peter H.R. Green. They are variously associated with the Department of Pharmacology, Department of Medicine, Department of Pathology, Columbia University College of Physicians and Surgeons in New York. Images taken with videocapsule endoscopy can be useful for diagnosing celiac disease, but their interpretation is highly subjective. Quantitative disease markers might help to determine the degree of villous atrophy and efficacy of treatment. The team gathered capsule endoscopy images from a group of 11 celiac patients with small bowel pathology, and from a group of 10 control patients. Images had a resolution of 576×576 pixels, with 256 grayscale tones, and a frame-rate of 2 s−1. The team measured over 10×10 pixel sub-images for pixel brightness and image texture. They then averaged the results for for 56×56 sub-images per frame. For each patient, the team took measurements at from five locations in the proximal to distal small intestine. At each location, they figured measurements using 200 consecutive image frames (100 s). For classification with a nonlinear discriminant function, they computed mean frame-to-frame pixel brightness, image texture, periodicity in brightness, and estimated wall motion or intestinal motility. By pooling the data, the team found that images from the celiac group showed greater texture than did images from control group (p < 0.001). Images from the celiac disease group exhibited more frame-to-frame brightness variation as well (p = 0.032). Celiac patients showed longer dominant period of brightness in celiacs (p = 0.001), which may indicate reduced motility. Markers for three-dimensional nonlinear classification of celiacs versus controls showed sensitivity of 92.7% and specificity of 93.5%. Both celiac patients and control subjects showed an approximately linear association between dominant period and small intestinal transit time (r2 = 0.42 and r2 =0 .55, respectively). The results show that videocapsule images can be used to reveal villous atrophy throughout the small intestine, and to distinguish individuals with celiac disease from individuals without mucosal atrophy. Source: Science Direct. doi:10.1016/j.cmpb.2010.02.005
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Diagnosis of Celiac Disease at Open Access Endoscopy
Scott Adams posted an article in Latest Research
William Dickey Department of Gastroenterology, Altnagelvin Hospital, Londonderry, Northern Ireland, UK Scandinavian Journal of Gastroenterology 1998; 33: 612-5. Abstract Background: Coeliac disease may present with dyspepsia or reflux. There are characteristic duodenal appearances associated with villous atrophy (mosaic pattern mucosa and loss, reduction in number or scalloping of duodenal folds) which may prompt small bowel biopsy during routine upper gastrointestinal endoscopy. These appearances were sought in patients referred by their general practitioners for open access endoscopy (OAE), to determine the prevalence and significance of coeliac disease as a cause of symptoms. Methods: Five hundred consecutive patients undergoing OAE by one consultant gastroenterologist were studied. Forceps biopsies from the distal duodenum were taken if appearances were suggestive. If villous atrophy was confirmed, the response of symptoms to dietary gluten exclusion was assessed. Results: Ten patients had suspicious endoscopic appearances of whom 8 had villous atrophy, giving a prevalence of coeliac disease of 1.6% (1:63). All 8 had mosaic pattern mucosa with three also having reduction of duodenal folds, and four having scalloped folds. All had serum endomysial antibodies (EmA). Apart from diarrhea, described by one patient, there were no symptoms of typical coeliac disease at diagnosis: three patients were overweight. After dietary gluten exclusion, all reported symptomatic improvement with disappearance of EmA in 5 patients to date. Conclusions- There is a high prevalence of coeliac disease among patients undergoing OAE, which is relevant to their clinical symptoms and which can be identified by careful endoscopic inspection of the duodenum.
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