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Showing results for tags 'capsule endoscopy'.
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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. 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
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Celiac.com 03/11/2020 - Researchers don't have a very good understanding about the connection between symptoms, blood tests, and the results of small bowel capsule endoscopy (SBCE) in celiac patients. Better understanding such connections will help to figure out whether symptoms and blood tests can determine the severity and extent of disease using SBCE. A team of researchers recently set out determine if symptoms and blood tests can determine the severity and extent of disease using SBCE. The team included Stefania Chetcuti Zammit, David S. Sanders and Reena Sidhu, of the Academic Unit of Gastroenterology, Royal Hallamshire Hospital, Sheffield, UK. The research team enrolled newly diagnosed celiac patients, and noted Information on SBCE, along with symptoms and indications upon presentation, blood test results, and levels of disease histology in the duodenum. A total of 60 newly diagnosed celiac patients were included, who averaged about 45 years of age. Older patients and those with iron deficiency anemia showed more small bowel involvement. Nearly 40% of patients with weight loss had small bowel involvement beyond the duodenum, compared to those without. Patients with iron deficient anemia and weight loss were much older at the time of diagnosis. There was no significant association between blood antibodies and amount of small bowel mucosa damage. Patients with higher Marsh scores on duodenal histology showed more widespread small bowel involvement. This is the largest assessment of SBCE in newly diagnosed celiac disease so far conducted. The data reveal that older patients showed more widespread celiac disease on SBCE upon diagnosis. Aside from weight loss and iron deficiency anaemia, symptoms and blood test results were independent of the team's findings. Read more in the Eur J Gastroenterol Hepatol 31: 1496–1501
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Celiac.com 02/26/2020 - Patients with established celiac disease can present with signs and symptoms requiring small bowel capsule endoscopy (SBCE) to assess for persistent disease beyond the duodenum and to rule out complications. There is limited data celiac disease and histology, clinical and serological parameters as they reflect the extent of celiac disease on small bowel capsule endoscopy. A team of researchers recently set out to assess the role of small bowel capsule endoscopy in established celiac disease, by looking at the relationship between symptoms, celiac disease serology and Marsh classification of disease and extent of disease on small bowel capsule endoscopy in patients with established celiac disease. The team included S. Chetcuti Zammit; M. Kurien; D.S. Sanders; and R. Sidhu. They are associated with the Academic Department of Gastroenterology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals in Sheffield, UK. The researchers conducted small bowel capsule endoscopies on 100 known celiac patients, and 200 control subjects. The results were reviewed by a team of experts. The team noted the progression of disease on small bowel capsule endoscopy, celiac disease findings and small bowel transit times. The gold standard for diagnosing celiac disease is a duodenal histology, with D2 and Marsh 3a or above. The team's results show that small bowel capsule endoscopy can spot active disease with over 87% sensitivity, and 89% specificity. Univariate analysis showed that the degree of affected small bowel mucosa correlates with the patient's age at small bowel capsule endoscopy, albumin, and hemoglobin, Marsh score of histology from the duodenal bulb (D1) and the second part of the duodenum, and refractory celiac disease on histology. Multiple regression analysis, albumin and Marsh score of histology (D1) all showed vitamin B12 and folate levels to be measurably significant. Celiac patients with complications including those with refractory celiac disease show much more affected SB mucosa. This is the first time a study has shown a connection between degree of disease and levels of malabsorption for duodenal histology markers, such as folate levels and vitamin B12, along with the complications of celiac disease. Among other findings, the study shows that: small bowel capsule endoscopy reveals macroscopic changes in celiac disease patients with a high level of sensitivity; low levels of vitamin B12 and folate due to malabsorption match the severity of celiac disease; celiac patients with a normal small bowel capsule endoscopy result are not likely to have significant active disease. Read more in Clinics and Research in Hepatology and Gastroenterology
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Celiac.com 02/10/2020 - There are no articles in the medical literature about the role of repeat small bowel capsule endoscopy (SBCE) in patients with refractory celiac disease (RCD) following treatment with steroids and/or immunosuppressants. A team of researchers recently set out to compare the findings on SBCEs from a group of 23 patients with histologically proven RCD against the results of 48 patients with uncomplicated celiac disease. All patients had concurrent duodenal histology and serology taken at the time of SBCE. The team included Stefania Chetcuti Zammit, David S. Sanders, Simon S. Cross, and Reena Sidhu. They are variously associated with Academic Department of Gastroenterology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals, Sheffield; and the Academic Unit of Pathology, Department of Neuroscience, Faculty of Medicine, Dentistry & Health, The University of Sheffield, Sheffield, UK. SBCE revealed refractory celiac disease patients to have greater mucosal involvement than patients with uncomplicated celiac disease. After steroid and/or immunosuppressant treatment, refractory celiac disease patients showed an improvement in the extent of affected small bowel mucosa. Statistically, both histology and serology were the same for first and second SBCE in refractory celiac disease patients. The study data indicates that SBCE is useful in documenting the degree of mucosal involvement in refractory celiac disease patients. The team notes that this is the first study to demonstrate the value of a second look SBCE to assess the degree of improvement in celiac disease in the small bowel following treatment. However, more study is needed to more firmly establish these results. Read more in J Gastrointestin Liver Dis, March 2019 Vol. 28 No 1: 15-22
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