Capsule endoscopy in nonresponsive celiac disease

David S. Atlas, Alberto Rubio-Tapia, Carol T. Van Dyke, Brian D. Lahr, Joseph A Murray

Research output: Contribution to journalArticle

47 Citations (Scopus)

Abstract

Background: Nonresponsive celiac disease (CD) is defined by persistent or recurrent symptoms, common after treatment with a gluten-free diet (GFD). Objective: To evaluate the utility of capsule endoscopy (CE) in nonresponsive CD. Design: Case-control study. Setting: Tertiary-care center. Patients: Forty-two consecutive patients with nonresponsive CD and 84 age- and sex-matched CD-free controls who underwent CE were included. In addition, capsules taken after treatment with a GFD were retrospectively evaluated in 30 patients with uncomplicated CD. Intervention: CE. Main Outcome Measurements: Diagnostic accuracy of CE for the detection of mucosal abnormalities in nonresponsive CD. Results: Macroscopic features of villous atrophy were detected in 13 of 42 patients (31%) with nonresponsive CD compared with none among 84 CD-free controls and 14 of 30 patients (47%) with uncomplicated CD. Among nonresponsive CD cases, the overall sensitivity and specificity of CE for the detection of any degree of villous atrophy as graded by histology were 56% and 85%, respectively. Single or multiple erosions/ulcerations of the gut were observed in 19% of nonresponsive CD patients, 18% of CD-free controls, and 31% of patients with uncomplicated CD (P =.35). The presence of erosions/ulcerations was associated with increased aspirin/nonsteroidal anti-inflammatory drug use in nonresponsive CD (P =.05). Two severe complications (ulcerative jejunitis and adenocarcinoma) were detected by CE in nonresponsive CD. Limitations: Single-center, retrospective study. Conclusions: Mucosal abnormalities were observed by CE in patients with both nonresponsive CD and uncomplicated CD. CE can detect severe complications in patients with nonresponsive CD.

Original languageEnglish (US)
Pages (from-to)1315-1322
Number of pages8
JournalGastrointestinal Endoscopy
Volume74
Issue number6
DOIs
StatePublished - Dec 2011

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Capsule Endoscopy
Celiac Disease
Gluten-Free Diet
Atrophy

ASJC Scopus subject areas

  • Gastroenterology
  • Radiology Nuclear Medicine and imaging

Cite this

Atlas, D. S., Rubio-Tapia, A., Van Dyke, C. T., Lahr, B. D., & Murray, J. A. (2011). Capsule endoscopy in nonresponsive celiac disease. Gastrointestinal Endoscopy, 74(6), 1315-1322. https://doi.org/10.1016/j.gie.2011.05.049

Capsule endoscopy in nonresponsive celiac disease. / Atlas, David S.; Rubio-Tapia, Alberto; Van Dyke, Carol T.; Lahr, Brian D.; Murray, Joseph A.

In: Gastrointestinal Endoscopy, Vol. 74, No. 6, 12.2011, p. 1315-1322.

Research output: Contribution to journalArticle

Atlas, DS, Rubio-Tapia, A, Van Dyke, CT, Lahr, BD & Murray, JA 2011, 'Capsule endoscopy in nonresponsive celiac disease', Gastrointestinal Endoscopy, vol. 74, no. 6, pp. 1315-1322. https://doi.org/10.1016/j.gie.2011.05.049
Atlas, David S. ; Rubio-Tapia, Alberto ; Van Dyke, Carol T. ; Lahr, Brian D. ; Murray, Joseph A. / Capsule endoscopy in nonresponsive celiac disease. In: Gastrointestinal Endoscopy. 2011 ; Vol. 74, No. 6. pp. 1315-1322.
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AB - Background: Nonresponsive celiac disease (CD) is defined by persistent or recurrent symptoms, common after treatment with a gluten-free diet (GFD). Objective: To evaluate the utility of capsule endoscopy (CE) in nonresponsive CD. Design: Case-control study. Setting: Tertiary-care center. Patients: Forty-two consecutive patients with nonresponsive CD and 84 age- and sex-matched CD-free controls who underwent CE were included. In addition, capsules taken after treatment with a GFD were retrospectively evaluated in 30 patients with uncomplicated CD. Intervention: CE. Main Outcome Measurements: Diagnostic accuracy of CE for the detection of mucosal abnormalities in nonresponsive CD. Results: Macroscopic features of villous atrophy were detected in 13 of 42 patients (31%) with nonresponsive CD compared with none among 84 CD-free controls and 14 of 30 patients (47%) with uncomplicated CD. Among nonresponsive CD cases, the overall sensitivity and specificity of CE for the detection of any degree of villous atrophy as graded by histology were 56% and 85%, respectively. Single or multiple erosions/ulcerations of the gut were observed in 19% of nonresponsive CD patients, 18% of CD-free controls, and 31% of patients with uncomplicated CD (P =.35). The presence of erosions/ulcerations was associated with increased aspirin/nonsteroidal anti-inflammatory drug use in nonresponsive CD (P =.05). Two severe complications (ulcerative jejunitis and adenocarcinoma) were detected by CE in nonresponsive CD. Limitations: Single-center, retrospective study. Conclusions: Mucosal abnormalities were observed by CE in patients with both nonresponsive CD and uncomplicated CD. CE can detect severe complications in patients with nonresponsive CD.

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