Capsule endoscopy in nonresponsive celiac disease - 02/12/11
, Alberto Rubio-Tapia, MD 2, , Carol T. Van Dyke 2, Brian D. Lahr, MS 3, Joseph A. Murray, MD 2, ⁎Reprint requests: Joseph A. Murray, MD, Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905Résumé |
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.
Le texte complet de cet article est disponible en PDF.Abbreviations : CD, CE, GFD, NSAID
Plan
| DISCLOSURE: This article was supported by the National Institutes of Health (NIH) Training Grant in Allergic Diseases T32 AI-07047, American College of Gastroenterology Junior Faculty Development Award (A.R-T.), and NIH grant DK57892 (J.A.M.). The authors disclosed no financial relationships relevant to this publication. |
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| See CME section; p. 1376. |
Vol 74 - N° 6
P. 1315-1322 - décembre 2011 Retour au numéro
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- The role of capsule endoscopy in patients with nonresponsive celiac disease
- Christina A. Tennyson, Peter H.R. Green
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