Capsule Endoscopy in Celiac Disease

Akın, Ebru; Ersoy, Osman

doi:10.1155/2012/676073

Cited by 8 publications

(5 citation statements)

References 41 publications

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“…The so-called endoscopic markers of celiac disease include shortening and thickening of intestinal villi, or a lack of intestinal villi (fissures); flattening or a lack of circular folds; fissures of the mucosa, a mosaic mucosal pattern or granulation of the mucosa [12,15]. The positive predictive value of endoscopic markers of celiac disease has been assessed at 68%; more specifically, a mosaic structure of the duodenal mucosa has been assessed at 65%, granulation of mucosa at 75.5% and scalloping of circular folds at 64.4% [16].…”

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The Range of Lesions in the Small Intestine of Children with Celiac Disease Determined by Capsule Endoscopy

2014

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Background. Celiac disease is a chronic gluten intolerance which can cause small intestinal inflammatory lesions of different intensity, scope and distribution. Objectives. The aim of the study was to assess the distribution and scope of lesions revealed by endoscopy in the small intestine of children and adolescents with untreated celiac disease. Material and Methods. A total of nine patients aged from 15 to 18 years (average age: 16 years) were enrolled in the study, including seven girls and two boys who had been diagnosed with histologically confirmed celiac disease. Following a bowel cleansing all the patients were subjected to examination of the small intestine using an endoscopic capsule (EndoCapsule EC, Olympus, Tokyo, Japan). Results. The examination was complete in eight of the patients. In six patients the capsule endoscopy revealed continuous lesions in the duodenum and the proximal small intestine. In one child continuous lesions occurred only in a short section of the bowel, within the duodenum. In one patient the abnormalities were located in the proximal small intestine without any lesions in duodenum. In one case, segmental lesions were observed in the distal small intestine, without any lesions in the duodenum or in the proximal part of the bowel. The results for the endoscopic markers of celiac disease were as follows: in all the patients a significant shortening or complete lack of villous structure was noted; in six patients scalloping was observed at the peaks of the circular folds; in three patients granulation was observed; and in three patients a mosaic mucosal pattern was noted. Conclusions. The most frequent type of lesions revealed by capsule endoscopy in pediatric patients with untreated celiac disease seems to be continuous lesions in the duodenum and the proximal small intestine. Some patients can develop macroscopic lesions (and probably microscopic ones as well) that are beyond the reach of traditional endoscopy. In such cases, capsule endoscopy can help to determine and diagnose celiac disease and to establish the need for lifelong dietary treatment (Adv Clin Exp Med 2014, 23, 5, 785-790).

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“…The positive predictive value of endoscopic markers of celiac disease has been assessed at 68%; more specifically, a mosaic structure of the duodenal mucosa has been assessed at 65%, granulation of mucosa at 75.5% and scalloping of circular folds at 64.4% [16]. According to various data, those markers are present in 67-93% patients with celiac disease [15].…”

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The Range of Lesions in the Small Intestine of Children with Celiac Disease Determined by Capsule Endoscopy

2014

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“…In the study performed by Akram et al ,10 7 patients of 15 were examined with capsule endoscopy, and showed villous pathology restricted to the proximal small bowel in all patients but one, while we found shortened villi throughout the small bowel. WCE is a valuable diagnostic tool in a variety of diseases where mucosal damage is involved, such as coeliac disease and refractory coeliac disease 12. However, in coeliac disease, capsule endoscopy does not contribute to diagnosis when compared with duodenal biopsies 13.…”

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Wireless capsule endoscopy as a tool in diagnosing autoimmune enteropathy

Gram-Kampmann¹,

Lillevang

Detlefsen

et al. 2015

BMJ Case Reports

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Autoimmune enteropathy (AE) is an immune mediated illness of the intestinal mucosa. The cause is unknown, and the diagnosis is based on typical characteristics displayed. There is no gold standard for treatment. We present two adult cases of AE and demonstrate the challenges in establishing the diagnosis. The extensive diagnostic work up excluded other more common causes of protracted diarrhoea. Wireless capsule endoscopy (WCE) displayed universal small intestinal mucosal damage with shortened villi that led to the suspicion of AE in both patients. The diagnosis was confirmed with microscopy, showing shortened villi, villous blunting and hyperplasia of crypts in both patients. In one patient, deep crypt lymphocytosis with minimal intraepithelial lymphocytosis was found as well. Both patients were successfully treated with high-dose immunosuppressant therapy to induce and maintain remission. Use of WCE as a diagnostic tool was invaluable in establishing the diagnosis of AE.

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“…In addition, none of the previous reports have included carriers of HLA-DQ2 or DQ8 or patients who developed villous atrophy in the small intestine before EATL occurrence in the Japanese populations. Data in Japan is scarce regarding the significance of capsule endoscopy (CE) and magnifying narrow-band imaging (NBI) in the management of EATL in patients with CeD, although there are a couple of publications on these in the Western countries [7][8][9][10].…”

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confidence: 99%

A case of celiac disease with type I enteropathy-associated T-cell lymphoma in a Japanese male patient

Hiraga

Sakuraba

Tanaka

et al. 2019

Immunological Medicine

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A 45-year-old Japanese male patient who was diagnosed with celiac disease (CeD) developed type I enteropathy-associated T-cell lymphoma (EATL). In 2013, the patient was admitted to our hospital with worsening of diarrhea and weight loss. Pathological examination of biopsy specimens from the duodenum and ileum led to a diagnosis of suspected EATL. A previous total colonoscopy (TCS) indicated villous atrophy in the terminal ileum. The patient was changed to a gluten-free diet, and the nutritional status gradually improved. In September 2014, he experienced acute right lower abdominal pain. He underwent urgent surgery, and a perforation was identified in the ileum. A diagnosis of type I EATL was made following histopathological examination. After eight courses of CHOP therapy, the patient entered complete remission. TCS and esophagogastroduodenoscopy with magnifying narrow-band imaging performed in 2015 identified villous regrowth in the distal ileum and duodenum. Capsule endoscopy also found villous regrowth in the entire small intestine. To our knowledge, this is the first case of type I EATL following CeD with villous atrophy before EATL occurrence in a Japanese HLA-DQ2 carrier. The possibility of type I EATL occurring after CeD should be recognized, although CeD is quite rare in Japan.

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Capsule Endoscopy in Celiac Disease

Cited by 8 publications

References 41 publications

The Range of Lesions in the Small Intestine of Children with Celiac Disease Determined by Capsule Endoscopy

The Range of Lesions in the Small Intestine of Children with Celiac Disease Determined by Capsule Endoscopy

Wireless capsule endoscopy as a tool in diagnosing autoimmune enteropathy

A case of celiac disease with type I enteropathy-associated T-cell lymphoma in a Japanese male patient

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