Studies of Celiac Sprue. IV. The Response of the Whole Length of the Small Bowel to a Gluten-Free Diet

Capsule Endoscopy in Celiac Disease: Diagnosis and Management

“…Murray and colleagues [42] demonstrated that the length of bowel involved at capsule endoscopy in celiac disease capsule endoscopy did not correlate with the mode of symptomatic presentation in patients. It has been known for a while that the ileum can be involved in the inflammatory process [43]. This was confirmed recently in a series of patients who had celiac disease who had ileal biopsies at colonoscopy [44].…”

Duodenal bulb biopsies for diagnosing adult celiac disease: is there an optimal biopsy site?

“…20 The rationale in taking duodenal bulb biopsy specimens could be substantiated by a conventional understanding that villous atrophy is most severe proximally where the gluten load is greatest. 21 Improving the detection of these bulbar changes could come from novel endoscopic techniques, with a recent study highlighting the merits of confocal endomicroscopy for this purpose. 22 A recent pediatric study suggested that 4 biopsy specimens are required from the duodenal bulb in addition to specimens from the distal duodenum to optimize the diagnostic accuracy of celiac disease.…”

Celiac disease and selected long-term health issues

“…Pathological changes in this disorder also occur along the length of the small bowel [17]. These may have special importance in assessing the gluten-free diet response.…”

“…An alternative explanation might be that the effects on the small intestinal mucosa in celiac disease are "indirect", driven by immune-mediated effects caused by re-circulating memory T-cells [18]. Although the ileum appears normal or minimally affected, the ileal mucosa in celiac disease still appears to be exceedingly sensitive to gluten-containing peptides infused through long intestinal tubes [17].…”