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Capsule endoscopy accurately diagnoses refractory celiac disease, may predict type
Intestinal mucosa assessment via capsule endoscopy can accurately diagnose celiac disease, may be predictive of refractory disease type and also can detect overt lymphoma, according to recent results.
In a retrospective study, researchers evaluated data from 38 patients with celiac disease (CD), including nine cases of symptomatic CD, 11 of refractory CD type I (RCDI) and 18 of refractory CD type II (RCDII), along with 45 controls without CD. All participants received capsule endoscopy (CE) and either enteroscopy or upper endoscopy and received a median follow-up of 20 months.
Forty-seven CEs were performed within each group, including 10 among symptomatic CD patients, 11 in those with RCDI and 26 among patients with RCDII. Results were considered to be of good quality in 70% of CD patients, with 61% of procedures reaching the caecum.
Patients with CD had villous atrophy (81% of patients compared with 2%, P<.0001), more than five ulcers (23% compared with 0%, P=.0005) and distally located ulcers (32% compared with 6%, P=.003) more often than controls.
Among participants with CD, only patients with RCDII had intestinal strictures (15% of patients, P=.39) and the appearance of more than five ulcers (42% of patients, P=.003). The procedure indicated more extensive mucosal damage in patients with RCDII than those with RCDI (P=.02). CE predicted histological villous atrophy degree more accurately than optical endoscopy, according to Cohen’s coefficient (0.45 compared with 0.24, P<.001).
Investigators also observed an association between serum albumin levels and the extent of intestinal lesions revealed by CE (P=.003), and indicated that mucosal damage as indicated by CE may be predictive of both the RCDII type and low albumin.
Enteropathy-associated T-cell lymphoma (EATL) occurred in seven patients with RCDII during follow-up. CE performed on three of these participants indicated severe villous atrophy in all of them and jejuna ulcers and intestinal strictures in two. Biopsy confirmed EATL in these three participants.
“Our data show how intestinal mucosal lesion assessment by CE in nonresponsive CD can predict the type of RCD, is associated with the patient’s nutritional status and is useful to detect EATL,” the researchers concluded. “These characteristics position CE among the first-line investigations for the characterization and follow-up of nonresponsive CD.”