Role of capsule endoscopy in suspected celiac disease: A European multi-centre study

Marisol Luján-Sanchis, Enrique Pérez-Cuadrado-Robles, Javier García-Lledó, José-Francisco Juanmartiñena Fernández, Luca Elli, Victoria-Alejandra Jiménez-García, Juan Egea-Valenzuela, Julio Valle-Muñoz, Cristina Carretero-Ribón, Ignacio Fernández-Urién-Sainz, Antonio López-Higueras, Noelia Alonso-Lázaro, Mileidis Sanjuan-Acosta, Francisco Sánchez-Ceballos, Bruno Rosa, Santiago González-Vázquez, Federica Branchi, Lucía Ruano-Díaz, César Prieto-de-Frías, Vicente Pons-Beltrán, Pilar Borque-Barrera, Begoña González-Suárez, Sofía Xavier, Federico Argüelles-Arias, Juan-Manuel Herrerías-Gutiérrez, Enrique Pérez-Cuadrado-Martínez, Javier Sempere-García-Argüelles, Marisol Luján-Sanchis, Enrique Pérez-Cuadrado-Robles, Javier García-Lledó, José-Francisco Juanmartiñena Fernández, Luca Elli, Victoria-Alejandra Jiménez-García, Juan Egea-Valenzuela, Julio Valle-Muñoz, Cristina Carretero-Ribón, Ignacio Fernández-Urién-Sainz, Antonio López-Higueras, Noelia Alonso-Lázaro, Mileidis Sanjuan-Acosta, Francisco Sánchez-Ceballos, Bruno Rosa, Santiago González-Vázquez, Federica Branchi, Lucía Ruano-Díaz, César Prieto-de-Frías, Vicente Pons-Beltrán, Pilar Borque-Barrera, Begoña González-Suárez, Sofía Xavier, Federico Argüelles-Arias, Juan-Manuel Herrerías-Gutiérrez, Enrique Pérez-Cuadrado-Martínez, Javier Sempere-García-Argüelles

Abstract

Aim: To analyze the diagnostic yield (DY), therapeutic impact (TI) and safety of capsule endoscopy (CE).

Methods: This is a multi-centre, observational, analytical, retrospective study. A total of 163 patients with suspicion of celiac disease (CD) (mean age = 46.4 ± 17.3 years, 68.1% women) who underwent CE from 2003 to 2015 were included. Patients were divided into four groups: seronegative CD with atrophy (Group-I, n = 19), seropositive CD without atrophy (Group-II, n = 39), contraindication to gastroscopy (Group-III, n = 6), seronegative CD without atrophy, but with a compatible context (Group-IV, n = 99). DY, TI and the safety of CE were analysed.

Results: The overall DY was 54% and the final diagnosis was villous atrophy (n = 65, 39.9%), complicated CD (n = 12, 7.4%) and other enteropathies (n = 11, 6.8%; 8 Crohn's). DY for groups I to IV was 73.7%, 69.2%, 50% and 44.4%, respectively. Atrophy was located in duodenum in 24 cases (36.9%), diffuse in 19 (29.2%), jejunal in 11 (16.9%), and patchy in 10 cases (15.4%). Factors associated with a greater DY were positive serology (68.3% vs 49.2%, P = 0.034) and older age (P = 0.008). On the other hand, neither sex nor clinical presentation, family background, positive histology or HLA status were associated with DY. CE results changed the therapeutic approach in 71.8% of the cases. Atrophy was associated with a greater TI (92.3% vs 45.3%, P < 0.001) and 81.9% of the patients responded to diet. There was one case of capsule retention (0.6%). Agreement between CE findings and subsequent histology was 100% for diagnosing normal/other conditions, 70% for suspected CD and 50% for complicated CD.

Conclusion: CE has a high DY in cases of suspicion of CD and it leads to changes in the clinical course of the disease. CE is safe procedure with a high degree of concordance with histology and it helps in the differential diagnosis of CD.

Keywords: Anti-transglutaminase antibodies; Capsule endoscopy; Celiac disease; Gluten-free diet; Non-celiac gluten sensitivity.

Conflict of interest statement

Conflict-of-interest statement: No potential conflicts of interest relevant to this article were reported.

Figures

Figure 1
Figure 1
Image suggestive of celiac disease by capsule endoscopy.
Figure 2
Figure 2
Groups with suspected celiac disease included and excluded in the study. CE: Capsule endoscopy; CD: Celiac disease; ATG: Anti-transglutaminase antibodies; GFD: Gluten-free diet.
Figure 3
Figure 3
Image suggestive of celiac disease complicated by ulcerative jejunitis.

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Source: PubMed

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