Capsule Endoscopy (CE) in Evaluation of Patients with Celiac Disease (CD)

Abstract

Aim: To establish the accuracy of CE in diagnosing villous atrophy (VA) using small bowel (SB) histology as a “gold standard”. To evaluate the ability of CE to correctly interpret mucosal changes in CD patients after introduction of a gluten free diet (GFD). Methods: Participants (CD and control group) had serology, upper endoscopy, SB biopsy and CE. Standard endoscopic criteria in identifying VA were applied to CE. An investigator blinded to other tests' findings randomly reviewed CE images. Patients' identification details were coded. Histological confirmation of CD (Marsh's III-IV type) was considered diagnostic of CD. All tests were repeated in CD group to assess patients' response after 6 months of the GFD. A dedicated dietitian assessed patients' baseline gluten intake followed by compliance to the GFD. The investigator blinded to other tests' findings reviewed and compared CE images taken before with the images taken after introduction of the GFD. Results: Evaluated 41 (29 CD, 12 healthy controls). Mean age-45.3 yr, SD=15.94 (range 17-77). 1 patient's data (CD group) was excluded from the analysis (Marsh's I-II type). In the diagnosis of VA, CE yielded a sensitivity/a specificity of 89.3%/91.7%, positive/negative predictive values of 96.2%/78.6%. Importantly, CE revealed 3 CD patients with ulcerative jejunitis. 15 CD patients were re-evaluated after 6 months of the GFD. 12/15 improved histologically and clinically. 3/15 did not experience any changes in their condition. 1 of the 3 was found completely and 1 partially non-complaint to the GFD. When compared to histology CE correctly interpreted positive/negative mucosal changes after introduction of the GFD in 12/15 patients (80%). Conclusions: CE may be suggested for further work up of histologically confirmed CD patients. With its ability to visualize the entire SB and high accuracy in identifying VA, CE could provide a non-invasive way of evaluating CD patients, monitoring the response to the GFD as well as lifelong screening for CD related complications such as ulcerative jejunitis or malignancy.