PWE-095 What is the role of capsule endoscopy in evaluating patients with refractory coeliac disease?

Abstract

Introduction Small bowel capsule endoscopy (SBCE) is used in refractory coeliac disease (RCD) to assess the extent of disease and ensure there are no complications (lymphoma or ulcerative jejunitis). However there are no published reports on SBCE in RCD following immunosuppressive therapy. Methods Patients with histologically confirmed refractory coeliac disease (RCD) who underwent a SBCE at baseline and after treatment were enrolled in this study. These were compared to a group of control CD patients with no underlying RCD. Results 19 patients (median 53 years) with RCD (12 patients; 63.2% – type 1) were compared to 28 patients with control CD (median 48 years). There was no statistically significant difference in duration of disease, gender, age at SBCE and serology between the 2 groups. Patients with RCD were more likely to have worse histology (Marsh 3a-c) than SBCE. control CD who had a higher percentage of normal histology at the time of SBCE. (p=0.002) Those with RCD had a longer abnormal small bowel (SB) mucosa (185 SD ±167.6 vs 29.5 SD ±73 min p=0.0001) and longer percentage of abnormal SB (53.9 SD ±38.0 vs 6.9 SD ±15.2 min p=0.0001) when compared to those with control CD. A repeat SBCE was carried out after a mean of 9.63 SD ±6.6 months in patients with RCD following treatment. There was no statistical significant difference in histology and serology at the time of the first and second SBCE. Patients received the following treatment: 36.8% steroids, 26.3% immunosuppressants, 36.1% combination of mycophenolate azathioprine and steroids. However, there was an improvement in the length of abnormal SB mucosa (185 vs 116 min; p=0.035) and the percentage of abnormal SB (50.8 vs 32.9%; p=0.027). 7 patients (36.8%) had diffuse mucosal involvement on the first SBCE but only 4 (21.1%) had diffuse disease on repeat SBCE. (p=0.007) There was no statistical correlation between coeliac serology and small bowel passage time, length of mucosal abnormality and percentage of affected SB at first and second SBCE. The same findings were also true for histology. Conclusions More severe SB involvement on SBCE can be found in patients with RCD. This is the first study that shows an improvement in SB abnormality on SBCE following treatment of RCD patients. Histology is useful in distinguishing RCD from non-RCD but not for assessing improvement in patients with RCD following treatment. SBCE might potentially be regarded as a less invasive, more accurate way of following up these patients.