Small Bowel Motility from Videocapsule Endoscopy: Beware of False Prophets!

Abstract

We read with interest the recent article by Ciaccio et al. in Digestive Diseases and Sciences [1] in which the authors reported the results of their study on using videocapsule endoscopy (VCE) in celiac disease (CD) patients. In this article, the authors stated that this method can be used to assess intestinal motility and to improve CD patient identifcation versus controls. Although these data are interesting, we wish to express some words in favour of a more cautious approach, since some things may not be what they seem. Although abnormal intestinal motility is actually present quite often in CD patients [2], it may revert to normal following a gluten-free diet [3, 4]. However, similar or identical dysmotility findings may also be present in patients with other pathological conditions, such as Whipple’s disease [5], irritable bowel syndrome [6], food hypersensitivity [7], enteric neuropathies [8], and chronic intestinal pseudo-obstruction [9], suggesting that the small bowel, from a motility point of view, responds in a monotonous or similar manner to different pathogenic noxae. Interestingly, in recent years a unifying hypothesis linking enteric dysmotilities and sensation has emerged which relies on the role of low-grade inflammations and disturbances of neuro-immune interactions [10]. Therefore, the fact that Ciaccio and colleagues did observe abnormalities by VCE in their CD patients is not surprising. Rather, these findings should only be considered as aspecific, since the authors did not recruit and compare their findings with those obtained in other patients’ group (such as food allergy, enteric neuropathies, etc.). In addition, it must certainly be kept in mind that for the development of the similar motor abnormalities found in CD and the other conditions described above, the presence of villous atrophy is not essential; in fact, these abnormalities may be found in patients with macroscopically normal intestinal mucosa [6–10]. For the above reasons, we strongly disagree with the authors’ conclusions that ‘‘...the classification of celiac patients versus controls can be based upon dynamic estimates of wall motility,’’ in that had the authors investigated patients with some of the conditions described above, they would have likely found similar or identical findings in these patients. Thus, while we have no doubts on the authors’ enthusiasm and ingenuity regarding their interesting results obtained with a new technique, we once again caution readers to assess these results in a critical manner in order to avoid misinterpretations and false hopes.