Introduction Demonstration of villous atrophy (VA) on small bowel biopsy and positive serology (endomysial antibody (EMA) and/or tissue transglutaminase (tTG)) is the current gold standard for diagnosing coeliac disease. Difficulty in establishing the diagnosis may arise for several reasons. A minority may have antibody negative disease. Some individuals may have positive antibodies with histological changes that fall short of VA (Marsh Grade 1 and 2 [MG1-2]) or are unable to tolerate gastroscopy. In addition, not all VA seen is caused by coeliac disease. The aim of this study was to assess the value of capsule endoscopy (CE) in equivocal coeliac disease.
Methods Data from all patients with equivocal coeliac disease who underwent CE between 2004 and 2011 in a tertiary gastroenterology department were analysed. Patients were subdivided into five main groups: Group 1—antibody negative VA; Group 2—MG1-2; Group 3—positive coeliac serology with normal duodenal biopsy; Group 4—miscellaneous including strong family history and non-gastrointestinal presentation of probable coeliac disease; Group 5—failed or refused gastroscopy. Demographic data, indication for CE, serology and histology were recorded prospectively. Videos were analysed by two experienced gastroenterologists blinded to the clinical data. Markers of coeliac disease such as scalloping, mosaic pattern and loss of folds were assessed. A diagnosis of coeliac disease was further supported by not only CE appearances but also combinations of HLA typing (DQ-2 or DQ-8), gluten challenge/response to a gluten free diet and in some cases repeat duodenal biopsy.
Results 102 patients, 72 female, median age 49 years, (range 18–89 y) underwent CE. 17/102 (16%) had features of coeliac disease on CE, with a further three cases of Crohn's disease identified (Abstract PTU-232 table 1). In patients with coeliac antibody negative VA, CE secures a diagnosis of coeliac or Crohn's in 9/32 (28%) significantly more than in other groups where previous gastroscopy was undertaken (p=0.04). In 57% (4/7) of patients with positive coeliac serology who either failed or refused gastroscopy, CE helped establish the diagnosis.
Conclusion CE may have a role in the assessment of patients with coeliac antibody negative VA and in antibody positive patients where previous gastroscopy has been refused or failed. Its routine use is not supported in other causes of “equivocal” coeliac disease.
Competing interests None declared.
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