Original article—alimentary tractMucosal Atrophy in Celiac Disease: Extent of Involvement, Correlation With Clinical Presentation, and Response to Treatment
Section snippets
Experimental Design
The study was a single-center prospective study of patients with newly diagnosed CD. Within 2 weeks of the diagnosis but before the onset of a GFD, patients giving informed consent underwent WCE. The video images of each patient were reviewed independently by 2 investigators (C.J.G. and J.A.M.) for the presence and distribution of mucosal abnormalities associated with CD. Each subject was invited to undergo repeat testing at least 6 months after starting a GFD.
Inclusion criteria
We included consecutive adult
Characteristics of Patients With Celiac Disease and Negative Control Group
Forty patients initially were enrolled into the study during the period from March 2003 to August 2004 at Mayo Clinic Rochester. Three patients ultimately were excluded because of the following: (1) incorrect initial diagnosis in 2 patients (both had negative celiac serology and absence of the HLA-DQ2 or -DQ8 haplotypes), and (2) the capsule did not exit the stomach in 1 patient (this patient was included as if she had normal WCE findings in the sensitivity analysis to avoid overestimation of
Discussion
This study showed that CD affects the proximal small intestine and extends distally for a variable distance in a more or less continuous fashion and also heals in the reverse direction after gluten withdrawal. The study confirmed that most patients have a continuous pattern of atrophy, almost always observable in the duodenum. Just 1 patient did not have observable atrophy changes on the duodenal images with atrophy being seen only in the jejunum. Although these data support the concept that CD
References (39)
- et al.
American Gastroenterological Association (AGA) Institute technical review on diagnosis and management of celiac disease
Gastroenterology
(2006) - et al.
Endoscopic features of celiac disease in children
Gastrointest Endosc
(2001) - et al.
Lack of correlation of degree of villous atrophy with severity of clinical presentation of celiac disease
Dig Liver Dis
(2007) - et al.
Morphology of the mucosal lesion in gluten sensitivity
Baillieres Clin Gastroenterol
(1995) - et al.
Studies of celiac sprue IV: the response of the whole length of the small bowel to a gluten free diet
Gastroenterology
(1964) - et al.
Scalloped valvulae conniventes: an endoscopic marker of celiac sprue
Gastroenterology
(1988) - et al.
The insensitivity of endoscopic markers in celiac disease
Am J Gastroenterol
(2002) - et al.
Reliability of the “immersion technique” during routine upper endoscopy for detection of abnormalities of duodenal villi in patients with dyspepsia
Gastrointest Endosc
(2004) - et al.
Combined magnification endoscopy with chromoendoscopy in the evaluation of patients with suspected malabsorption
Gastrointest Endosc
(1997) - et al.
Wireless endoscopy
Gastrointest Endosc
(2000)
Capsule endoscopy in celiac disease: diagnosis and management
Gastrointest Endoscopy Clin N Am
A prospective trial comparing small bowel radiographs and video capsule endoscopy for suspected small bowel diseases
Gastroenterology
The value of wireless capsule endoscopy in patients with complicated celiac disease
Gastrointest Endosc
Capsule endoscopy: an alternative to duodenal biopsy for the recognition of villous atrophy in celiac disease?
Dig Liver Dis
Reliability of antitransglutaminase antibodies as predictors of gluten-free compliance in adult celiac disease
Am J Gastroenterol
Disappearance of endomysial antibodies in treated celiac disease does not indicate histological recovery
Am J Gastroenterol
Duodenal histology in patients with celiac disease after treatment with a gluten-free diet
Gastrointest Endosc
Gluten, major histocompatibility complex, and the small intestineA molecular and immunobiologic approach to the spectrum of gluten sensitivity (“Celiac sprue”)
Gastroenterology
Trends in the identification and clinical features of celiac disease in a North American community: 1950–2001
Clin Gastroenterol Hepatol
Cited by (0)
Supported in part by Given Imaging Ltd, who did not have any role in the design, execution, analysis, or preparation of the manuscript. Also supported by National Institutes of Health grants DK-57892 and DK-070031 (J.A.M.).