Original articleClinical endoscopyCapsule endoscopy in nonresponsive celiac disease
Section snippets
Study population
We included 42 consecutive patients with biopsy-proven CD. CE was performed because of nonresponsive CD defined by persistent or recurrent symptoms (such as diarrhea, weight loss, and abdominal pain) after at least 6 months on a GFD.3 The control group consisted of 84 age- and sex-matched subjects with normal duodenal histology who underwent CE concurrently with the evaluation of nonresponsive CD patients. Blind review of images was achieved by mixing the CE videos and assigning a numeric code
Patients
Forty-two consecutive patients with nonresponsive CD and 84 age- and sex-matched CD-free controls were studied. In addition, we did a retrospective re-review of CE in 30 patients with treated uncomplicated CD who underwent CE evaluation after treatment with a GFD for approximately 6 months or more (Table 1).
CE findings
All 126 patients swallowed the capsule successfully, and no capsule failed to leave the stomach. Small-bowel transit time was significantly longer in nonresponsive CD patients compared with
Discussion
This study yielded 3 major findings. First, macroscopic features of villous atrophy were detected by CE in 31% of patients with nonresponsive CD and 47% of patients with treated uncomplicated CD, suggesting persistent mucosal damage despite a GFD. Second, small-intestine erosions/ulcerations are no more frequent in nonresponsive CD than in either the CD-free controls or patients with treated uncomplicated CD, but those with nonresponsive CD are associated with increased aspirin/NSAID use.
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DISCLOSURE: This article was supported by the National Institutes of Health (NIH) Training Grant in Allergic Diseases T32 AI-07047, American College of Gastroenterology Junior Faculty Development Award (A.R-T.), and NIH grant DK57892 (J.A.M.). The authors disclosed no financial relationships relevant to this publication.
See CME section; p. 1376.
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Drs. Atlas and Rubio-Tapia contributed equally to this work.