Capsule endoscopy in refractory celiac disease

Daum, S; Wahnschaffe, Ulrich; Glasenapp, Rosane; Borchert, Margret; Ullrich, Reiner; Zeitz, M.; Faiss, S

doi:10.1055/s-2007-966239

Cited by 113 publications

(53 citation statements)

References 14 publications

(27 reference statements)

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“…Workup includes an exclusion of malignancy [69,76,88,89] (EATL and small bowel adenocarcinoma) with an abdominal CT enterography or MR Enterography. Endoscopy reveals multiple benign ulcers concentrated mainly in the jejunum [70,71]; and if negative should be followed by a capsule endoscopy [90,91]. It usually carries a poor prognosis; while surgical resection of localized ulcerations and structured small bowel improves prognosis [71,76,89,92].…”

Section: Ulcerative Jejunitismentioning

confidence: 99%

Gluten and the Gut: A Brief Review of Gluten-Related Gastrointestinal Disorders

Shah¹

2017

SOJI

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We conducted online electronic searches (published manuscripts in English) of the Cochrane Library, pub med and manual searches of selected specialty journals to identify any pertinent literature. The search was conducted using the key words 'celiac disease', 'gluten related disorder', 'non celiac gluten sensitivity', 'wheat allergy', 'gluten', , 'gluten free diet'. Studies not published in English or published only in the abstract form were excluded. We also conducted a focused review of available references to identify subsequent pertinent papers. AbstractCeliac disease (CD) was the first gluten-related disorder to be described. Presently the realm of gluten-related disorders also includes non-celiac gluten sensitivity (NCGS) and wheat allergy (WA). CD is a multisystem immune mediated enteropathy observed in genetically susceptible individuals exposed to dietary gluten present in barley, rye and wheat. Although the prevalence of CD is on the rise, it still largely remains under diagnosed given that many cases can be silent, subtle or atypical. The Pathophysiology of CD includes both innate and adaptive immune response to dietary gluten. Patients present with a wide variety of intestinal and extra-intestinal symptoms and are at risk for non-Hodgkin's lymphoma and small intestinal adenocarcinoma. The corner stone for treatment of CD is a gluten-free diet (GFD). NCGS is an emerging condition associated with gluten ingestion and the diagnosis of which is based on exclusion of CD and WA. Further evidence and studies are required to fully appreciate the clinical entity of NCGS and WA to detail its epidemiology and pathogenesis. The symptoms of NCGS and WA may overlap with CD and hence it is imperative to differentiate these clinical entities and select patients for appropriate management.Keywords: Celiac disease, gluten related disorder, non-celiac gluten sensitivity, wheat allergy, gluten, epidemiology, clinical features, Pathophysiology, management, gluten free diet.Core tip: CD is largely under-diagnosed while the incidence and prevalence of gluten-related disorders are on the rise. A clear understanding of the various clinical presentations of gluten-related disorders can help differentiate CD from NCGS and WA. The management for these conditions differs and hence accurate diagnosis leads to improved patient outcomes with avoidance of longterm complications as well as unnecessary testing which can be both invasive and expensive. Celiac DiseaseThe term celiac is derived from the Greek word "koiliaks" meaning "abdominal". It was first described in the second century in modern day Turkey by a Greek physician Aretaeus of Cappadocia [1]. In 1888, Samuel Gee; a pediatrician from the United Kingdom gave the first modern-day description of the condition and associated diet to the treatment of celiac disease EpidemiologyCeliac disease occurs in about 1% of the general population worldwide [7]. Data from the USA suggests CD to be more common in Caucasians as compared to African-Americans and Hispanics [8,9]. The initial ...

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Section: Ulcerative Jejunitismentioning

confidence: 99%

Gluten and the Gut: A Brief Review of Gluten-Related Gastrointestinal Disorders

Shah¹

2017

SOJI

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“…Using duodenal histology as a gold standard, another study found good sensitivity (87.5%) and specificity (90.9%) for the detection of villous atrophy [61]. Capsule endoscopy has been shown promise in the monitoring of type II refractory celiac disease for ulcerative jejunitis and intenstinal T-cell lymphoma, but larger studies are needed [62]. Capsule endoscopy may also be useful in complicated disease.…”

Section: Celiac Diseasementioning

confidence: 99%

Video Capsule Endoscopy: The Past, Present, and Future

Whitmer¹

2013

J Gastrointest Dig Syst

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“…Two studies [57,58] , p ub lish ed in 2005 a nd 2007 respectively, evaluated the role of capsule endoscopy in patients with complicated/refractory celiac disease. In this particular subset of patients capsule endoscopy has been performed to rule out malignant neoplasms [primarily enteropathy associated T-cell lymphoma (EATL)] or other complications (i.e.…”

Section: Other Indicationsmentioning

confidence: 99%

“…ulcerative jejunitis). The study of Culliford [57] depicted for the first time the spectrum of findings (such as scalloping of folds, nodularity and villous atrophy, but also strictures, intussusceptions or submucosal masses), identified by capsule endoscopy in patients with complicated celiac disease, while Daum et al [58] , demonstrated that capsule endoscopy adds significant clinical infor mation affecting further management mostly in patients with refractory celiac disease type Ⅱ. Nevertheless, both studies included a small number of patients with refractory/complicated celiac disease undergoing a huge number of examinations to exclude strictures; in fact, as previously mentioned for Crohn' s disease, refractory celiac disease can also result in a structuring disease.…”

Section: Other Indicationsmentioning

confidence: 99%

Small bowel capsule endoscopy in 2007: Indications, risks and limitations

Rondonotti¹,

Villa²,

Mulder³

et al. 2007

WJG

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Capsule endoscopy has revoluzionized the study of the small bowel by providing a reliable method to evaluate, endoscopically, the entire small bowel. In the last six years several papers have been published exploring the possible role of this examination in different clinical conditions. At the present time capsule endoscopy is generally recommended as a third examination, after negative bidirectional endoscopy, in patients with obscure gastrointestinal bleeding. A growing body of evidence suggests also an important role for this examination in other clinical conditions such as Crohn's disease, celiac disease, small bowel polyposis syndromes or small bowel tumors. The main complication of this examination is the retention of the device at the site of a previously unknown small bowel stricture. However there are also some other open issues mainly due to technical limitations of this tool (which is not driven from remote control, is unable to take biopsies, to insufflate air, to suck fluids or debris and sometimes to correctly size and locate lesions).The recently developed double balloon enteroscope, owing to its capability to explore a large part of the small bowel and to take targeted biopsies, although being invasive and time consuming, can overcome some limitations of capsule endoscopy. At the present time, in the majority of clinical conditions (i.e. obscure GI bleeding), the winning strategy seems to be to couple these two techniques to explore the small bowel in a painless, safe and complete way (with capsule endoscopy) and to define and treat the lesions identified (with double balloon enteroscopy).

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Capsule endoscopy in refractory celiac disease

Cited by 113 publications

References 14 publications

Gluten and the Gut: A Brief Review of Gluten-Related Gastrointestinal Disorders

Gluten and the Gut: A Brief Review of Gluten-Related Gastrointestinal Disorders

Video Capsule Endoscopy: The Past, Present, and Future

Small bowel capsule endoscopy in 2007: Indications, risks and limitations

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