The Range of Lesions in the Small Intestine of Children with Celiac Disease Determined by Capsule Endoscopy

Abstract

Background. Celiac disease is a chronic gluten intolerance which can cause small intestinal inflammatory lesions of different intensity, scope and distribution. Objectives. The aim of the study was to assess the distribution and scope of lesions revealed by endoscopy in the small intestine of children and adolescents with untreated celiac disease. Material and Methods. A total of nine patients aged from 15 to 18 years (average age: 16 years) were enrolled in the study, including seven girls and two boys who had been diagnosed with histologically confirmed celiac disease. Following a bowel cleansing all the patients were subjected to examination of the small intestine using an endoscopic capsule (EndoCapsule EC, Olympus, Tokyo, Japan). Results. The examination was complete in eight of the patients. In six patients the capsule endoscopy revealed continuous lesions in the duodenum and the proximal small intestine. In one child continuous lesions occurred only in a short section of the bowel, within the duodenum. In one patient the abnormalities were located in the proximal small intestine without any lesions in duodenum. In one case, segmental lesions were observed in the distal small intestine, without any lesions in the duodenum or in the proximal part of the bowel. The results for the endoscopic markers of celiac disease were as follows: in all the patients a significant shortening or complete lack of villous structure was noted; in six patients scalloping was observed at the peaks of the circular folds; in three patients granulation was observed; and in three patients a mosaic mucosal pattern was noted. Conclusions. The most frequent type of lesions revealed by capsule endoscopy in pediatric patients with untreated celiac disease seems to be continuous lesions in the duodenum and the proximal small intestine. Some patients can develop macroscopic lesions (and probably microscopic ones as well) that are beyond the reach of traditional endoscopy. In such cases, capsule endoscopy can help to determine and diagnose celiac disease and to establish the need for lifelong dietary treatment (Adv Clin Exp Med 2014, 23, 5, 785-790).

Celiac disease in children: Increasing prevalence and changing clinical presentations

“…Celiac disease (CD) is a chronic autoimmune enteropathy [1][2][3][4][5] . It results from genetic predisposition and exposure to gluten containing food 1,2,4,5) .…”

“…Celiac disease (CD) is a chronic autoimmune enteropathy [1][2][3][4][5] . It results from genetic predisposition and exposure to gluten containing food 1,2,4,5) . Individuals carrying human leucocytes antigen (HLA) markers DQ2 or DQ8 are genetically predisposed [4][5][6] .…”

“…It results from genetic predisposition and exposure to gluten containing food 1,2,4,5) . Individuals carrying human leucocytes antigen (HLA) markers DQ2 or DQ8 are genetically predisposed [4][5][6] . Gluten is a protein found in wheat, rye and barley; the main ingredients of bread, pasta and pastries [2][3][4]7) .…”

“…Recent spread of CD awareness encouraged food industries to produce ranges of harmless substitutes for gluten containing foods, but the choices are still restricted 3) . CD in children has been evaluated worldwide and in several neighboring countries to Bahrain [1][2][3][4][5][6][7][10][11][12][13][14][15][16][17][18][19][20][21] . To our knowledge, CD in children has not been evaluated in Bahrain.…”

Current technologies for the endoscopic assessment of duodenal villous pattern in celiac disease

“…The principal indication of videocapsule endoscopy is the diagnosis of obscure bleeding [73]. Moreover, this methodology appears to be able to show the typical signs of celiac disease, such as nodularity, mosaic pattern of mucosa, reduction of duodenal plicae and scalloping [74][75][76][77]. First report for celiac disease, demonstrated a sensitivity of 87.5% and a specificity of 90.9% for capsule endoscopy in the detections of duodenal mucosa alterations, compared to histopathology [78].…”