Monitoring non-responsive patients with celiac disease.
Current data clearly suggest that VCE has an important role in the diagnostic workup of complicated Cd, especially in those cases with suspected RCd or EATL. This is supported by the high yield of relevant pathological findings in distal parts of the small intestine, such as severe ulceration and mucosal infiltration, by VCE compared to conventional upper GI endoscopy. In this setting, VCE allows for an assessment of the extent of small bowel involvement, detection of overt though often small neoplasms and assists in planning further diagnostic procedures, especially push or double-balloon enteroscopy which are necessary to obtain specimens either to rule out or to confirm aberrant monoclonal T cell proliferation. Currently, those patients in whom RCd type II or EATL are excluded profit most from a thorough diagnostic workup, since most of them can be treated or cured pharmacologically. At present the prognosis of RCd type II or EATL is poor due to lack of effective therapies. However, treatments that effectively target the aberrant lymphocytes can be anticipated.
Schuppan
Detlef
D
Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA. dschuppa@bidmc.harvard.edu
Kelly
Ciaran P
CP
Krauss
Norbert
N
D000465:Algorithms; D002446:Celiac Disease / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D003955:Diagnostic Tests, Routine; D020776:Endoscopes, Gastrointestinal; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D006801:Humans; D007421:Intestine, Small / Q000473:pathology; D008403:Mass Screening; D008904:Miniaturization; D008991:Monitoring, Physiologic / Q000379:methods*; D017211:Treatment Failure; D014741:Video Recording / Q000295:instrumentation