Mucosal atrophy in celiac disease: extent of involvement, correlation with clinical presentation, and response to treatment.
OBJECTIVE
Wireless capsule endoscopy provides an opportunity to study the macroscopic features in celiac disease by providing a magnified view of the intestinal mucosa. In this study, we evaluated the following: (1) the distribution of atrophy in untreated celiac disease, (2) the correlation between extent of changes and clinical manifestations, (3) the accuracy and interobserver agreement of wireless capsule endoscopy assessment, and (4) the effect of gluten withdrawal.


METHODS
Thirty-eight consecutive patients with untreated biopsy-proven celiac disease underwent wireless capsule endoscopy. Each subject was invited to undergo repeat testing after at least 6 months of gluten withdrawal. The video images of each patient were reviewed independently by 2 investigators.


RESULTS
Thirty-five (92%) subjects had visible atrophy detected by capsule endoscopy. Twenty-two (59%) subjects showed an extensive enteropathy, 12 (32%) had enteropathy limited to the duodenum, and only 1 had a jejunal enteropathy. No association was shown between the extent of the lesion and clinical manifestations. Capsule endoscopy had a better overall sensitivity for the detection of atrophy as compared with upper endoscopy (92% vs 55%, P = .0005), with a specificity of 100%. The overall interobserver agreement for the 2 reviewers was relatively high (% total agreement, 86.5%). After gluten withdrawal, the extent and the pattern of atrophy improved both qualitatively and quantitatively.


CONCLUSIONS
Celiac disease affects a highly variable portion of the small intestine starting at the duodenum. The extent of visible enteropathy does not explain differences in clinical presentation. Most subjects with visually detected villous atrophy showed a clinically significant improvement after gluten withdrawal.
Murray
Joseph A
JA
Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, Minnesota 55905, USA. murray.joseph@mayo.edu
Rubio-Tapia
Alberto
A
Van Dyke
Carol T
CT
Brogan
Deanna L
DL
Knipschield
Mary A
MA
Lahr
Brian
B
Rumalla
Ashwin
A
Zinsmeister
Alan R
AR
Gostout
Christopher J
CJ
D000328:Adult; D000368:Aged; D001284:Atrophy / Q000175:diagnosis* / Q000473:pathology*; D053704:Capsule Endoscopy; D002446:Celiac Disease / Q000150:complications* / Q000473:pathology / Q000503:physiopathology; D004035:Diet Therapy; D005260:Female; D006801:Humans; D007413:Intestinal Mucosa / Q000473:pathology*; D007421:Intestine, Small / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D012680:Sensitivity and Specificity; D016896:Treatment Outcome