title: Capsule endoscopy in nonresponsive celiac disease.
abstract: BACKGROUND
  Nonresponsive celiac disease (CD) is defined by persistent or recurrent symptoms, common after treatment with a gluten-free diet (GFD).
  
  
  OBJECTIVE
  To evaluate the utility of capsule endoscopy (CE) in nonresponsive CD.
  
  
  METHODS
  Case-control study.
  
  
  METHODS
  Tertiary-care center.
  
  
  METHODS
  Forty-two consecutive patients with nonresponsive CD and 84 age- and sex-matched CD-free controls who underwent CE were included. In addition, capsules taken after treatment with a GFD were retrospectively evaluated in 30 patients with uncomplicated CD.
  
  
  METHODS
  CE.
  
  
  METHODS
  Diagnostic accuracy of CE for the detection of mucosal abnormalities in nonresponsive CD.
  
  
  RESULTS
  Macroscopic features of villous atrophy were detected in 13 of 42 patients (31%) with nonresponsive CD compared with none among 84 CD-free controls and 14 of 30 patients (47%) with uncomplicated CD. Among nonresponsive CD cases, the overall sensitivity and specificity of CE for the detection of any degree of villous atrophy as graded by histology were 56% and 85%, respectively. Single or multiple erosions/ulcerations of the gut were observed in 19% of nonresponsive CD patients, 18% of CD-free controls, and 31% of patients with uncomplicated CD (P = .35). The presence of erosions/ulcerations was associated with increased aspirin/nonsteroidal anti-inflammatory drug use in nonresponsive CD (P =.05). Two severe complications (ulcerative jejunitis and adenocarcinoma) were detected by CE in nonresponsive CD.
  
  
  CONCLUSIONS
  Single-center, retrospective study.
  
  
  CONCLUSIONS
  Mucosal abnormalities were observed by CE in patients with both nonresponsive CD and uncomplicated CD. CE can detect severe complications in patients with nonresponsive CD.
authors.affiliation: Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA.
authors.forename: David S
authors.initials: DS
authors.lastname: Atlas
authors.forename: Alberto
authors.initials: A
authors.lastname: Rubio-Tapia
authors.forename: Carol T
authors.initials: CT
authors.lastname: Van Dyke
authors.forename: Brian D
authors.initials: BD
authors.lastname: Lahr
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Murray
mesh_terms: D053704:Capsule Endoscopy / Q000379:methods*; D002446:Celiac Disease / Q000175:diagnosis* / Q000178:diet therapy; D003937:Diagnosis, Differential; D055050:Diet, Gluten-Free / Q000379:methods*; D005260:Female; D006801:Humans; D007413:Intestinal Mucosa / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D017211:Treatment Failure