title: Diagnostic yield of capsule endoscopy in refractory celiac disease.
abstract: OBJECTIVE
  Capsule endoscopy (CE) allows for the assessment of the small bowel in numerous intestinal diseases, including celiac disease (CD). The main advantage of CE is the complete visualization of the intestinal mucosal surface. The objective of this study was to investigate whether CE can predict the severity of CD and detect complications.
  
  
  METHODS
  We retrospectively studied the medical files of 9 patients with symptomatic CD, 11 patients with refractory celiac disease type I (RCDI) and 18 patients with refractory celiac disease type II (RCDII), and 45 patients without CD who were investigated both CE and upper endoscopy or enteroscopy. The type of CD was diagnosed on the basis of a centralized histological review, flow cytometry analysis of intraepithelial lymphocytes, and the analysis of T-cell receptor rearrangement by multiplex polymerase chain reaction.
  
  
  RESULTS
  A total of 47 CEs (10, 11, and 26 CEs in the symptomatic CD, RCDI, and RCDII groups, respectively) from the 38 celiac patients and 47 CEs from the 45 nonceliac patients were retrospectively reviewed. Villous atrophy, numerous, or distally located ulcers were more frequent in celiac patients than in controls. Among celiac patients, CE was of acceptable quality in 96% of cases and was complete in 62% of cases. The concordance of CE with histology for villous atrophy was better than that of optic endoscopy (κ coefficient =0.45 vs. 0.24, P<0.001). Extensive mucosal damage on CE was associated with low serum albumin (P=0.003) and the RCDII form (P=0.02). Three cases of overt lymphoma were detected by CE during the follow-up.
  
  
  CONCLUSIONS
  CE findings have a satisfactory concordance with histology and nutritional status in patients with symptomatic or refractory CD. Moreover, CE may predict the type of RCD and allows for the early detection of overt lymphoma.
authors.affiliation: Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, Service d'Hépato-gastro-entérologie, Paris, France.
authors.forename: Maximilien
authors.initials: M
authors.lastname: Barret
authors.forename: Georgia
authors.initials: G
authors.lastname: Malamut
authors.forename: Gabriel
authors.initials: G
authors.lastname: Rahmi
authors.forename: Elia
authors.initials: E
authors.lastname: Samaha
authors.forename: Joël
authors.initials: J
authors.lastname: Edery
authors.forename: Virginie
authors.initials: V
authors.lastname: Verkarre
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Macintyre
authors.forename: Emilie
authors.initials: E
authors.lastname: Lenain
authors.forename: Gilles
authors.initials: G
authors.lastname: Chatellier
authors.forename: Nadine
authors.initials: N
authors.lastname: Cerf-Bensussan
authors.forename: Christophe
authors.initials: C
authors.lastname: Cellier
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D001284:Atrophy; D053704:Capsule Endoscopy; D002446:Celiac Disease / Q000175:diagnosis*; D055088:Early Detection of Cancer; D005260:Female; D005434:Flow Cytometry; D006801:Humans; D007413:Intestinal Mucosa / Q000473:pathology; D007414:Intestinal Neoplasms / Q000175:diagnosis; D007421:Intestine, Small / Q000473:pathology*; D008214:Lymphocytes / Q000378:metabolism / Q000473:pathology; D008223:Lymphoma / Q000175:diagnosis; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D011237:Predictive Value of Tests; D011948:Receptors, Antigen, T-Cell / Q000378:metabolism; D012008:Recurrence; D012189:Retrospective Studies; D012709:Serum Albumin / Q000378:metabolism; D012720:Severity of Illness Index; D055815:Young Adult
chemical_list: D011948:Receptors, Antigen, T-Cell; D012709:Serum Albumin