title: Capsule endoscopy in adult celiac disease: a potential role in equivocal cases of celiac disease?
abstract: BACKGROUND
  There have been limited studies evaluating capsule endoscopy (CE) in equivocal celiac disease (CD).
  
  
  OBJECTIVE
  To determine the role CE may have in equivocal CD cases, compared with patients with biopsy-proven and serology-proven CD who have persisting symptoms.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  University hospital.
  
  
  METHODS
  A total of 62 patients with equivocal CD and 69 patients with nonresponsive CD.
  
  
  METHODS
  CE.
  
  
  METHODS
  Diagnostic yield of CE in equivocal cases and accuracy of mucosal abnormality detection in patients with nonresponsive CD.
  
  
  RESULTS
  Equivocal cases (n = 62) were divided into two subgroups: group A (antibody-negative villous atrophy, n = 32) and group B (Marsh 1-2 changes, n = 30). In group A, CE secured a diagnosis of CD or Crohn's disease in 28% (9/32), significantly higher than the diagnostic yield in group B (7%; P = .044). In patients with CD with persisting symptoms, significant CE findings were identified in 12% (8/69), including 2 cases of enteropathy-associated lymphoma, 4 type 1 refractory disease cases, 1 polypoidal mass histologically confirmed to be a fibroepithelial polyp, and 1 case of ulcerative jejunitis. This outcome was significantly lower than the diagnostic yield of CE in antibody-negative villous atrophy (P = .048).
  
  
  CONCLUSIONS
  Single center.
  
  
  CONCLUSIONS
  There have been no previous reports systematically evaluating equivocal CD by using CE. The diagnostic yield of CE in patients with antibody-negative villous atrophy is better than that of CE in patients with CD with persisting symptoms. We advocate the use of CE in equivocal cases, particularly in patients with antibody-negative villous atrophy.
authors.affiliation: Department of Gastroenterology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, South Yorkshire, United Kingdom.
authors.forename: Matthew
authors.initials: M
authors.lastname: Kurien
authors.forename: Kate E
authors.initials: KE
authors.lastname: Evans
authors.forename: Imran
authors.initials: I
authors.lastname: Aziz
authors.forename: Reena
authors.initials: R
authors.lastname: Sidhu
authors.forename: Kaye
authors.initials: K
authors.lastname: Drew
authors.forename: Thea L
authors.initials: TL
authors.lastname: Rogers
authors.forename: Mark E
authors.initials: ME
authors.lastname: McAlindon
authors.forename: David S
authors.initials: DS
authors.lastname: Sanders
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D053704:Capsule Endoscopy; D002446:Celiac Disease / Q000175:diagnosis* / Q000276:immunology; D015331:Cohort Studies; D003424:Crohn Disease / Q000175:diagnosis; D003937:Diagnosis, Differential; D005260:Female; D006683:HLA-DQ Antigens / Q000097:blood; D006801:Humans; D007070:Immunoglobulin A / Q000097:blood; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies
chemical_list: D015415:Biomarkers; D006683:HLA-DQ Antigens; D007070:Immunoglobulin A