title: Capsule endoscopy: a valuable tool in the follow-up of people with celiac disease on a gluten-free diet.
abstract: OBJECTIVE
  Traditional celiac disease guidelines recommend follow-up endoscopy and duodenal biopsies at 6-12 months after commencing a gluten-free diet (GFD). However, histology may remain abnormal even 1-2 years later. We evaluated the role of capsule endoscopy in patients with celiac disease after treatment with a GFD.
  
  
  METHODS
  Twelve adult patients with newly diagnosed celiac disease were prospectively enrolled. All patients had baseline symptom assessment, celiac serology (tissue transglutaminase antibody, tTG), and capsule endoscopy. Twelve months after commencing a GFD, patients underwent repeat symptom assessment, celiac serology, upper gastrointestinal endoscopy, and capsule endoscopy.
  
  
  RESULTS
  At baseline, capsule endoscopy detected endoscopic markers of villous atrophy in the duodenum and extending to a variable distance along the small intestine. On the basis of small bowel transit time, the mean±s.e.m. percentage of small intestine with villous atrophy was 18.2±3.7%. After 12 months on a GFD, repeat capsule endoscopy demonstrated mucosal healing from a distal to proximal direction, and the percentage of small intestine with villous atrophy was significantly reduced to 3.4±1.2% (P=0.0014) and this correlated with improvement in the symptom score (correlation 0.69, P=0.01). There was a significant improvement in symptom score (5.2±1.0 vs. 1.7±0.4, P=0.0012) and reduction in immunoglobulin A-tTG levels (81.5±10.6 vs. 17.5±8.2, P=0.0005). However, 42% of subjects demonstrated persistent villous abnormality as assessed by duodenal histology.
  
  
  CONCLUSIONS
  After 12 months on a GFD, patients with celiac disease demonstrate an improvement in symptoms, celiac serology, and the extent of disease as measured by capsule endoscopy. Mucosal healing occurs in a distal to proximal direction. The extent of mucosal healing correlates with improvement in symptoms. Duodenal histology does not reflect the healing that has occurred more distally.
authors.affiliation: Department of Gastroenterology and Hepatology, The Queen Elizabeth Hospital, Woodville South, South Australia, Australia.
authors.forename: Ilmars
authors.initials: I
authors.lastname: Lidums
authors.forename: Edward
authors.initials: E
authors.lastname: Teo
authors.forename: John
authors.initials: J
authors.lastname: Field
authors.forename: Adrian G
authors.initials: AG
authors.lastname: Cummins