title: Role of capsule endoscopy in suspected celiac disease: A European multi-centre study.
abstract: OBJECTIVE
  To analyze the diagnostic yield (DY), therapeutic impact (TI) and safety of capsule endoscopy (CE).
  
  
  METHODS
  This is a multi-centre, observational, analytical, retrospective study. A total of 163 patients with suspicion of celiac disease (CD) (mean age = 46.4 ± 17.3 years, 68.1% women) who underwent CE from 2003 to 2015 were included. Patients were divided into four groups: seronegative CD with atrophy (Group-I,n= 19), seropositive CD without atrophy (Group-II,n= 39), contraindication to gastroscopy (Group-III,n= 6), seronegative CD without atrophy, but with a compatible context (Group-IV,n= 99). DY, TI and the safety of CE were analysed.
  
  
  RESULTS
  The overall DY was 54% and the final diagnosis was villous atrophy (n= 65, 39.9%), complicated CD (n= 12, 7.4%) and other enteropathies (n= 11, 6.8%; 8 Crohn's). DY for groups I to IV was 73.7%, 69.2%, 50% and 44.4%, respectively. Atrophy was located in duodenum in 24 cases (36.9%), diffuse in 19 (29.2%), jejunal in 11 (16.9%), and patchy in 10 cases (15.4%). Factors associated with a greater DY were positive serology (68.3%vs49.2%,P= 0.034) and older age (P= 0.008). On the other hand, neither sex nor clinical presentation, family background, positive histology or HLA status were associated with DY. CE results changed the therapeutic approach in 71.8% of the cases. Atrophy was associated with a greater TI (92.3%vs45.3%,P< 0.001) and 81.9% of the patients responded to diet. There was one case of capsule retention (0.6%). Agreement between CE findings and subsequent histology was 100% for diagnosing normal/other conditions, 70% for suspected CD and 50% for complicated CD.
  
  
  CONCLUSIONS
  CE has a high DY in cases of suspicion of CD and it leads to changes in the clinical course of the disease. CE is safe procedure with a high degree of concordance with histology and it helps in the differential diagnosis of CD.
authors.affiliation: Marisol Luján-Sanchis, Javier Sempere-García-Argüelles, Digestive Diseases Unit, General University Hospital of Valencia, 46026 Valencia, Spain.
authors.forename: Marisol
authors.initials: M
authors.lastname: Luján-Sanchis
authors.affiliation: Marisol Luján-Sanchis, Javier Sempere-García-Argüelles, Digestive Diseases Unit, General University Hospital of Valencia, 46026 Valencia, Spain.
authors.forename: Enrique
authors.initials: E
authors.lastname: Pérez-Cuadrado-Robles
authors.affiliation: Marisol Luján-Sanchis, Javier Sempere-García-Argüelles, Digestive Diseases Unit, General University Hospital of Valencia, 46026 Valencia, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: García-Lledó
authors.affiliation: Marisol Luján-Sanchis, Javier Sempere-García-Argüelles, Digestive Diseases Unit, General University Hospital of Valencia, 46026 Valencia, Spain.
authors.forename: José-Francisco
authors.initials: JF
authors.lastname: Juanmartiñena Fernández
authors.affiliation: Marisol Luján-Sanchis, Javier Sempere-García-Argüelles, Digestive Diseases Unit, General University Hospital of Valencia, 46026 Valencia, Spain.
authors.forename: Luca
authors.initials: L
authors.lastname: Elli
authors.affiliation: Marisol Luján-Sanchis, Javier Sempere-García-Argüelles, Digestive Diseases Unit, General University Hospital of Valencia, 46026 Valencia, Spain.
authors.forename: Victoria-Alejandra
authors.initials: VA
authors.lastname: Jiménez-García
authors.affiliation: Marisol Luján-Sanchis, Javier Sempere-García-Argüelles, Digestive Diseases Unit, General University Hospital of Valencia, 46026 Valencia, Spain.
authors.forename: Juan
authors.initials: J
authors.lastname: Egea-Valenzuela
authors.affiliation: Marisol Luján-Sanchis, Javier Sempere-García-Argüelles, Digestive Diseases Unit, General University Hospital of Valencia, 46026 Valencia, Spain.
authors.forename: Julio
authors.initials: J
authors.lastname: Valle-Muñoz
authors.affiliation: Marisol Luján-Sanchis, Javier Sempere-García-Argüelles, Digestive Diseases Unit, General University Hospital of Valencia, 46026 Valencia, Spain.
authors.forename: Cristina
authors.initials: C
authors.lastname: Carretero-Ribón
authors.affiliation: Marisol Luján-Sanchis, Javier Sempere-García-Argüelles, Digestive Diseases Unit, General University Hospital of Valencia, 46026 Valencia, Spain.
authors.forename: Ignacio
authors.initials: I
authors.lastname: Fernández-Urién-Sainz
authors.affiliation: Marisol Luján-Sanchis, Javier Sempere-García-Argüelles, Digestive Diseases Unit, General University Hospital of Valencia, 46026 Valencia, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: López-Higueras
authors.affiliation: Marisol Luján-Sanchis, Javier Sempere-García-Argüelles, Digestive Diseases Unit, General University Hospital of Valencia, 46026 Valencia, Spain.
authors.forename: Noelia
authors.initials: N
authors.lastname: Alonso-Lázaro
authors.affiliation: Marisol Luján-Sanchis, Javier Sempere-García-Argüelles, Digestive Diseases Unit, General University Hospital of Valencia, 46026 Valencia, Spain.
authors.forename: Mileidis
authors.initials: M
authors.lastname: Sanjuan-Acosta
authors.affiliation: Marisol Luján-Sanchis, Javier Sempere-García-Argüelles, Digestive Diseases Unit, General University Hospital of Valencia, 46026 Valencia, Spain.
authors.forename: Francisco
authors.initials: F
authors.lastname: Sánchez-Ceballos
authors.affiliation: Marisol Luján-Sanchis, Javier Sempere-García-Argüelles, Digestive Diseases Unit, General University Hospital of Valencia, 46026 Valencia, Spain.
authors.forename: Bruno
authors.initials: B
authors.lastname: Rosa
authors.affiliation: Marisol Luján-Sanchis, Javier Sempere-García-Argüelles, Digestive Diseases Unit, General University Hospital of Valencia, 46026 Valencia, Spain.
authors.forename: Santiago
authors.initials: S
authors.lastname: González-Vázquez
authors.affiliation: Marisol Luján-Sanchis, Javier Sempere-García-Argüelles, Digestive Diseases Unit, General University Hospital of Valencia, 46026 Valencia, Spain.
authors.forename: Federica
authors.initials: F
authors.lastname: Branchi
authors.affiliation: Marisol Luján-Sanchis, Javier Sempere-García-Argüelles, Digestive Diseases Unit, General University Hospital of Valencia, 46026 Valencia, Spain.
authors.forename: Lucía
authors.initials: L
authors.lastname: Ruano-Díaz
authors.affiliation: Marisol Luján-Sanchis, Javier Sempere-García-Argüelles, Digestive Diseases Unit, General University Hospital of Valencia, 46026 Valencia, Spain.
authors.forename: César
authors.initials: C
authors.lastname: Prieto-de-Frías
authors.affiliation: Marisol Luján-Sanchis, Javier Sempere-García-Argüelles, Digestive Diseases Unit, General University Hospital of Valencia, 46026 Valencia, Spain.
authors.forename: Vicente
authors.initials: V
authors.lastname: Pons-Beltrán
authors.affiliation: Marisol Luján-Sanchis, Javier Sempere-García-Argüelles, Digestive Diseases Unit, General University Hospital of Valencia, 46026 Valencia, Spain.
authors.forename: Pilar
authors.initials: P
authors.lastname: Borque-Barrera
authors.affiliation: Marisol Luján-Sanchis, Javier Sempere-García-Argüelles, Digestive Diseases Unit, General University Hospital of Valencia, 46026 Valencia, Spain.
authors.forename: Begoña
authors.initials: B
authors.lastname: González-Suárez
authors.affiliation: Marisol Luján-Sanchis, Javier Sempere-García-Argüelles, Digestive Diseases Unit, General University Hospital of Valencia, 46026 Valencia, Spain.
authors.forename: Sofía
authors.initials: S
authors.lastname: Xavier
authors.affiliation: Marisol Luján-Sanchis, Javier Sempere-García-Argüelles, Digestive Diseases Unit, General University Hospital of Valencia, 46026 Valencia, Spain.
authors.forename: Federico
authors.initials: F
authors.lastname: Argüelles-Arias
authors.affiliation: Marisol Luján-Sanchis, Javier Sempere-García-Argüelles, Digestive Diseases Unit, General University Hospital of Valencia, 46026 Valencia, Spain.
authors.forename: Juan-Manuel
authors.initials: JM
authors.lastname: Herrerías-Gutiérrez
authors.affiliation: Marisol Luján-Sanchis, Javier Sempere-García-Argüelles, Digestive Diseases Unit, General University Hospital of Valencia, 46026 Valencia, Spain.
authors.forename: Enrique
authors.initials: E
authors.lastname: Pérez-Cuadrado-Martínez
authors.affiliation: Marisol Luján-Sanchis, Javier Sempere-García-Argüelles, Digestive Diseases Unit, General University Hospital of Valencia, 46026 Valencia, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Sempere-García-Argüelles
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001284:Atrophy; D053704:Capsule Endoscopy; D002446:Celiac Disease / Q000000981:diagnostic imaging*; D002648:Child; D055050:Diet, Gluten-Free; D005060:Europe; D005260:Female; D005773:Gastroscopy; D006801:Humans; D008297:Male; D008875:Middle Aged; D061214:Patient Safety; D015995:Prevalence; D012189:Retrospective Studies; D055815:Young Adult
keywords: Anti-transglutaminase antibodies; Capsule endoscopy; Celiac disease; Gluten-free diet; Non-celiac gluten sensitivity