Capsule endoscopy in nonresponsive celiac disease

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. Design: Case-control study. Setting: Tertiary-care center. Patients: 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. Intervention: CE. Main Outcome Measurements: 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. Limitations: 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. (Gastrointest Endosc 2011;74:1315-22.)