What’s New in Celiac Disease

 Has enough been said about the symptoms of Celiac Disease?  Better yet, does everyone have celiac disease?  If you can’t prove that you have gluten intolerance (another name for celiac disease), you might consider this collection of case studies.  And tell them I sent you!

Diagnosing Celiac Disease by Video Capsule Endoscopy (VCE) When Esophogastroduodenoscopy (EGD) and Biopsy is Unable to Provide a Diagnosis

Matthew S Chang, Moshe Rubin, Suzanne K Lewis, Peter H Green  BMC Gastroenterol. 2012;12(90) (Nov 01,2012)

Video capsule endoscopy (VCE) is mainly used to evaluate patients with celiac disease in whom their course after diagnosis has been unfavorable and the diagnosis of adenocarcinoma, lymphoma or refractory celiac disease is entertained, but it has been suggested that VCE could replace esophagogastroduodenoscopy (EGD) and biopsy under certain circumstances.
Methods: We report a single center case series of 8 patients with suspected celiac disease who were diagnosed by VCE.
Results: EGD and biopsy had been performed in 4 patients resulting in a negative biopsy, declined by 2, and contraindicated in 2 due to hemophilia and von Willebrand disease. In all patients, mucosal changes of scalloping, mucosal mosaicism and reduced folds were seen in either the duodenum or jejunum on VCE. Follow-up in 7 patients demonstrated improvement in either their serological abnormalities or their presenting clinical features on a gluten-free diet.
Conclusions:Our case series demonstrates that VCE and the visualization of the characteristic mucosal changes of villous atrophy may replace biopsy as the mode of diagnosis when EGD is either declined or contraindicated, or when duodenal biopsies are negative and there remains a high index of suspicion. Further study is needed to clarify the role and cost of diagnosing celiac disease with VCE.

Here’s my comments on this series:

1. New technology, although expensive, can really change the way we diagnose and treat disease.  This method (VCE) would bypass the need for endoscopy….what that means is no sedation and a less extensive bowel prep. 

2.  As with any new technology, results have to be confirmed in larger studies and by other research groups.  I’ll be waiting to hear about more published work.

3.  If it becomes easier to diagnose celiac disease, perhaps we can limit the number of patients who think they are intolerant to gluten but have never taken the time or money to find out conclusively. 

What do you think?  Would a video camera that you have to swallow make you more likely to find out if you really have celiac disease?

 

 

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