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Capsule endoscopy in the management of refractory coeliac disease
Stefania Chetcuti Zammit1, David S Sanders2, Simon S Cross3
1Academic Department of Gastroenterology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals, Sheffield, UK.stf_che@yahoo.com.
Background And Aims:
There is no literature on the role of repeat small bowel capsule endoscopy (SBCE) in patients with refractory coeliac disease (RCD) following treatment with steroids +/- immunosuppressants.
Methods:
The findings on SBCEs from a group of patients with histologically proven RCD (n=23) were compared to the findings from patients with uncomplicated coeliac disease (n=48). All patients had concurrent duodenal histology and serology taken at the time of SBCE.
Results:
Patients with RCD had a greater extent of mucosal involvement on SBCE than patients with uncomplicated CD (42.4+/-34.1% vs 9.7+/-21.7%, p=0.0001). Following treatment with steroids and / or immunosuppressants, patients with RCD had an improvement in the extent of affected small bowel mucosa (42.4+/-34.1% vs 26.4+/-28.9% p=0.012). There was no statistical difference in histology and serology taken at the time of the first and second SBCE in patients with RCD.
Conclusions:
Our study suggests that SBCE is valuable in documenting the extent of mucosal involvement in patients with RCD. This is the first study that delineates the value of a second look SBCE to assess improvement in the extent of disease in the small bowel following treatment.
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