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Capsule Endoscopy in the Management of Refractory Coeliac Disease

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Stefania Chetcuti Zammit1, David S. Sanders1, Simon S. Cross2, Reena Sidhu1

1) Academic Department of Gastroenterology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals, Sheffield
2) Academic Unit of Pathology, Department of Neuroscience, Faculty of Medicine, Dentistry & Health, The University of Sheffield, Sheffield, UK

DOI: http://dx.doi.org/10.15403/jgld.2014.1121.281.cel

Background & 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.
Key words: coeliac disease – refractory coeliac disease – small bowel capsule endoscopy – immunosuppressants – steroids.
Abbreviations: CD: coeliac disease; GFD: gluten free diet; EATL: enteropathy associated T cell lymphoma; RCD: refractory coeliac disease; SM: small bowel; SBCE: small bowel capsule endoscopy.