TAKE A GLIMPSE TO THE SMALL BOWEL: ASSESSING MUCOSAL HEALING IN CELIAC PATIENTS WITH CAPSULE ENDOSCOPY

Aims Capsule endoscopy (CE) is useful in the management of complicated Celiac Disease (CD). However, its use to monitor treated CD is unclear and small bowel mucosal healing (SBMH) in CD is not usually assessed. The aim of this study was to determine the SBMH of CD patients monitored with CE.

Methods 37 consecutive CD patients (30 females, mean age 47), undergoing multiple CE (at least 2) were enrolled. CE findings, their localization and extension were analyzed.

Results 107 CEs were performed (mean CE per patient 3), follow-up 4 years. Indications were alarming symptoms (42%), refractory Celiac Disease (RCD) (38%), non-adherence to GFD (16%) and persistent anti-transglutaminase antibodies positivity (4%). 80% of CEs were positive; atrophy was the most common finding (79%), mostly represented in duodenum and jejunum (97%). Successive CEs demonstrated a partial SBMH in 19% and a complete SBMH in 21%; 11% of cases presented a worsening of the previous findings, while a stable picture was detected in 49% of cases. Notably, in patients non-adherent to GFD, 53% of CEs were normal and 40% of follow up CEs showed a SBMH over time. In RCD, 49% of CEs showed a partial SBMH after immunosuppressive therapy, usually occurring in a distal to proximal fashion. A single case of lymphoma was detected (incidence: 0.006). There were no major complications.

Conclusions Our data showed that CE is effective and safe in assessing SBMH during CD monitoring. During follow up, half of the patients presents a partial to complete SBMH.

Publication History

Article published online:
14 April 2022