Capsule endoscopy in adult celiac disease: a potential role in equivocal cases of celiac disease?

Background There have been limited studies evaluating capsule endoscopy (CE) in equivocal celiac disease (CD). Objective To determine the role CE may have in equivocal CD cases, compared with patients with biopsy-proven and serology-proven CD who have persisting symptoms. Design Prospective cohort study. Setting University hospital. Patients A total of 62 patients with equivocal CD and 69 patients with nonresponsive CD. Intervention CE. Main Outcome Measurements Diagnostic yield of CE in equivocal cases and accuracy of mucosal abnormality detection in patients with nonresponsive CD. Results Equivocal cases (n = 62) were divided into two subgroups: group A (antibody-negative villous atrophy, n=32) and group B (Marsh 1-2 changes, n=30). In group A, CE secured a diagnosis of CD or Crohn's disease in 28% (9/32), significantly higher than the diagnostic yield in group B (7%; P = .044). In patients with CD with persisting symptoms, significant CE findings were identified in 12% (8/69), including 2 cases of enteropathy-associated lymphoma, 4 type 1 refractory disease cases, 1 polypoidal mass histologically confirmed to be a fibroepithelial polyp, and 1 case of ulcerative jejunitis. This outcome was significantly lower than the diagnostic yield of CE in antibody-negative villous atrophy ( P = .048). Limitations Single center. Conclusion There have been no previous reports systematically evaluating equivocal CD by using CE. The diagnostic yield of CE in patients with antibody-negative villous atrophy is better than that of CE in patients with CD with persisting symptoms. We advocate the use of CE in equivocal cases, particularly in patients with antibody-negative villous atrophy.