| Figures/TablesFigures/Tables | ReferencesReferences
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.
