Advances in Clinical and Experimental Medicine

Title abbreviation: Adv Clin Exp Med
JCR Impact Factor (IF) – 2.1
5-Year Impact Factor – 2.2
Scopus CiteScore – 3.4 (CiteScore Tracker 3.7)
Index Copernicus  – 161.11; MNiSW – 70 pts

ISSN 1899–5276 (print)
ISSN 2451-2680 (online)
Periodicity – monthly

Download original text (EN)

Advances in Clinical and Experimental Medicine

2014, vol. 23, nr 5, September-October, p. 785–790

Publication type: original article

Language: English

The Range of Lesions in the Small Intestine of Children with Celiac Disease Determined by Capsule Endoscopy

Anna Szaflarska-Popławska1,A,B,D,E,F, Monika Parzęcka1,C,E, Renata Kuczyńska2,C,E

1 Department of Pediatric Endoscopy and Gastrointestinal Function Testing, Ludwik Rydygier Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland

2 Department and Clinic of Pediatrics, Allergology and Gastroenterology, Ludwik Rydygier Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland

Abstract

Background. Celiac disease is a chronic gluten intolerance which can cause small intestinal inflammatory lesions of different intensity, scope and distribution.
Objectives. The aim of the study was to assess the distribution and scope of lesions revealed by endoscopy in the small intestine of children and adolescents with untreated celiac disease.
Material and Methods. A total of nine patients aged from 15 to 18 years (average age: 16 years) were enrolled in the study, including seven girls and two boys who had been diagnosed with histologically confirmed celiac disease. Following a bowel cleansing all the patients were subjected to examination of the small intestine using an endoscopic capsule (EndoCapsule EC, Olympus, Tokyo, Japan).
Results. The examination was complete in eight of the patients. In six patients the capsule endoscopy revealed continuous lesions in the duodenum and the proximal small intestine. In one child continuous lesions occurred only in a short section of the bowel, within the duodenum. In one patient the abnormalities were located in the proximal small intestine without any lesions in duodenum. In one case, segmental lesions were observed in the distal small intestine, without any lesions in the duodenum or in the proximal part of the bowel. The results for the endoscopic markers of celiac disease were as follows: in all the patients a significant shortening or complete lack of villous structure was noted; in six patients scalloping was observed at the peaks of the circular folds; in three patients granulation was observed; and in three patients a mosaic mucosal pattern was noted.
Conclusion. The most frequent type of lesions revealed by capsule endoscopy in pediatric patients with untreated celiac disease seems to be continuous lesions in the duodenum and the proximal small intestine. Some patients can develop macroscopic lesions (and probably microscopic ones as well) that are beyond the reach of traditional endoscopy. In such cases, capsule endoscopy can help to determine and diagnose celiac disease and to establish the need for lifelong dietary treatment.

Key words

celiac disease, capsule endoscopy, children.

References (16)

  1. Husby S, Koletzko S, Korponay-Szabó IR, Mearin ML, Philips A, Shamir R, Troncone R, Giersiepen K, Branski D, Catassi C, Lelgeman M, Mäki M, Ribes-Koninckx C, Ventura A, Zimmer KP: ESPGHAN Working Group on Coeliac Disease Diagnosis; ESPGHAN Gastroenterology Committee; European Society for Pediatric Gastroenterology, Hepatology and Nutrition. European Society for Pediatric Gastroenterology, Hepatology and Nutrition guidelines for the diagnosis of coeliac disease. J Pediatr Gastroenterol Nutr 2012,
  2. Giersiepen K, Lelgemann M, Stuhldreher N, Ronfani L, Husby S, Koletzko S, Korponay-Szabó IR: ESPGHAN Working Group on Coeliac Disease Diagnosis. Accurancy of diagnostic tests for coeliac disease in children: summary of an evidence report. J Pediatr Gastroenterol Nutr 2012, 54, 229–241.
  3. Murray JA, Rubio-Tapia A, van Dyke CT, Brogan DL, Knipschield MA, Lahr B, Rumalla A, Zinsmeister AR, Gostout CJ: Mucosal atrophy in celiac disease: extent of involvement, correlation with clinical presentation, and response to treatment. Clin Gastroenterol Hepatol 2008, 6, 186–193.
  4. Hopper AD, Huristone DP, Leeds JS, McAlindon ME, Dube AK, Stephenson TJ, Sanders DS: The occurrence of terminal ileal histological abnormalities in patients with coeliac disease. Dig Liver Dis 2006, 38, 815–819.
  5. Nenna R, Pontone S, Pontone P, Petrarca L, Mennini M, Standoli M, Mastrogiorgio G, Bonamico M, Magliocca FM: Duodenal bulb in celiac adults: the “whether biopsying” dilemma. J Clin Gastroenterol 2012, 46, 302–307.
  6. Evans KE, Aziz I, Cross SS, Sahota GR, Hopper AD, Hadjivassiliou M, Sanders DS: A prospective study of duodenal bulb biopsy in newly diagnosed and established adult coeliac disease. Am J Gastroenterol 2011, 106, 1837–1842.
  7. Shamir R, Eliakim R: Capsule endoscopy in pediatric patients. World J Gastroenterol 2008, 14, 4152–4155.
  8. Jensen MK, Tipnis NA, Bajorunaite R, Sheth MK, Sato TT, Noel RJ: Capsule endoscopy performed across the pediatric range: indications, incomplete studies, and utility in management of inflammatory bowel disease. Gastrointestinal Endosc 2010, 72, 95–102.
  9. Cohen SA, Klevens AI: Use of capsule endoscopy in diagnosis and management of pediatric patients, based on meta-analysis. Clin Gastroenterol Hepatol 2011, 9, 490–496.
  10. Cohen SA, Ephrath H, Lewis JD, Klevens A, Bergwerk A, Liu S, Patel D, Reed-Knight B, Stallworth A, Wakhisi T, Gold BD: Pediatric capsule endoscopy: review of the small bowel and patency capsules. J Pediatr Gastroenterol Nutr 2012, 54, 409–413.
  11. Rokkas T, Niv Y.: The role of video capsule endoscopy in the diagnosis of celiac disease: a meta-analysis. Eur J Gastroenterol Hepatol 2012, 24, 303–308.
  12. Chang MS, Rubin M, Lewis SK, Green PH: Diagnosing celiac disease by video capsule endoscopy (VCE) when esophagogastroduodenoscopy (EGD) and biopsy is unable to provide a diagnosis: a case series. BMC Gastroenterol 2012, 12, 90–94.
  13. Atlas DS, Rubio-Tapia A, Van Dyke CT, Lahr BD, Murray JA: Capsule endoscopy in nonresponsive celiac disease. Gastrointest Endosc 2011, 74, 1315–1322.
  14. Barret M, Malamut G, Rahmi G, Samaha E, Edery J, Verkarre V, Macintyre E, Lenain E, Chatellier G, CerfBensussan N, Cellier C: Diagnostic yield of capsule endoscopy in refractory celiac disease. Am J Gastroenterol 2012, 107, 1546–1553.
  15. Akin E, Ersoy O: Capsule endoscopy in celiac disease. Gastroenterol Res Pract 2012, ID 676073.
  16. Piazzi L, Zancanella L, Chilovi F, Merighi A, De Vitis I, Feliciangeli G, Borgheresi P, Snider L, Grassi SA, Manfrini C, Orzes N, Bianco MA, Cugia L, Lenoci N, Castagnini A: Progetto Celiachia-S.I.E.D. Group. Diagnostic value of endoscopic markers for celiac disease in adults: a multicenter prospective Italian study. Minerva Gastroenterol Dietol 2008, 54, 335–346.
© Wroclaw Medical University