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. 2008 Feb;6(2):186-93; quiz 125.
doi: 10.1016/j.cgh.2007.10.012. Epub 2007 Dec 21.

Mucosal atrophy in celiac disease: extent of involvement, correlation with clinical presentation, and response to treatment

Joseph A Murray  1 , Alberto Rubio-Tapia, Carol T Van Dyke, Deanna L Brogan, Mary A Knipschield, Brian Lahr, Ashwin Rumalla, Alan R Zinsmeister, Christopher J Gostout
Affiliations

Mucosal atrophy in celiac disease: extent of involvement, correlation with clinical presentation, and response to treatment

Joseph A Murray et al. Clin Gastroenterol Hepatol. 2008 Feb.

Abstract

Background & aims: Wireless capsule endoscopy provides an opportunity to study the macroscopic features in celiac disease by providing a magnified view of the intestinal mucosa. In this study, we evaluated the following: (1) the distribution of atrophy in untreated celiac disease, (2) the correlation between extent of changes and clinical manifestations, (3) the accuracy and interobserver agreement of wireless capsule endoscopy assessment, and (4) the effect of gluten withdrawal.

Methods: Thirty-eight consecutive patients with untreated biopsy-proven celiac disease underwent wireless capsule endoscopy. Each subject was invited to undergo repeat testing after at least 6 months of gluten withdrawal. The video images of each patient were reviewed independently by 2 investigators.

Results: Thirty-five (92%) subjects had visible atrophy detected by capsule endoscopy. Twenty-two (59%) subjects showed an extensive enteropathy, 12 (32%) had enteropathy limited to the duodenum, and only 1 had a jejunal enteropathy. No association was shown between the extent of the lesion and clinical manifestations. Capsule endoscopy had a better overall sensitivity for the detection of atrophy as compared with upper endoscopy (92% vs 55%, P = .0005), with a specificity of 100%. The overall interobserver agreement for the 2 reviewers was relatively high (% total agreement, 86.5%). After gluten withdrawal, the extent and the pattern of atrophy improved both qualitatively and quantitatively.

Conclusions: Celiac disease affects a highly variable portion of the small intestine starting at the duodenum. The extent of visible enteropathy does not explain differences in clinical presentation. Most subjects with visually detected villous atrophy showed a clinically significant improvement after gluten withdrawal.

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Figures

Figure 1
Figure 1
Examples of features of atrophy detected by WCE in CD. (A) Normal villi, (B) scalloping of the mucosa on circular folds, (C) mosaic pattern. Note the absence of villi in the mucosa that shows features of atrophy.
Figure 2
Figure 2
Distribution of features of villous atrophy detected by WCE in untreated CD.
See this image and copyright information in PMC

Comment in

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