Coeliac disease and the videocapsule: what have we learned till now

Abstract

Celiac disease is diagnosed in part by finding areas of pathology in the small bowel (SB) mucosa. This can often be difficult because the pathologic alterations, including atrophy of the small intestinal villi, can often be sparse and subtle. Some of the quantitative methods for detecting and measuring the presence of villous atrophy from videocapsule endoscopy (VCE) images are presented and discussed. These methods consist of static features of measurement including texture, gray level, and presence and abundance of fissures contained within each acquired image. The methods also consist of dynamic measurements including spectral analysis, and determining motion from a sequence of endoscopic images as obtained from a VCE clip. Thus far, several methods have been found useful to characterize the SB mucosa of untreated celiac disease patients versus control patients lacking villous atrophy, which have revealed significant differences in texture, frequency, and motion on analysis of VCE. In untreated celiac patients undergoing endoscopy, there tends to be greater magnitude of changes and spatial differences in textural descriptors, longer periodic components, indicating slower periodic activity, and differences in feature location, suggesting alterations in motility at areas of pathology as compared to patients without villous atrophy. Improvements in the quantitative analysis of VCE imaging in celiac patients is important to detect pathology in suspected patients, so that biopsies can be obtained from pertinent regions of the small intestinal mucosa. Improvements are also necessary so that patients with celiac disease can be monitored to evaluate the progress of mucosal healing after onset of treatment.

Keywords: Celiac disease; endoscopy; small intestine; videocapsule; villous atrophy.

Figure 1

Example of scalloped mucosal folds, untreated celiac patient, duodenum. Notice the multiple indentations in the folds on the right-hand side.

Figure 2

Example of mottled mucosal appearance, untreated celiac patient, duodenum. This is quite evident particularly on the right-hand side of the image.

Figure 3

Example of dark region—long axis, untreated celiac patient, duodenum. This region appears at lower right in the image and represents the long axis of the small intestine in the local region. The region is dark due to the distance of the mucosal surface along this axis.

Figure 4

Examples of substantial presence of air bubbles and opaque fluid, untreated celiac patient, duodenum. The opaque fluids are the yellow materials, mostly located on the left side of the image. A cluster of air bubbles can be observed at right middle.