Capsule endoscopy can detect intestinal damage from celiac disease
6 March 2008
Mayo Clinic researchers in the US have found that endoscopy using a
pill-sized capsule can help physicians detect and diagnose celiac
disease, as well as measure intestinal healing following treatment. The
findings are published in this month's issue of Clinical
Gastroenterology and Hepatology.
The capsule is approximately the size of a large vitamin, and it
includes a miniature colour video camera, light, battery and
transmitter. The patient swallows the capsule, which takes approximately
eight hours to move through the small intestine.
As the capsule moves through the digestive tract, images recorded by
the video camera are transmitted to a number of sensors attached to the
patient's torso and recorded digitally on a device worn around the
patient's waist. Then, the recording device is removed and its contents
are downloaded to a computer for examination.
Approximately three million Americans, or about one in 100 people,
are affected by celiac disease. Individuals who have celiac disease are
intolerant to proteins (collectively called gluten) found in wheat,
barley and rye grains. In these people, gluten stimulates an immune
reaction in the small intestine, which causes intestinal damage and the
subsequent inability to absorb certain nutrients from food.
Treatment is to avoid foods containing gluten (the so-called
gluten-free diet). Untreated, celiac disease can cause many medical
complications and increase the risk of death. However, when a medically
supervised diet plan is implemented, patients can experience almost
complete reversal of symptoms and complications from the disease.
"Capsule endoscopy allows us to look at the entire 30 feet of the
small intestine, not just the first one to two feet that can be
visualized with other types of endoscopy," says Joseph Murray, MD, the
study's lead author and a gastroenterologist at Mayo Clinic.
This study, the first of its kind, used capsule endoscopy to view
intestinal damage in 37 patients with untreated, biopsy-proven celiac
Ninety-two percent had visible damage detected by capsule endoscopy.
Twenty-two patients had extensive damage in the duodenum (first portion
of the small intestine) and patchy damage throughout the jejunum (the
small intestine's middle portion). Twelve patients had damage limited to
the duodenum, and one patient had only patchy damage throughout the
jejunum. However, no association was shown between the extent of
intestinal damage and the patients' symptoms. Six months after a
gluten-free diet was implemented, capsule endoscopy showed improvement,
or decreased intestinal damage, in most patients.
"This study confirmed our suspicions that the most extensive
intestinal damage in celiac disease patients is primarily to the
duodenum. However, we were surprised to discover no correlation between
extent of intestine damage and patient symptoms," says Dr Murray.
"Capsule endoscopy will now be another tool to diagnose celiac disease
and detect intestinal damage both prior to and following treatment."