Chetcuti Zammit, S., Kurien, M. orcid.org/0000-0002-4227-9500, Sanders, D.S. et al. (1 more author) (2020) What is the role of small bowel capsule endoscopy in established coeliac disease? Clinics and Research in Hepatology and Gastroenterology, 44 (5). pp. 753-761. ISSN 2210-7401
Abstract
Introduction
Patients with established coeliac disease (CD) can present with signs and symptoms requiring small bowel capsule endoscopy (SBCE) to assess for persistent disease beyond the duodenum and to rule out complications. There is paucity of data on extent of disease on SBCE in relation to histology, clinical and serological parameters. The aim of this study was to assess the relationship between symptoms, CD serology and Marsh classification of disease and extent of disease on SBCE in patients with established CD.
Methods
Hundred patients with established CD and 200 controls underwent a SBCE. SBCEs were reviewed by expert reviewers. Extent of disease on SBCE, CD findings and small bowel transit were recorded.
Results
Considering duodenal histology (D2; Marsh 3a or above) as the gold standard for diagnosing CD activity, the sensitivity of SBCE to delineate active disease was 87.2%. The specificity was 89.0%. Age at SBCE (P = 0.006), albumin (P = 0.004) and haemoglobin (P = 0.0001), Marsh score of histology from the duodenal bulb (D1) (P = 0.0001) and the second part of the duodenum (P = 0.0001), refractory CD (P = 0.007) on histology correlated with extent of affected small bowel (SB) mucosa on univariate analysis. On multiple regression analysis, albumin (P = 0.036) and Marsh score of histology (D1) (P = 0.019), vitamin B12 (P = 0.001) and folate levels (P = 0.008) were statistically significant. Extent of affected SB mucosa (11.0% vs 1.35%) was greater in patients with complications including those with refractory CD (P = 0.008).
Conclusions
This is the first study showing correlation between extent of disease and severity of duodenal histology, markers of malabsorption such as folate levels and vitamin B12 and complications of CD.
Metadata
Item Type: | Article |
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Authors/Creators: |
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Copyright, Publisher and Additional Information: | © 2019 Elsevier Masson SAS. This is an author produced version of a paper subsequently published in Clinics and Research in Hepatology and Gastroenterology. Uploaded in accordance with the publisher's self-archiving policy. Article available under the terms of the CC-BY-NC-ND licence (https://creativecommons.org/licenses/by-nc-nd/4.0/). |
Keywords: | Coeliac disease; Small bowel transit; Extent of disease; Small bowel capsule endoscopy |
Dates: |
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Institution: | The University of Sheffield |
Academic Units: | The University of Sheffield > Sheffield Teaching Hospitals |
Depositing User: | Symplectic Sheffield |
Date Deposited: | 10 Sep 2020 11:31 |
Last Modified: | 20 May 2022 14:07 |
Status: | Published |
Publisher: | Elsevier |
Refereed: | Yes |
Identification Number: | 10.1016/j.clinre.2019.11.011 |
Related URLs: | |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:165375 |