Video capsule may soon diagnose celiac disease

NEW YORK (Reuters Health) - A new device -- video capsule enteroscopy (VCE) -- accurately detects intestinal atrophy in patients suspected to have celiac disease, according to a report in the American Journal of Gastroenterology.

The diagnosis of celiac disease currently requires upper GI endoscopy with multiple biopsies to identify the characteristic irregularities in the mucus tissue of the small bowel, the authors explain. GI endoscopy is a procedure in which a tube is inserted into the digestive tract. The tube is equipped with a small camera to visualize abnormal tissues, which can be biopsied or removed.

Celiac disease is a genetic disorder in which the body's immune system damages the small intestine in responses to foods containing gluten, a protein in wheat, rye and barley. Celiac disease may cause a variety of symptoms. Diarrhea, abdominal pain, irritability and depression are common, but some people may have no symptoms. Treatment for the condition is a gluten-free diet.

Dr. Roberto de Franchis from the University of Milan, Italy and associates tested the performance of VCE in 43 patients with signs or symptoms suggestive of celiac disease and compared the results to those obtained by conventional upper GI endoscopy with biopsies.

Of 32 patients found to have abnormal tissue, 28 were diagnosed with celiac disease by capsule endoscopy, yielding a sensitivity of 87.5 percent.

VCE had 90.9 percent specificity, 96.5 percent positive predictive value, 71.4 percent negative predictive value for diagnosing celiac disease.

"The recently introduced VCE may be a valid alternative to...biopsy in this patient population, since it provides high-quality images of the small bowel mucosa," the investigators conclude. "Furthermore, it is minimally invasive, which may improve patient acceptance, and it allows exploration of the whole small intestine, which may lead to the identification of (abnormal tissue) beyond the segments reached by upper GI endoscopy."

They add that the findings "await confirmation in a larger study."

SOURCE: American Journal of Gastroenterology, August, 2007.