Small bowel capsule endoscopy in refractory celiac disease: a luxury or a necessity?

Authors Stefania Chetcuti Zammit, Luca Elli, Lucia Scaramella, David S. Sanders, Gian Eugenio Tontini, Reena Sidhu.


Background Small bowel capsule endoscopy (SBCE) has an established role in the management of refractory celiac disease (RCD) for the detection of complications. The aim of this study was to define the role of SBCE in the management of patients with RCD.

Method Patients with histologically confirmed RCD who underwent successive SBCEs were recruited retrospectively from 2 tertiary centers.

Results Sixty patients with RCD were included. The percentage extent of the affected small bowel (SB) mucosa improved on repeating a second SBCE in 26 patients (49.1%) (median 27.6% vs. 18.1%, P=0.007). Patients with RCD type II had more extensive disease than those with RCD type I on first (41.4% vs. 19.2%, P=0.004) and second (29.8% vs. 12.0%, P=0.016) SBCE. Patients with RCD type I tended to show a greater improvement in percentage of abnormal SB involved on repeat SBCE compared to those with RCD type II (P=0.049). Nine patients (15%) had RCD-related complications. Five patients developed ulcerative jejunoileitis, 3 patients developed enteropathyassociated T-cell lymphoma, and 1 patient developed cutaneous T-cell lymphoma.

Conclusions SBCE can be a useful tool for monitoring the effects of treatment, primarily following its initiation. Patients with RCD type II have more extensive SB disease, equating to a more aggressive disease pattern.

Keywords Celiac disease, refractory celiac disease, small bowel capsule endoscopy, extent of disease

Ann Gastroenterol 2021; 34 (2): 188-195

Original Articles