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To investigate a group of IBS patients (Rome criteria) with positive coeliac serology (EMA, TTG, IgG or IgA AGA) and normal small bowel biopsies. Video capsule endoscopy (VCE) findings of the small bowell were compared with DQ-typing.
Twenty-two patients with chronic abdominal pain (with or without diarrhea) and at least one positive result of any...
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Celiac disease (CD) is one of the most common inflammatory diseases of the small intestine which causes abdominal pain, diarrhoea, malabsorption, weight loss, anorexia, and iron deficiency anaemia in humans. It is a human leukocyte antigen (HLA)-linked disorder that is triggered by the gluten and gliadin proteins from wheat and related cereals. The...
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Resumen
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Citations
... e., positive IgA tTG and/or EmA) but normal duodenal histology, and patients with histologically detected villous atrophy but negative celiac serology [246]. In the first scenario, previous studies indicated that SBCE usually does not detect relevant findings that change the clinical management of the patients [238,247,248]. ...
Main Recommendations
MR1 ESGE recommends small-bowel capsule endoscopy as the first-line examination, before consideration of other endoscopic and radiological diagnostic tests for suspected small-bowel bleeding, given the excellent safety profile of capsule endoscopy, its patient tolerability, and its potential to visualize the entire small-bowel mucosa.Strong recommendation, moderate quality evidence.
MR2 ESGE recommends small-bowel capsule endoscopy in patients with overt suspected small-bowel bleeding as soon as possible after the bleeding episode, ideally within 48 hours, to maximize the diagnostic and subsequent therapeutic yield.Strong recommendation, high quality evidence.
MR3 ESGE does not recommend routine second-look endoscopy prior to small-bowel capsule endoscopy in patients with suspected small-bowel bleeding or iron-deficiency anemia.Strong recommendation, low quality evidence.
MR4 ESGE recommends conservative management in those patients with suspected small-bowel bleeding and high quality negative small-bowel capsule endoscopy.Strong recommendation, moderate quality evidence.
MR5 ESGE recommends device-assisted enteroscopy to confirm and possibly treat lesions identified by small-bowel capsule endoscopy.Strong recommendation, high quality evidence.
MR6 ESGE recommends the performance of small-bowel capsule endoscopy as a first-line examination in patients with iron-deficiency anemia when small bowel evaluation is indicated.Strong recommendation, high quality evidence.
MR7 ESGE recommends small-bowel capsule endoscopy in patients with suspected Crohn’s disease and negative ileocolonoscopy findings as the initial diagnostic modality for investigating the small bowel, in the absence of obstructive symptoms or known bowel stenosis.Strong recommendation, high quality evidence.
MR8 ESGE recommends, in patients with unremarkable or nondiagnostic findings from dedicated small-bowel cross-sectional imaging, small-bowel capsule endoscopy as a subsequent investigation if deemed likely to influence patient management.Strong recommendation, low quality evidence.
MR9 ESGE recommends, in patients with established Crohn’s disease, the use of a patency capsule before small-bowel capsule endoscopy to decrease the capsule retention rate.Strong recommendation, moderate quality evidence.
MR10 ESGE recommends device-assisted enteroscopy (DAE) as an alternative to surgery for foreign bodies retained in the small bowel requiring retrieval in patients without acute intestinal obstruction.Strong recommendation, moderate quality evidence.
MR11 ESGE recommends DAE-endoscopic retrograde cholangiopancreatography (DAE-ERCP) as a first-line endoscopic approach to treat pancreaticobiliary diseases in patients with surgically altered anatomy (except for Billroth II patients).Strong recommendation, moderate quality evidence.
... An explanation for positive CD related serology but negative histology is the patchy nature of CD [57][58][59]. The diagnostic yield of SBCE in patients with positive serology and normal histology has been reported to vary between 55% and 69% [30,60]. In contrast however, a study by , reported a negative SBCE in all patients with negative histology despite positive CD serology [61]. ...
Small bowel capsule endoscopy (SBCE) can identify macroscopic changes of coeliac disease and assess the extent of disease in the small bowel beyond the duodenum. SBCE has a good sensitivity for the detection of coeliac disease in comparison to histology owing to several ideal features such as a high magnification. It also plays a useful role in detecting complications in patients with refractory coeliac disease. Several studies have been carried out on transforming images obtained from small bowel capsule endoscopy to enable the automated detection of features related to coeliac disease. This review discusses the current roles played by small bowel capsule endoscopy in coeliac disease. It identifies future potential roles of this technique and describes in great detail the role of computational analysis in the detection of coeliac disease and how it can be adapted to current available technology.
... 2006, Adler et al.[25] evaluated by VCE 22 patients with symptoms (fulfilling the Rome criteria for the diagnosis of irritable bowel syndrome), positive celiac serology and normal duodenal histology. Interestingly, al-though VCE detected abnormalities within the small bowel in 55% of cases, the findings were mostly minor and subtle (i.e. ...
Because of its technical characteristics (i.e. 8-fold magnification, capability to inspect the entire small bowel) and minimal invasiveness, videocapsule endoscopy (VCE) has been proposed as a useful tool for managing patients with celiac disease (CD). Key Messages: Although VCE has been found to be highly sensitive and specific in identifying CD endoscopic markers, it is still inadequate to replace esophagogastroduodenoscopy (EGD) with biopsies in the diagnosis of CD. Nevertheless, it represents a reliable alternative in patients unable or unwilling to undergo EGD. Up to now, available studies have failed to identify any correlation between the length of small bowel involvement and the severity of symptoms. The available evidence on the use of VCE in diagnosing CD in equivocal cases (patients with positive serology and negative or nonspecific histology or those with negative serology and histologically proven villous atrophy) is limited, and its role is still under discussion. In CD patients not improving on gluten-free diet, a complete workup is necessary. In patients with nonresponsive (NRCD) or refractory CD (RCD), VCE has been shown to be able not only to detect significant findings, driving further management, but also to rule out major complications. Nevertheless, in this setting, the inability of VCE to take tissue samples and the risk of capsule retention can represent major limitations.
At the present time, for diagnostic purposes, VCE can be proposed only in patients unable or unwilling to undergo EGD, whereas it could be useful in some equivocal cases. Conversely, there is no room for VCE either to estimate the length of the small bowel affected by villous atrophy or to follow up patients improving on gluten-free diet. In patients with NRCD or RCD, VCE can play a role, but it should be combined with other diagnostic techniques. © 2015 S. Karger AG, Basel.
... In a study of 8 patients with positive serological results (EMA or tTG) and normal findings from duodenal biopsy, VCE did not reveal any endoscopic features of coeliac disease [319]. Thus the investigators concluded that there was no benefit in performing VCE for this subgroup of patients; another similar study came to the same conclusions [321]. There is however conflicting evidence. ...
This Guideline is an official statement of the European Society of Gastrointestinal Endoscopy (ESGE). The Guideline was also reviewed and endorsed by the British Society of Gastroenterology (BSG). It addresses the roles of small-bowel capsule endoscopy and device-assisted enteroscopy for diagnosis and treatment of small-bowel disorders. Main recommendations 1 ESGE recommends small-bowel video capsule endoscopy as the first-line investigation in patients with obscure gastrointestinal bleeding (strong recommendation, moderate quality evidence). 2 In patients with overt obscure gastrointestinal bleeding, ESGE recommends performing small-bowel capsule endoscopy as soon as possible after the bleeding episode, optimally within 14 days, in order to maximize the diagnostic yield (strong recommendation, moderate quality evidence). 3 ESGE does not recommend the routine performance of second-look endoscopy prior to small-bowel capsule endoscopy; however whether to perform second-look endoscopy before capsule endoscopy in patients with obscure gastrointestinal bleeding or iron-deficiency anaemia should be decided on a case-by-case basis (strong recommendation, low quality evidence). 4 In patients with positive findings at small-bowel capsule endoscopy, ESGE recommends device-assisted enteroscopy to confirm and possibly treat lesions identified by capsule endoscopy (strong recommendation, high quality evidence). 5 ESGE recommends ileocolonoscopy as the first endoscopic examination for investigating patients with suspected Crohn's disease (strong recommendation, high quality evidence). In patients with suspected Crohn's disease and negative ileocolonoscopy findings, ESGE recommends small-bowel capsule endoscopy as the initial diagnostic modality for investigating the small bowel, in the absence of obstructive symptoms or known stenosis (strong recommendation, moderate quality evidence).ESGE does not recommend routine small-bowel imaging or the use of the PillCam patency capsule prior to capsule endoscopy in these patients (strong recommendation, low quality evidence). In the presence of obstructive symptoms or known stenosis, ESGE recommends that dedicated small bowel cross-sectional imaging modalities such as magnetic resonance enterography/enteroclysis or computed tomography enterography/enteroclysis should be used first (strong recommendation, low quality evidence). 6 In patients with established Crohn's disease, based on ileocolonoscopy findings, ESGE recommends dedicated cross-sectional imaging for small-bowel evaluation since this has the potential to assess extent and location of any Crohn's disease lesions, to identify strictures, and to assess for extraluminal disease (strong recommendation, low quality evidence). In patients with unremarkable or nondiagnostic findings from such cross-sectional imaging of the small bowel, ESGE recommends small-bowel capsule endoscopy as a subsequent investigation, if deemed to influence patient management (strong recommendation, low quality evidence). When capsule endoscopy is indicated, ESGE recommends use of the PillCam patency capsule to confirm functional patency of the small bowel (strong recommendation, low quality evidence). 7 ESGE strongly recommends against the use of small-bowel capsule endoscopy for suspected coeliac disease but suggests that capsule endoscopy could be used in patients unwilling or unable to undergo conventional endoscopy (strong recommendation, low quality evidence).
© Georg Thieme Verlag KG Stuttgart · New York.
... Epidemiological studies indicate familial inheritance in IBS patients and a higher risk rate of IBS co-occurrence in monozygotic twins than in dizygotic twins (Neagoe et al., 2004), suggesting that genetic susceptibility is likely responsible for IBS incidence; thus, screening for IBS-related susceptible genes is important. Wahnschaffe et al. (2007) and Adler et al. (2006) investigated the correlation between diarrhea-predominant IBS and HLA-DQA1*0501/ DQB1*0201 and found a high rate of occurrence of HLA-DQ2 in diarrhea-predominant IBS. The major histocompatibility complex, HLA, is a gene cluster closely related to immune response (Liu et al., 2009). ...
We examined patients of Han nationality diagnosed with irritable bowel syndrome with diarrhea (IBS-D) in Guangdong, China, to analyze the correlation between DQB1 allele polymorphisms and the genetic susceptibility to IBS-D. A total of 120 IBS-D patients of Han nationality in Guangdong, China, and 60 healthy control volunteers were included. DQB1 allele polymorphisms were investigated by polymerase chain reaction. Subjects' serum interleukin (IL)-10 level, colonic permeability, and tight junction marker zonula occludens 1 (ZO1) mRNA level were also investigated. Our data showed that the DQB1*02 allele frequency was significantly higher in IBS-D patients, while the DQB1*0603 frequency was lower than in healthy volunteers. The DQB1*03, DQB1*04, DQB1*05, DQB1*0601, DQB1*0602, and DQB1*0604 alleles did not show significant differences between IBS-D patients and healthy controls. Furthermore, patients with DQB1*03- positive and DQB1*0603-negative alleles showed more severe colonic permeability and lower serum IL-10 level and ZO1 level compared to healthy controls or even IBS-D patients with other genotypes. The present study indicated the DQB1*02 or DQB1*0603 alleles are related to IBS-D occurrence in Guangdong, China, and the mechanism of the disease may be related to reduced serum IL-10 levels.
... This is similar to the findings reported by Adler et al 21 and Carroccio et al. 22 Close to half of their patients with gluten sensitivity were positive for either IgG and/or IgA AGA, but only a few of them were EMA positive, showing only mild changes on wireless capsule endoscopy, and these patients were deemed not to have CD. 21,22 Eighteen percent of our patients were IgA DGP positive among whom all but one were IgA EMA negative, and less than half had villous blunting. In addition, one of our patients with positive IgA DGP was diagnosed with systemic lupus erythematosus, suggesting an autoimmune diathesis. ...
... 3,25 In a prospective gluten challenge study, the prevalence of HLA-DQ2 or DQ8 was 53% in the NCGS group and 100% in the CD group. 21 The low prevalence of HLA-DQ8 and absence of HLA-DQ2 in our patients confirm that our population has a low genetic susceptibility to CD, yet there is significant gluten sensitivity, suggesting that dietary rather than genetic factors are relevant in the emergence of NCGS in this part of the world. Increased IEL can be a non-specific finding associated with many non-CD causes such as drugs, infection, immune dysregulation, inflammatory bowel disease, microscopic colitis, sarcoidosis and IgA deficiency. ...
Background/Aims
Non-celiac gluten sensitivity has been increasingly recognized as a predisposing factor for irritable bowel syndrome (IBS)-like symptoms in Western populations where celiac disease (CD) is relatively common. In Asia where CD is rare, we wish to determine the prevalence of gluten protein associated serology in IBS patients, which has not been formally studied, and its relation to histological and human leukocyte antigen (HLA) markers.
Methods
We reviewed a consecutive cohort of Asian patients with IBS, who had undergone serologic testing for IgA against deamidated gliadin peptide antibodies (IgA DGP) and IgA anti-endomysium antibodies, and who also had duodenal biopsies during clinical workup. In addition, a subset of Chinese patients with positive serology was further tested for HLA-DQ2 and HLA-DQ8.
Results
Of 186 patients, 34 (18%) were positive for IgA DGP; bloating, abdominal pain, belching and diarrhea were the most commonly reported symptoms but diarrhea as the most bothersome symptom was significantly more common in IgA DGP positive patients. Mildly increased intra-epithelial lymphocytes on duodenal biopsy was also more common (29% vs. 9%, P = 0.001). Nine of 21 Chinese patients tested as IgA DGP positive undertook HLA-DQ2/DQ8 testing, with only 2 being positive for HLA-DQ8. All patients with positive IgA DGP reported symptom improvement with gluten withdrawal.
Conclusions
We have described a series of Asian, mainly Chinese, patients with IBS who were tested positive for IgA DGP, and improved on a gluten exclusion diet. We believe this is the first report of non-celiac gluten sensitivity in Asia, a region where CD is uncommon.
... Thus, the investigators concluded that there was no benefit in performing CE for this subgroup of patients. In a further study, 22 irritable bowel syndrome patients with positive AGA, EMA or tTG and normal duodenal histology underwent CE and HLA genotyping [197]. Subtle mucosal abnormalities within in the small bowel, such as mucosal breaks, ulceration or denuded and blunted villi, were seen in 55 % (12/22) of cases. ...
... Thus, the investigators concluded that there was no benefit in performing CE for this subgroup of patients. In a further study, 22 irritable bowel syndrome patients with positive AGA, EMA or tTG and normal duodenal histology underwent CE and HLA genotyping [197]. Subtle mucosal abnormalities within in the small bowel, such as mucosal breaks, ulceration or denuded and blunted villi, were seen in 55 % (12/22) of cases. ...
To date, only one system is available for wireless examination of the oesophagus (PillCam(r)ESO 2; Given Imaging(r)Ltd, Yoqneam, Israel). Tethered examination of the oesophagus has been attempted with both PillCam and OMOM(r) (Chongqing Jinshan Science and Technology Group Co., Ltd, Beijing, China). Although a useful alternative to conventional endoscopy for anxious patients, evidence on the validity of oesophageal capsule endoscopy in Barrett's oesophagus, oesophagitis and oesophageal varices is less favourable. In this chapter, we present the technical specifications of the oesophageal capsule, the ingestion protocol, indications and contraindications for its use, potential alternatives and on-going projects.
... Thus, the investigators concluded that there was no benefit in performing CE for this subgroup of patients. In a further study, 22 irritable bowel syndrome patients with positive AGA, EMA or tTG and normal duodenal histology underwent CE and HLA genotyping [197]. Subtle mucosal abnormalities within in the small bowel, such as mucosal breaks, ulceration or denuded and blunted villi, were seen in 55 % (12/22) of cases. ...
... However, the small bowel histology has been shown to have moderate agreement with VCE findings when investigated in 26 patients with CD and therefore VCE did not seem a suitable tool to replace duodenal biopsy in the diagnosis of CD [186]. Moreover, another study in 21 patients with irritable bowel syndrome according to the Rome criteria, at least one positive serological markers (AGA, tTGA, EMA), and normal duodenal biopsy, has shown that VCE detected small bowel lesions compatible with a diagnosis of CD and supported by HLA-DQ testing, in 6 (28.5%) patients [187]. The authors emphasized on the role of VCE in patients who have a high suspicion of CD, but in whom the histology is normal or equivocal [187]. ...
... Moreover, another study in 21 patients with irritable bowel syndrome according to the Rome criteria, at least one positive serological markers (AGA, tTGA, EMA), and normal duodenal biopsy, has shown that VCE detected small bowel lesions compatible with a diagnosis of CD and supported by HLA-DQ testing, in 6 (28.5%) patients [187]. The authors emphasized on the role of VCE in patients who have a high suspicion of CD, but in whom the histology is normal or equivocal [187]. When 20 patients with a positive EMA were offered VCE next to regular endoscopy, the sensitivity, specificity, positive and negative predictive values for VCE recognizing villous atrophy were 85%, 100%, 100%, 88.9%, respectively [188]. ...
Celiac disease affects a great proportion of children and adults. Due to its protean manifestations the diagnosis is often missed. Thanks to the presence of serological and genetic tests as well the possibility to obtain small bowel biopsy specimens through endoscopy the diagnosis is relatively easy to make in the majority of patients with uncomplicated form of celiac disease. The prognosis of these patients is very good provided they follow a strict-gluten free diet. A different story is those patients with complicated forms of the disease and the so-called refractory celiac disease with a sombre prognosis that fails to respond to a gluten-free diet. In this section we review the current algorithms to reach a diagnosis in both the uncomplicated as well as the complicated forms using new technology and the knowledge derived from current etiopathogenetic concepts.
