Capsule endoscopy detects intestinal damage caused by celiac disease

Mayo Clinic researchers have found that capsule endoscopy can provide a magnified view of the intestinal damage caused by celiac disease.

This new information can help physicians detect and diagnose celiac disease, as well as measure intestinal healing following treatment. These findings are published in this month's issue of Clinical Gastroenterology and Hepatology.

Approximately 3 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, M.D., the study's lead author and a gastroenterologist at Mayo Clinic.

The capsule is approximately the size of a large vitamin, and it includes a miniature color 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.

This study, the first of its kind, used capsule endoscopy to view intestinal damage in 37 patients with untreated, biopsy-proven celiac disease. 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."

Other members of the Mayo Clinic research team included Alberto Rubio Tapia, M.D., Carol Van Dyke, Deanna Brogan, Mary Knipschield, Brian Lahr, Ashwin Rumalla, Alan Zinsmeister, Ph.D., and Christopher Gostout, M.D.