If you have been diagnosed with celiac disease, you have had an endoscopy. No one really likes endoscopy. While colonoscopy definitely has a worse preparation as well as a more uncomfortable aftermath, endoscopy only looks better by comparison. It still involves not eating or drinking for a certain period of time. The test is done under at least some anesthesia, meaning you cannot drive yourself home afterwards, no matter how many you have had done or how you feel. Between the prep, the test, and the time afterwards, it’s pretty much at least one day committed to the testing.
For celiac disease, endoscopy is used to biopsy the small intestine, for diagnosis or to evaluate response to treatment. How many tests you need, and when you need them, depends on how you are doing, as well as what your doctor believes is the best way to make sure your disease is under control. While all the blood tests can help ascertain that, nothing beats the “gold standard” of an intestinal biopsy.
The development of accurate blood tests that can help screen for celiac disease changed the entire way the medical community thinks about celiac disease. It went from being thought of as a rare disease, usually found in children who were very sick to a condition that as many as one out of every 100 people has, often without knowing it. All of the implications of this knowledge are still unclear.
Now there is another relatively new test that may change some of the way celiac disease is followed. It is probably not an advance like the blood tests that will change the entire perception of CD, but it may very well change the way people are followed at some point in the future.
You may have heard about this device, called capsule endoscopy. It is a tiny, digital device that after being swallowed can, at least theoretically, transmit pictures of inner surface of the entire intestinal tract. It is best at getting images of the part of the small bowel that is hard to reach with regular endoscopy. It also does not involve sedation and the removal of tissue samples.
A small study was done in Australia to determine how capsule endoscopy might be used to get information on healing in celiac disease. A number of patients with positive blood tests subsequently had biopsies of the small intestine. A total of 14 patients had positive blood tests and villous atrophy on biopsy.
Twelve patients were placed on a gluten-free diet and were able to complete the year-long study. After a year on the gluten-free diet, most had improvement of their symptoms. Nine of the 12 no longer had positive serology. Small bowel biopsy showed a significant improvement in 7 out of the 12; the others still had significant abnormalities. They also had capsule endoscopy, and there was a correlation between villous atrophy as seen by capsule endoscopy and improvement in symptoms.
This small study did not demonstrate whether or not biopsy or capsule endoscopy abnormalities were more correlated with symptomatic improvement. There was one new piece of information learned by capsule endoscopy. The capsule endoscopy showed that healing started distally, at the end of the small intestine, and continued proximally, which means the healing progressed from the end of the small intestine in the direction of the stomach. It is possible that biopsies may miss the part of the small intestine that is starting to heal. It is also possible that the involved bowel in total may be more important in terms of symptomatic improvement than just improvement in one area.
Much more research needs to be done. It seems likely that capsule endoscopy can give doctors more information about the health of the entire small intestine. It may also be able to give information about healing that cannot be seen from a set of biopsies. While this is only a piece of the puzzle, it may turn out to be an important piece. It may also allow follow up for patients that does not always involve biopsies.
Anything that can help researchers learn more about celiac disease is important. So is anything that makes evaluation or treatment of the disease easier. Capsule endoscopy may be able to do both of these things.