Department of Gastroenterology and Hepatology, VU University Medical Centre, Amsterdam, The Netherlands.
J Clin Gastroenterol. 2013 May-Jun;47(5):393-9. doi: 10.1097/MCG.0b013e31826bea12.
Discriminating between patients with nonresponsive but otherwise uncomplicated celiac disease (CD) and patients with refractory celiac disease (RCD) and/or lymphoma is difficult, especially as many abnormalities encountered in complicated CD are not within reach of conventional gastroduodenoscopy. We aimed to describe video capsule endoscopy (VCE) findings in patients with CD and persisting or relapsing symptoms despite a gluten-free diet and to identify VCE findings associated with poor prognosis.
We retrospectively analyzed 48 VCE studies performed in adult patients with CD because of persisting or relapsing symptoms despite adherence to a gluten-free diet. Patients with either uncomplicated CD or RCD type I were considered to have a good prognosis, whereas patients with either RCD type II or enteropathy-associated T-cell lymphoma were considered to have a poor prognosis. Multivariate analysis was performed to identify VCE findings independently associated with either good or poor prognosis.
Proximal focal erythema (odds ratio, 6.7; 95% confidence interval, 1.2-38.7; P=0.033) and absence of progression of the capsule to the distal intestine (odds ratio, 16.5; 95% confidence interval, 1.2-224.9; P=0.035) were independently associated with poor prognosis. Of the 28 patients with none of these 2 features, none died during follow-up, compared with 2 (13.3%) of the 15 patients with one of both features, and 4 (80.0%) of the 5 patients with both the features.
VCE is a minimally invasive endoscopic modality that could be of use in identifying patients with nonresponsive CD who are at risk of poor prognosis.
鉴别非应答但无其他并发症的乳糜泻（CD）患者与难治性乳糜泻（RCD）和/或淋巴瘤患者具有一定难度，尤其是因为复杂 CD 中遇到的许多异常情况无法通过常规胃肠镜检查。我们旨在描述在遵循无麸质饮食后仍持续或复发症状的 CD 患者的胶囊内镜检查（VCE）结果，并确定与不良预后相关的 VCE 结果。
我们回顾性分析了 48 例因坚持无麸质饮食后仍持续或复发症状而进行 VCE 检查的成年 CD 患者。无并发症 CD 或 RCD 1 型患者被认为预后良好，而 RCD 2 型或肠病相关 T 细胞淋巴瘤患者则被认为预后不良。进行多变量分析以确定与良好或不良预后独立相关的 VCE 结果。
近端局限性红斑（优势比，6.7；95%置信区间，1.2-38.7；P=0.033）和胶囊无法到达远端肠道（优势比，16.5；95%置信区间，1.2-224.9；P=0.035）是与不良预后独立相关的特征。在没有这两个特征的 28 例患者中，无一例在随访期间死亡，而在有一个特征的 15 例患者中，有 2 例（13.3%）死亡，在有两个特征的 5 例患者中，有 4 例（80.0%）死亡。
VCE 是一种微创内镜检查方式，可用于识别非应答性 CD 患者中预后不良的风险。
