胶囊内镜：在 gluten-free diet 下对乳糜泻患者进行随访的有价值工具。
Capsule endoscopy: a valuable tool in the follow-up of people with celiac disease on a gluten-free diet.
机构信息
Department of Gastroenterology and Hepatology, The Queen Elizabeth Hospital, Woodville South, South Australia, Australia.
出版信息
Clin Transl Gastroenterol. 2011 Aug 18;2(8):e4. doi: 10.1038/ctg.2011.3.
OBJECTIVES
Traditional celiac disease guidelines recommend follow-up endoscopy and duodenal biopsies at 6-12 months after commencing a gluten-free diet (GFD). However, histology may remain abnormal even 1-2 years later. We evaluated the role of capsule endoscopy in patients with celiac disease after treatment with a GFD.
METHODS
Twelve adult patients with newly diagnosed celiac disease were prospectively enrolled. All patients had baseline symptom assessment, celiac serology (tissue transglutaminase antibody, tTG), and capsule endoscopy. Twelve months after commencing a GFD, patients underwent repeat symptom assessment, celiac serology, upper gastrointestinal endoscopy, and capsule endoscopy.
RESULTS
At baseline, capsule endoscopy detected endoscopic markers of villous atrophy in the duodenum and extending to a variable distance along the small intestine. On the basis of small bowel transit time, the mean±s.e.m. percentage of small intestine with villous atrophy was 18.2±3.7%. After 12 months on a GFD, repeat capsule endoscopy demonstrated mucosal healing from a distal to proximal direction, and the percentage of small intestine with villous atrophy was significantly reduced to 3.4±1.2% (P=0.0014) and this correlated with improvement in the symptom score (correlation 0.69, P=0.01). There was a significant improvement in symptom score (5.2±1.0 vs. 1.7±0.4, P=0.0012) and reduction in immunoglobulin A-tTG levels (81.5±10.6 vs. 17.5±8.2, P=0.0005). However, 42% of subjects demonstrated persistent villous abnormality as assessed by duodenal histology.
CONCLUSIONS
After 12 months on a GFD, patients with celiac disease demonstrate an improvement in symptoms, celiac serology, and the extent of disease as measured by capsule endoscopy. Mucosal healing occurs in a distal to proximal direction. The extent of mucosal healing correlates with improvement in symptoms. Duodenal histology does not reflect the healing that has occurred more distally.
目的
传统的乳糜泻指南建议在开始无麸质饮食（GFD）后 6-12 个月进行内镜检查和十二指肠活检。然而，即使在 1-2 年后，组织学可能仍然异常。我们评估了在接受 GFD 治疗后乳糜泻患者胶囊内镜的作用。
方法
前瞻性纳入 12 例新诊断为乳糜泻的成年患者。所有患者均进行基线症状评估、乳糜泻血清学（组织转谷氨酰胺酶抗体，tTG）和胶囊内镜检查。在开始 GFD 治疗 12 个月后，患者再次进行症状评估、乳糜泻血清学、上消化道内镜和胶囊内镜检查。
结果
在基线时，胶囊内镜检测到十二指肠和沿小肠延伸的绒毛萎缩的内镜标志物。基于小肠通过时间，绒毛萎缩的小肠平均±标准误百分比为 18.2±3.7%。在 GFD 治疗 12 个月后，重复胶囊内镜显示从远端到近端的黏膜愈合，绒毛萎缩的小肠百分比显著降低至 3.4±1.2%（P=0.0014），并且与症状评分的改善相关（相关系数 0.69，P=0.01）。症状评分显著改善（5.2±1.0 与 1.7±0.4，P=0.0012），免疫球蛋白 A-tTG 水平降低（81.5±10.6 与 17.5±8.2，P=0.0005）。然而，42%的患者通过十二指肠组织学评估显示持续的绒毛异常。
结论
在 GFD 治疗 12 个月后，乳糜泻患者的症状、乳糜泻血清学和胶囊内镜测量的疾病程度均有所改善。黏膜愈合从远端到近端发生。黏膜愈合程度与症状改善相关。十二指肠组织学不能反映更远处发生的愈合。
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