Assessment of disease severity on capsule endoscopy in patients with small bowel villous atrophy.
celiac disease
serology negative villous atrophy
severity score
small bowel capsule endoscopy
Journal
Journal of gastroenterology and hepatology
ISSN: 1440-1746
Titre abrégé: J Gastroenterol Hepatol
Pays: Australia
ID NLM: 8607909
Informations de publication
Date de publication:
Apr 2021
Apr 2021
Historique:
revised:
14
05
2020
received:
19
02
2020
accepted:
09
08
2020
pubmed:
19
8
2020
medline:
25
9
2021
entrez:
19
8
2020
Statut:
ppublish
Résumé
There is a lack of uniformity of reporting on features of celiac disease (CD) on small bowel capsule endoscopy (SBCE). This makes determining extent of disease and comparison of severity of disease challenging. De-identified SBCEs of 300 patients (78 CD [26%], 18 serology negative villous atrophy [6%], and 204 controls with normal duodenal histology [68%]) were included. Videos were reviewed by two experts. All patients had duodenal histology taken within 2 weeks of SBCE. The degree of agreement in CD features and extent of disease was then determined. The resulting score for each factor was used to determine overall severity of disease. There was substantial agreement in the kappa coefficient for the detection of CD features between reviewers (0.67). Agreement for extent of affected small bowel (SB) mucosa was high (0.97). On multiple regression analysis, several features of CD correlated with extent of affected SB mucosa for both reviewers. The odds ratios derived from this analysis were then used to score features of CD, enabling scores of severity to be calculated for each patient. The median overall scores for patients increased significantly according to the independent classification of severity by the capsule reviewers: mild (20, 0-79), moderate (45, 25-123), and severe (89, 65-130) (P = 0.0001). The good correlation of CD scores between expert reviewers confirms the validity of features of CD on SBCE. An objective score of CD features in the SB is useful in the follow up of patients with CD and serology negative villous atrophy.
Sections du résumé
BACKGROUND AND AIM
OBJECTIVE
There is a lack of uniformity of reporting on features of celiac disease (CD) on small bowel capsule endoscopy (SBCE). This makes determining extent of disease and comparison of severity of disease challenging.
METHODS
METHODS
De-identified SBCEs of 300 patients (78 CD [26%], 18 serology negative villous atrophy [6%], and 204 controls with normal duodenal histology [68%]) were included. Videos were reviewed by two experts. All patients had duodenal histology taken within 2 weeks of SBCE. The degree of agreement in CD features and extent of disease was then determined. The resulting score for each factor was used to determine overall severity of disease.
RESULTS
RESULTS
There was substantial agreement in the kappa coefficient for the detection of CD features between reviewers (0.67). Agreement for extent of affected small bowel (SB) mucosa was high (0.97). On multiple regression analysis, several features of CD correlated with extent of affected SB mucosa for both reviewers. The odds ratios derived from this analysis were then used to score features of CD, enabling scores of severity to be calculated for each patient. The median overall scores for patients increased significantly according to the independent classification of severity by the capsule reviewers: mild (20, 0-79), moderate (45, 25-123), and severe (89, 65-130) (P = 0.0001).
CONCLUSION
CONCLUSIONS
The good correlation of CD scores between expert reviewers confirms the validity of features of CD on SBCE. An objective score of CD features in the SB is useful in the follow up of patients with CD and serology negative villous atrophy.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1015-1021Informations de copyright
© 2020 Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd.
Références
Murray JA, Rubio-Tapia A, Van Dyke CT et al. Mucosal atrophy in celiac disease: extent of involvement, correlation with clinical presentation, and response to treatment. Clin. Gastroenterol. Hepatol. 2008; 6: 186-193; quiz 125. 2007/12/21. https://doi.org/10.1016/j.cgh.2007.10.012
Rondonotti E, Spada C, Cave D et al. Video capsule enteroscopy in the diagnosis of celiac disease: a multicenter study. Am. J. Gastroenterol. 2007; 102: 1624-1631. 2007/04/24. https://doi.org/10.1111/j.1572-0241.2007.01238.x
Branchi F, Ferretti F, Orlando S et al. Small-bowel capsule endoscopy in patients with celiac disease, axial vs. lateral/panoramic view: results from a prospective randomized trial. Dig. Endosc. 2019 2019/11/04. https://doi.org/10.1111/den.13575
Parfenov AI, Akopova AO, Shcherbakov PL et al. Is it necessary to use capsular endoscopy to diagnose celiac disease? Ter. Arkh. 2018; 90: 8-11. https://doi.org/10.26442/terarkh20189048-11
Petroniene R, Dubcenco E, Baker JP et al. Given capsule endoscopy in celiac disease: evaluation of diagnostic accuracy and interobserver agreement. Am. J. Gastroenterol. 2005; 100: 685-694. https://doi.org/10.1111/j.1572-0241.2005.41069.x
Lidums I, Cummins AG, Teo E. The role of capsule endoscopy in suspected celiac disease patients with positive celiac serology. Dig. Dis. Sci. 2011; 56: 499-505. https://doi.org/10.1007/s10620-010-1290-6
Perez-Cuadrado-Robles E, Lujan-Sanchis M, Elli L et al. Role of capsule endoscopy in alarm features and non-responsive celiac disease: a European multicenter study. Dig. Endosc. 2018; 30: 461-466. 2018/01/22. https://doi.org/10.1111/den.13002
Chetcuti Zammit S, Sanders DS, Cross SS et al. Capsule endoscopy in the management of refractory coeliac disease. J. Gastrointestin. Liver Dis. 2019; 28: 15-22. https://doi.org/10.15403/jgld.2014.1121.281.cel
Lidums I, Teo E, Field J et al. Capsule endoscopy: a valuable tool in the follow-up of people with celiac disease on a gluten-free diet. Clin. Transl. Gastroenterol. 2011; 2: e4. https://doi.org/10.1038/ctg.2011.3
Chetcuti Zammit S, Kurien M, Sanders DS et al. What is the role of small bowel capsule endoscopy in established coeliac disease? Clin. Res. Hepatol. Gastroenterol. 2020 2020/01/09. https://doi.org/10.1016/j.clinre.2019.11.011
Chetcuti Zammit S, Sanders DS, Sidhu R. Coeliac disease: older patients have the most extensive small bowel involvement on capsule endoscopy. Eur. J. Gastroenterol. Hepatol. 2019; 31: 1496-1501. https://doi.org/10.1097/MEG.0000000000001503
Gralnek IM, Defranchis R, Seidman E et al. Development of a capsule endoscopy scoring index for small bowel mucosal inflammatory change. Aliment. Pharmacol. Ther. 2008; 27: 146-154. 2007/10/23. https://doi.org/10.1111/j.1365-2036.2007.03556.x
Cotter J, Dias de Castro F, Magalhães J et al. Validation of the Lewis score for the evaluation of small-bowel Crohn's disease activity. Endoscopy 2015; 47: 330-335. 2014/11/20. https://doi.org/10.1055/s-0034-1390894
DeGaetani M, Tennyson CA, Lebwohl B et al. Villous atrophy and negative celiac serology: a diagnostic and therapeutic dilemma. Am. J. Gastroenterol. 2013; 108: 647-653. https://doi.org/10.1038/ajg.2013.45
Aziz I, Peerally MF, Barnes JH et al. The clinical and phenotypical assessment of seronegative villous atrophy; a prospective UK centre experience evaluating 200 adult cases over a 15-year period (2000-2015). Gut 2017; 66: 1563-1572. 2016/09/07. https://doi.org/10.1136/gutjnl-2016-312271
Pais WP, Duerksen DR, Pettigrew NM et al. How many duodenal biopsy specimens are required to make a diagnosis of celiac disease? Gastrointest. Endosc. 2008; 67: 1082-1087. https://doi.org/10.1016/j.gie.2007.10.015
Ludvigsson JF, Bai JC, Biagi F et al. Diagnosis and management of adult coeliac disease: guidelines from the British Society of Gastroenterology. Gut 2014; 63: 1210-1228. 2014/06/10. https://doi.org/10.1136/gutjnl-2013-306578
Oberhuber G, Granditsch G, Vogelsang H. The histopathology of coeliac disease: time for a standardized report scheme for pathologists. Eur. J. Gastroenterol. Hepatol. 1999; 11: 1185-1194 Review.
Zwinger LL, Siegmund B, Stroux A et al. CapsoCam SV-1 versus PillCam SB 3 in the detection of obscure gastrointestinal bleeding: results of a prospective randomized comparative multicenter study. J. Clin. Gastroenterol. 2018 2018/01/23. https://doi.org/10.1097/MCG.0000000000000994
Goldstein JL, Eisen GM, Lewis B et al. Video capsule endoscopy to prospectively assess small bowel injury with celecoxib, naproxen plus omeprazole, and placebo. Clin. Gastroenterol. Hepatol. 2005; 3: 133-141.
Biagi F, Rondonotti E, Campanella J, et al. Video capsule endoscopy and histology for small-bowel mucosa evaluation: a comparison performed by blinded observers. Clin. Gastroenterol. Hepatol. Off. Clin. Pract. J. Am. Gastroenterol. Assoc. 2006; 4: 998-1003. DOI: S1542-3565(06)00421-6 [pii].
Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics 1977; 33: 159-174.
El-Matary W, Huynh H, Vandermeer B. Diagnostic characteristics of given video capsule endoscopy in diagnosis of celiac disease: a meta-analysis. J. Laparoendosc. Adv. Surg. Techniq. Part A 2009; 19: 815-820. https://doi.org/10.1089/lap.2008.0380
Hopper AD, Sidhu R, Hurlstone DP, et al. Capsule endoscopy: an alternative to duodenal biopsy for the recognition of villous atrophy in coeliac disease? Diges. Liver Dis. Off. J. Italian Soc. Gastroenterol. Italian Assoc. Study Liver 2007; 39: 140-145. DOI: S1590-8658(06)00336-7 [pii].
Lujan-Sanchis M, Perez-Cuadrado-Robles E, Garcia-Lledo J et al. Role of capsule endoscopy in suspected celiac disease: a European multi-centre study. World J. Gastroenterol. 2017; 23: 703-711. https://doi.org/10.3748/wjg.v23.i4.703
Rokkas T, Niv Y. The role of video capsule endoscopy in the diagnosis of celiac disease: a meta-analysis. Eur. J. Gastroenterol. Hepatol. 2012; 24: 303-308. https://doi.org/10.1097/MEG.0b013e32834fa914
Murray JA, Rubio-tapia A, van Dyke CT et al. Mucosal atrophy in celiac disease: extent of involvement, correlation with clinical presentation, and response to treatment. Clin. Gastroenterol. Hepatol. Off. Clin. Pract. J. Am. Gastroenterol. Assoc. 2008; 6: 186-125. https://doi.org/10.1016/j.cgh.2007.10.012
Hopper AD, Cross SS, Sanders DS. Patchy villous atrophy in adult patients with suspected gluten-sensitive enteropathy: is a multiple duodenal biopsy strategy appropriate? Endoscopy 2008; 40: 219-224. https://doi.org/10.1055/s-2007-995361
Rosa B, Moreira MJ, Rebelo A et al. Lewis score: a useful clinical tool for patients with suspected Crohn's disease submitted to capsule endoscopy. J. Crohns Colitis 2012; 6: 692-697. 2012/01/13. https://doi.org/10.1016/j.crohns.2011.12.002
Maiden L, Elliott T, McLaughlin SD et al. A blinded pilot comparison of capsule endoscopy and small bowel histology in unresponsive celiac disease. Dig. Dis. Sci. 2009; 54: 1280-1283. https://doi.org/10.1007/s10620-008-0486-5
Barret M, Malamut G, Rahmi G et al. Diagnostic yield of capsule endoscopy in refractory celiac disease. Am. J. Gastroenterol. 2012; 107: 1546-1553. https://doi.org/10.1038/ajg.2012.199
Rondonotti E, Spada C, Cave D, et al. Video capsule enteroscopy in the diagnosis of celiac disease: a multicenter study. Am. J. Gastroenterol. 2007; 102: 1624-1631. DOI: AJG1238 [pii].
Silvester JA, Kurada S, Szwajcer A et al. Tests for serum transglutaminase and endomysial antibodies do not detect most patients with celiac disease and persistent villous atrophy on gluten-free diets: a meta-analysis. Gastroenterology 2017; 153: 689, e681. 2017/05/22-701. https://doi.org/10.1053/j.gastro.2017.05.015