Positive coeliac serology in irritable bowel syndrome patients with normal duodenal biopsies: Video capsule endoscopy findings and HLA-DQ typing may affect clinical management.
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OBJECTIVES: To investigate a group of IBS patients (Rome criteria) with positive coeliac serology (EMA, TTG, IgG or IgA AGA) and normal small bowel biopsies. Video capsule endoscopy (VCE) findings of the small bowell were compared with DQ-typing. METHODS: Twenty-two patients with chronic abdominal pain (with or without diarrhea) and at least one positive result of any of the coeliac serological markers (AGA, TTG, EMA) and normal duodenal biopsy were enrolled and underwent VCE. Twelve healthy volunteers with VCE served as control group. Coeliac related HLA DQ2 or DQ8 markers were determined. RESULTS: 12/ 22 (55%) patients had small bowel abnormalities with VCE. No mucosal abnormalities were recognized in the control group (p = 0.002). Inflammatory changes were classified as moderate or pronounced. Eight patients (36%) had moderate changes and four patients (18%) demonstrated pronounced changes. Only 6 of the 21 IBS patients were positive for DQ2 and/or DQ8. CONCLUSIONS: The patients in this study fulfilled the diagnostic Rome criteria for Irritable Bowel Syndrome. We suggest that patients with positive coeliac serology and normal duodenal biopsies should undergo HLA typing. In patients positive for DQ2 and/or DQ8, a VCE should be performed. Patients with mucosal abnormalities compatible with CD should be considered as a group distinct from IBS patients and could be tested with gluten challenge or treated with a gluten free diet. (+info)
Gastrointestinal bleeding of obscure origin undetected by multiple tests for fecal occult blood and diagnosed only by capsule endoscopy: a case report.
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The term gastrointestinal bleeding of obscure origin is used to describe bleeding of unknown origin that persists or recurs after a negative initial esophagogastroduodenoscopy and colonoscopy. We report the case of a middle-aged woman with gastrointestinal bleeding of obscure origin who had 9 stool specimens that tested negative for occult blood but was found to have adenocarcinoma of the distal duodenum on capsule endoscopy. This case illustrates that, in the presence of unexplained iron-deficiency anemia, multiple negative fecal occult blood tests do not exclude the presence of GI blood loss, and that capsule endoscopy is a valuable diagnostic study in this context. (+info)
Diagnostic yield and safety of capsule endoscopy.
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INTRODUCTION: the capsule endoscopy (CE), from his approval, has become a first line diagnostic procedure for the study of the small bowel disease. The aim of this study is to report our experience since the implantation of this technique in our hospital. MATERIAL AND METHODS: retrospective review of the CE undertaken in Department of Endoscopy. There was gathered in every case the age, sex, motive of consultation, previous diagnostic procedures, capsule endoscopy findings and complication of the technique. One took to end a descriptive and analytical analysis. RESULTS: there was achieved a total of 416 explorations in 388 patients. The obscure gastrointestinal bleeding was the most frequent indication (83.30%) followed by suspected Crohn s disease (7.5%). Angiodisplasia was the endoscopic lesion more frequently detected (42.2%), especially, in patients with digestive bleeding of obscure origin (OR 3.13 p < 0.001), followed by the flebectasia (10.6%) and the ulcer suspicious of Crohn s disease (9.9%). The global diagnostic yield as for the detection of injuries was 77.34% with a case of "not defecation of the capsule" and therefore need of laparotomy. CONCLUSIONS: the capsule endoscopy is a technique consolidated and as his potential is known, his indications are extended. The obscure gastrointestinal bleeding is the most frequent indication and the angiodisplasia the most identified injury. Once known his diagnostic yield, larger studies are needed that assess the influence of capsule endoscopy on clinical outcoumes. (+info)
Use of video capsule endoscopy in a patient with an implantable cardiac defibrillator.
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Video capsule endoscopy (VCE) is a useful diagnostic tool in patients with unknown blood loss, particularly when there is a high suspicion of small bowel disease, but because of its use of radio frequency, it is relatively contraindicated in patients with a cardiac device. We report the case of a patient with an implantable cardiac defibrillator (ICD) who underwent VCE because of anaemia and previous surgery for colorectal cancer. Device interrogations were performed before and after the procedure. No interference between VCE and ICD was found. VCE is feasible and relatively safe in patients with ICDs. (+info)
Does capsule endoscopy recognise gastric antral vascular ectasia more frequently than conventional endoscopy?
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BACKGROUND: Gastric antral vascular ectasia (GAVE) is a rare cause of obscure gastrointestinal bleeding which can be difficult to recognise endoscopically. Capsule endoscopy is primarily designed to image the small bowel, but may identify gastric and colonic lesions. There have been few reported cases of GAVE diagnosed by capsule endoscopy in the literature. OBJECTIVE: Our aim was to assess the frequency of GAVE in patients with obscure gastrointestinal bleeding referred for capsule endoscopy. DESIGN: Case series. SETTING: This study was conducted in a tertiary referral hospital. PATIENTS. This study comprised 128 consecutive patients with obscure gastrointestinal bleeding. INTERVENTIONS: All patients underwent capsule endoscopy. RESULTS. Six patients were diagnosed with GAVE on the basis of the capsule endoscopy findings (4.7%, five female, median age 71.5 years). All patients had previously had numerous gastrointestinal investigations prior to capsule endoscopy. Five patients to date have been treated with argon plasma coagulation of their vascular lesions. This has resulted in stabilisation of their haemoglobin and cessation of blood transfusions in 4/5 cases with an average follow up period of 15 months. CONCLUSIONS: GAVE is commonly missed at gastroscopy and accounted for 4.7% of patients referred for capsule endoscopy with obscure gastrointestinal bleeding (in our series). This case series represents the largest number of GAVE recognised by capsule endoscopy. In the presence of any of the reported risk/associated factors for GAVE the gastroenterologist interpreting the capsule images should have a high index of suspicion. (+info)
The role of capsule endoscopy combined with double-balloon enteroscopy in diagnosis of small bowel diseases.
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BACKGROUND: The diagnosis of small bowel diseases remains relatively inefficient using traditional imaging techniques. Capsule endoscopy (CE) and double-balloon enteroscopy (DBE) are two novel methods of enteroscopy for examining the entire small bowel. The aim of this study was to evaluate the detection rate and diagnostic accuracy of CE and DBE in patients with suspected small bowel diseases and to investigate the clinical significance of combined use of these two novel modalities. METHODS: Two hundred and eighteen patients were evaluated for suspected small bowel disease, including 116 with obscure gastrointestinal bleeding and 102 with obscure abdominal pain or chronic diarrhea. One hundred and sixty-five out of these patients underwent CE first and 53 patients underwent DBE (under anesthesia with propofol) first. DBE was recommended after negative or equivocal evaluation on CE and vise versa. Introduction of the endoscope during DBE was either orally or anally and the patients were referred for a second procedure using the opposite route several days later when no abnormalities were found on the first procedure. The detection rates, diagnostic accuracy, tolerance and frequency of adverse events of these two modalities were then analyzed. RESULTS: Failure of the procedure was seen in one patient with CE and in two patients with DBE. Sixty-four DBE procedures were carried out in 51 patients; by the oral route in 34 cases, the anal route in 4 and both routes in 13 cases. The overall detection rate of small bowel diseases using CE (72.0%, 118/164) was superior to that with DBE (41.2%, 21/51); chi(2) = 16.1218, P < 0.0001. The diagnostic rate (51.8%, 85/164) was also higher than that with the latter procedure (39.2%, 20/51), but was not significantly different (chi(2) = 2.4771, P > 0.05). Furthermore, the detection rate of small bowel diseases in patients with obscure gastrointestinal bleeding using CE (88.0%, 88/100) was superior to that of DBE (60.0%, 9/15); chi(2) = 7.7457, P = 0.0054. Lesions were detected by DBE in 1 out of 4 patients in whom CE had a negative result. Suspected findings by CE were confirmed by DBE combined with biopsy in 12 out of 15 patients. On the other hand, small bowel lesions were identified by CE in all 3 patients after negative evaluations by DBE. There were no severe complications during or after either of the two procedures. CONCLUSIONS: The detection rate of small bowel diseases by CE is very high. CE should be selected for the initial diagnosis in patients with suspected small bowel diseases, especially in patients with obscure gastrointestinal bleeding. DBE appears to be inferior to CE in the diagnosis of small bowel diseases. However, it was shown that abnormalities could still be identified by DBE in patients with normal images or used to confirm suspected findings from CE. DBE can also serve as a good complementary approach after an initial diagnostic imaging using CE. (+info)
Intermittent bowel obstruction due to a retained wireless capsule endoscope in a patient with a small bowel carcinoid tumour.
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A 43-year-old man with a history of metastatic carcinoid disease is presented. The patient had symptoms of chronic intermittent abdominal pain two years after undergoing a wireless capsule endoscopy procedure. Radiological examinations revealed a retained capsule endoscope, and the patient underwent exploratory laparotomy with capsule retrieval. To the authors' knowledge, this is the first case presentation of chronic, partial small bowel obstruction caused by unrecognized retention of a capsule endoscope. (+info)
Capsule endoscopy retention as a helpful tool in the management of a young patient with suspected small-bowel disease.
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Capsule endoscopy is an easy and painless procedure permitting visualization of the entire small-bowel during its normal peristalsis. However, important problems exist concerning capsule retention in patients at risk of small bowel obstruction. The present report describes a young patient who had recurrent episodes of overt gastrointestinal bleeding of obscure origin, 18 years after small bowel resection in infancy for ileal atresia. Capsule endoscopy was performed, resulting in capsule retention in the distal small bowel. However, this event contributed to patient management by clearly identifying the site of obstruction and can be used to guide surgical intervention, where an anastomotic ulcer is identified. (+info)