![]() Incidental finding was of an angioectasia in proximal jejunum (Fig. There was significant mucosal oedema in one area of the proximal ileum (Fig. In the few areas of distal jejunum and proximal ileum, few erosions and small superficial ulcers were seen. The capsule endoscopy was performed on the patient, which showed that the entire length of the jejunum and ileum had diffuse blunted villi (Fig. On later investigations, C-ANCA was positive and Endomysial IgA (AEA) was elevated (25.7), which indicated coeliac etiology. Was treated initially with the help of PPIs and then started on steroids and 5-ASA with some symptomatic relief. She had significantly low Serum B12 levels (196 pg/ml), small bowel enema was reported as normal. Colonoscopy showed nothing apart from pale mucosa. Upper GI endoscopy was suggestive of inflammatory gastritis and erosive duodenitis. We present you the first reported case of diagnosing CD by CE in India.Ī 47 years non hypertensive, non diabetic, Sindhi female from Surat presented with complaints of recurrent diarrhoea, chronic dyspepsia (gastroesophageal reflux disease), anaemia and weight loss. An average of 50,000 images is obtained during an eight hour exam. The capsule is disposable and does not need to be retrieved by the patients. Once the acquisition time is reached, the recording device is downloaded to a computer workstation where software provides the images to the computer screen. The capsule obtains two images per second and transmits the data via radio frequency to a recording device worn about a patientàŠs waist. This chip requires less power than present CCD (charged couple device) chips found on video endoscopes and digital cameras, and it can operate at very low levels of illumination. The camera is a CMOS (Complementary metal oxide conductor chip). Gavriel Idan in 1981, the capsule, which measures 11 x 26 mm, contains 4LEDàŠs (Light emitting diodes), a lens, a colour camera chip, two batteries, a radio frequency transmitter and an antenna. An endoscopic capsule (Given Imaging limited, Yogneam, Israel) has been developed to obtain images from the entire small bowel. The method is now widely used in the setting of suspected small bowel bleeding as well as when small bowel disease is strongly suspected but conventional imaging techniques have failed to provide a diagnosis. Results show that wireless CE provides excellent visualization of the small intestine, is painless, well tolerated, and safe diagnostic procedure. According to revised criteria of the European Society of Paediatric Gastroenterology and nutrition, unequivocal diagnosis of CD requires characteristic histological findings with clinical response to a gluten free diet.4 Recently, with the advent of capsule endoscopy (CE) in the clinical practice which has the advantage of scanning the entire small bowel and gives highly magnified and detailed view of mucosa has facilitated in the diagnosis of CD and other small bowel disorders. Genetic testing of HLA-DQ2 and HLA-DQ8 may facilitate the diagnosis. Although the sensitivity and specificity of these tests are high, false negative results can occur in mild enteropathy and in patients with IgA deficiency. These include IgA anti-endomysial antibodies (AEA), IgA tissue-transglutaminase (tTG), IgA anti-gliadin antibodies (AGA), and IgA AGA antibodies. ![]() Recently, serologic tests have been introduced as a screening tool. More than 50% of CD patients have no GI symptoms or only non specific complaints such as dyspepsia or anorexia.1 On the other hand, growing body of evidence shows that early diagnosis and treatment can reduce the risk of malignant complication such as lymphoma.2 The gold standard for the diagnosis of CD is histopathology of the small bowel3. The diagnosis of CD may be difficult because only a proportion of these with histological abnormalities exhibit classical symptoms of CD. The prevalence of Celiac Sprue in India is not documented, but is quiet prevalent in North West India. ![]() This change in prevalence may be related to increasing physician awareness as well as improved diagnostic methods. More recent studies showed that Celiac Sprue is a common disease affecting an average one in 200 white individuals. Until fairly recently, CD was thought to be relatively rare disorder with prevalence rates 0.1%. In the majority of cases, the disease enters complete clinical and histologic remission when gluten is eliminated from the diet. Dietary gluten provokes inflammation in the small intestine, characterized by accumulation of the intra-epithelial lymphocytes, development of crypt hyperplasia, and ultimately, villous atrophy. Celiac Sprue or Celiac Disease (CD) also known as gluten sensitive enteropathy is an inflammatory disorder of the small intestine, caused by the exposure to dietary gluten in genetically susceptible individuals. ![]()
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