Novel Endoscopic Techniques in Celiac Disease

Celiac disease (CD) is a systemic, immune‐mediated illness that primarily affects the small bowel. A few decades ago, in the era of Watson and Crosby capsules, we used to sample the small bowel without even looking at it. Nowadays, with the continuous developing field of digestive endoscopy, we can even see the duodenal villi up closely, allowing for an optical, real‐time diagnosis of villous atrophy. Advanced endoscopic techniques such as magnification, chromoendoscopy (dye‐based and digital), water immersion, confocal endomicroscopy, endocytoscopy, and optical coherence tomography (OCT) have been evaluated in CD with good results: good agreement with histology, allowing for targeted biopsies and a reduction in the number of biopsies needed for diagnosis. Moreover, with the growing use of open‐access endoscopy in many parts of the world, endoscopy is now contributing to increasing the diagnostic rate of CD, by recognition of endoscopic markers in patients without clinical suspicion of this disease. This is however an observer‐dependent method; to overcome the endoscopists subjectiveness in assessing villous atrophy, in the last years, many papers have looked at means of computerized analysis of endoscopic images. Currently available data show that these automated, quantitative methods hold very promising for the future

Update on celiac disease – etiology, differential diagnosis, drug targets, and management advances

Celiac disease (CD) is an immune-mediated enteropathy triggered by exposure to wheat gluten and similar proteins found in rye and barley that affects genetically susceptible persons. This immune-mediated enteropathy is characterized by villous atrophy, intraepithelial lymphocytosis, and crypt hyperplasia. Once thought a disease that largely presented with malnourished children, the wide spectrum of disease activity is now better recognized and this has resulted in a shift in the presenting symptoms of most patients with CD. New advances in testing, both serologic and endoscopic, have dramatically increased the detection and diagnosis of CD. While the gluten-free diet is still the only treatment for CD, recent investigations have explored alternative approaches, including the use of altered nonimmunogenic wheat variants, enzymatic degradation of gluten, tissue transglutaminase inhibitors, induction of tolerance, and peptides to restore integrity to intestinal tight junctions

Computers in Biology and Medicine / Survey on computer aided decision support for diagnosis of celiac disease

Celiac disease (CD) is a complex autoimmune disorder in genetically predisposed individuals of all age groups triggered by the ingestion of food containing gluten. A reliable diagnosis is of high interest in view of embarking on a strict gluten-free diet, which is the CD treatment modality of first choice. The gold standard for diagnosis of CD is currently based on a histological confirmation of serology, using biopsies performed during upper endoscopy. Computer aided decision support is an emerging option in medicine and endoscopy in particular. Such systems could potentially save costs and manpower while simultaneously increasing the safety of the procedure. Research focused on computer-assisted systems in the context of automated diagnosis of CD has started in 2008. Since then, over 40 publications on the topic have appeared. In this context, data from classical flexible endoscopy as well as wireless capsule endoscopy (WCE) and confocal laser endomicrosopy (CLE) has been used. In this survey paper, we try to give a comprehensive overview of the research focused on computer-assisted diagnosis of CD.FWF 24366(VLID)223161

Efectividad diagnóstica de la cápsula endoscópica en el sangrado digestivo de origen oscuro, en los pacientes atendidos en el servicio de gastroenterología del Hospital Carlos Andrade Marín, en el periodo de octubre 2012 a octubre 2014

Introducción: El sangrado digestivo de origen oscuro, representa el 5% de todo el sangrado gastrointestinal y la cápsula endoscópica es el método de elección debido a que permite visualizar y localizar el sitio de la lesión, siendo su efectividad como prueba diagnóstica entre el 44 y el 82%. Objetivo: Evaluar la efectividad de la cápsula endoscópica en el Sangrado Digestivo Oscuro, en los pacientes que fueron atendidos en el servicio de Gastroenterología en el Hospital Carlos Andrade Marín, en el período de Octubre del 2012 a Octubre 2014. Metodología: Es Estudio Observacional de carácter retrospectivo, descriptivo, tipo prueba diagnóstica. Se seleccionara las historias clínicas mediante muestreo no probabilístico de conveniencia, a los pacientes a todos los que se colocó cápsulas endoscópica de tipo PillCam SB y PillCam COLON, en el Servicio de Gastroenterología. Para comprobar la efectividad de la cápsula endoscópica en el sangrado digestivo oscuro, se comparará con estudios similares realizados en Latinoamérica y en el resto del mundo y se acordara la relación entre otras variables. Resultados: Se colocaron 61 cápsulas endoscópicas, el 63,9% se colocaron en consulta externa, el tiempo total aproximado de grabación de PillCam SB es 12 horas con 6 minutos y fue positiva en 50 pacientes, lo que representa 81,97% de efectividad y las lesiones más frecuentes fueron de tipo vasculares y localizadas en duodeno. Conclusión: Es el método de elección para el diagnóstico de sangrado digestivo oscuro con alta efectividad, además de ser mínimamente invasivo, con buena tolerancia y pocas complicaciones