The role of capsule endoscopy in suspected celiac disease patients with positive celiac serology

BackgroundEndomysial antibody (EMA) and tissue transglutaminase (tTG) antibody testing is used to screen subjects with suspected celiac disease. However, the traditional gold standard for the diagnosis of celiac disease is histopathology of the small bowel. As villous atrophy may be patchy, duodenal biopsies could potentially miss the abnormalities. Capsule endoscopy can obtain images of the whole small intestine and may be useful in the early diagnosis of celiac disease.AimsTo evaluate suspected celiac disease patients who have positive celiac serology and normal duodenal histology and to determine, with capsule endoscopy, whether these patients have any endoscopic markers of celiac disease.MethodsTwenty-two subjects with positive celiac serology (EMA or tTG) were prospectively evaluated. Eight of the subjects had normal duodenal histology and 14 had duodenal histology consistent with celiac disease. All subjects underwent capsule endoscopy. Endoscopic markers of villous atrophy such as loss of mucosal folds, scalloping, mosaic pattern, and visible vessels were assessed.ResultsEight subjects with normal duodenal histology had normal capsule endoscopy findings. In the 14 subjects with duodenal histology that was consistent with celiac disease, 13 had celiac disease changes seen at capsule endoscopy. One subject with normal capsule endoscopy findings showed Marsh IIIc on duodenal histology. Using duodenal histology as the gold standard, capsule endoscopy had a sensitivity of 93%, specificity of 100%, PPV of 100%, and NPV of 89% in recognizing villous atrophy.ConclusionsCapsule endoscopy is useful in the detection of villous abnormalities in untreated celiac disease. Patients with positive celiac serology (EMA or tTG) and normal duodenal histology are unlikely to have capsule endoscopy markers of villous atrophy.Ilmars Lidums, Adrian G. Cummins, Edward Te

Comparison of capsule endoscopy and magnetic resonance (MR) enteroclysis in suspected small bowel disease

BACKGROUND AND AIMS: Small bowel MR enteroclysis and wireless capsule endoscopy (WCE) are new diagnostic tools for the investigation of the small bowel. The aim of this study was to compare the diagnostic yield of WCE with MR enteroclysis in the detection of small bowel pathologies. METHODS: A total of 36 patients were included in the study. Indications for imaging of the small bowel were proven or suspected small bowel Crohn's disease (CD; n=18), obscure gastrointestinal (GI) bleeding (n=14) and tumour surveillance (n=4). RESULTS: In patients with Crohn's disease WCE detected significantly more inflammatory lesions in the first two segments of the small bowel compared with MR enteroclysis (12 patients vs. 1 patient, p=0.016). In 5 out of 14 (36%) patients with GI bleeding, angiodysplasia was detected as a possible bleeding source. Three of these patients had active bleeding sites detected by WCE. One patient had scattered inflammation of the mucosa. MR enteroclysis did not reveal any intestinal abnormalities in this patient group. MR enteroclysis provided extraintestinal pathologies in 10 out of 36 (28%) patients. CONCLUSION: In patients with Crohn's disease WCE revealed significantly more inflammatory lesions in the proximal and middle part of the small bowel in comparison to MR enteroclysis, whereas in patients with obscure GI bleeding WCE was superior to MR enteroclysis

Jia Zhangke’s Mountains May Depart (2015) and the China Dream or, How Chinese art cinema learned to stop worrying and love Chinese soft power

Taking Jia Zhangke’s Mountains May Depart as the case in focus, this chapter examines a segment of Chinese screen culture which has managed to circulate in domestic theatres without conforming to the normative state narrative epitomized by Xi Jinping’s catchphrase China Dream. A close reading of Jia Zhangke’s works and references to Diao Yinan’s Black Coal, Thin Ice and Ann Hui’s The Golden Era, aims to shed some light on how cinematic structures such as multiple narratives, juxtaposition of different time frames, and the adoption of diverse points of view contribute a multifaceted articulation of the rhetoric of the China Dream. Furthermore, by discussing these films against the background of the current Chinese film industry, this chapter points out how the officially promoted soft power gives way to challenging works, which often undermine China’s official narrative while endorsing China’s success. These works also testify to the increasing complexity of Chinese filmmaking both in relation to the domestic and the international film scene