Capsule Endoscopy for Celiac Disease Diagnosis

camera in pill capsule
Can a capsule camera diagnose celiac disease?. Alan Crawford/Getty Images

Traditionally, physicians have used endoscopy — a procedure in which the doctor threads an instrument down your throat and past your stomach into your small intestine — to diagnose celiac disease. However, a new, more patient-friendly technology known as capsule endoscopy is gaining favor at some medical centers for use in the diagnosis of celiac disease.

Capsule endoscopy allows your physician to see — and record images of — the entire length of your small intestine, not just the top one to two feet that can be viewed in a traditional endoscopy. So it sounds like the perfect diagnostic tool for celiac disease, a condition that can involve damage throughout the small intestine, not just in those upper two feet.

Still, capsule endoscopy for celiac disease diagnosis does have a couple of drawbacks. Here's what you need to know if you and your doctor are considering a capsule endoscopy to test for celiac disease.

Capsule Endoscopy Diagnoses Celiac Disease Through Video Images

When you have a capsule endoscopy, you swallow a capsule that's about the size of a large vitamin pill. That "pill" contains a tiny video camera, complete with a light, transmitter and a battery to power the unit.

The pill moves down your esophagus and through your stomach, and then transits your small intestine — all 30 feet of it.

The images it takes as it's moving through your digestive tract are transmitted to sensors attached around your torso and then recorded on a device you wear on a belt around your waist.

Following the procedure, your doctor will review the video images, looking for the characteristic intestinal damage known as villous atrophy that signals celiac disease.

If she sees that damage, you'll be diagnosed with the condition.

Capsules Offer More Patient-Friendly Diagnostic Method

Many patients prefer capsule endoscopy to the more traditional endoscopy procedure, which requires anesthesia and likely will cost you a day at work or school.

Although you still need to avoid eating for about half a day prior to the capsule endoscopy procedure (as you would for a traditional endoscopy), you don't need any anesthesia, and in fact, you can continue your usual daily activities, including driving and working, as the capsule moves through your body.

Once the capsule has completed its video tour of your small intestine, it will continue through your colon and out as part of a bowel movement. However, you don't need to worry about it — you just need to flush it when it appears in the toilet. You will, however, pack up the sensors and recording device to return to your physician.

Device Could Miss Some Early Celiac Cases

As I said before, capsule endoscopy allows your physician to view your entire small intestine, not just the top one to two feet reachable through a traditional endoscopy. Therefore, if your celiac-related damage is patchy (as it frequently is), or if it's concentrated lower down in your intestine, it's more likely to be identified if you have a capsule endoscopy that can view your small intestine in its entirety.

In fact, a study conducted by the Mayo Clinic used capsule endoscopy to view damage in 37 patients who already had been diagnosed with celiac disease using traditional endoscopy. The study found that almost all of them — 92% — had damage that could be seen by the capsule's video camera... and in one case, the patient had only patchy damage in the lower part of the small intestine, with no visible damage in the upper part of the small intestine.

The Mayo Clinic study noted another interesting finding: the amount of intestinal damage found in the capsule endoscopy procedures for each patient didn't correlate at all with the celiac disease symptoms those patients reported.

In other words, you can have lots of damage with few symptoms, or you can have little damage with lots of symptoms.

So, while it's not yet used routinely, capsule endoscopy looks promising as a diagnostic tool for celiac disease, and it's also potentially useful to monitor healing in diagnosed celiacs. However, a review of the literature on capsule endoscopy in celiac disease diagnosis finds one major drawback: it doesn't always "see" intestinal abnormalities in patients with less-severe intestinal damage. In fact, if you have only inflammation in your intestinal lining, without partial villous atrophy, capsule endoscopy may not identify it.

In addition, capsule endoscopy does not allow your physician to take actual samples of your small intestine lining for examination under a microscope. Therefore, if the results of your capsule endoscopy aren't conclusive, your physician may still ask you to undergo a traditional endoscopy.

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