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The Role of Endoscopy in Refractory Coeliac Disease

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Refractory Celiac Disease

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Abstract

Refractory coeliac disease (RCD) is defined as ongoing small intestinal inflammation typical of coeliac disease despite strict removal of gluten from the diet. Individuals with RCD have an increased risk of small bowel malignancy, which carries a poor 5-year prognosis. Small intestinal inflammation in RCD and associated pre-malignant/malignant complications can affect anywhere along the length of the small intestine. Therefore, endoscopic inspection of the entire length of the small bowel is essential when assessing patients with suspected RCD, or monitoring individuals with established disease. In this respect, small bowel capsule endoscopy is a useful, minimally invasive approach. The test enables identification of mucosal irregularities beyond the reach of a standard gastroscope and helps to guide more invasive enteroscopy to obtain targeted biopsies. Further studies are needed to identify the clinical, laboratory and endoscopic abnormalities associated with RCD and malignant complications, to improve identification of those who should undergo more invasive endoscopic evaluation.

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Notes

  1. 1.

    Other causes of villous atrophy include immune-mediated (e.g. autoimmune enteropathy), immune deficiency (e.g. CVID), inflammatory (e.g. eosinophilic gastroenteritis, IBD), infectious (e.g. giardiasis), iatrogenic (e.g. NSAIDs) and idiopathic [4].

  2. 2.

    Including abdominal pain, diarrhoea, weight loss, blood in faeces, faecal calprotectin elevation, or iron-deficiency anaemia [27].

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Acknowledgements

No funding was obtained for this review. HAP is a Wellcome Clinical Fellow funded on grant 203,914/Z/16/Z to the Universities of Manchester, Leeds, Newcastle, and Sheffield. DSS receives an educational grant from Schaer (a gluten-free food manufacturer). Dr. Schaer did not have any input in drafting of this manuscript. Sheffield Teaching Hospitals NHS Trust is the NHS England National Centre for Refractory Coeliac Disease.

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Authors and Affiliations

  1. Academic Unit of Gastroenterology, University of Sheffield, Sheffield, UK

    H. A. Penny, S. Chetcuti Zammat, R. Sidhu & D. S. Sanders

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  1. H. A. Penny
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  2. S. Chetcuti Zammat
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  3. R. Sidhu
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  4. D. S. Sanders
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Correspondence to H. A. Penny .

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Editors and Affiliations

  1. Department of Gastroenterology, AP-HP. Centre-Université de Paris Hôpital Cochin, Paris, France

    Georgia Malamut

  2. Laboratory of Intestinal Immunity, Université de Paris, INSERM UMR 1163 and Imagine Institute, Paris, France

    Nadine Cerf-Bensussan

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Penny, H.A., Chetcuti Zammat, S., Sidhu, R., Sanders, D.S. (2022). The Role of Endoscopy in Refractory Coeliac Disease. In: Malamut, G., Cerf-Bensussan, N. (eds) Refractory Celiac Disease. Springer, Cham. https://doi.org/10.1007/978-3-030-90142-4_5

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  • DOI: https://doi.org/10.1007/978-3-030-90142-4_5

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