Diagnosing a Patient With Severe and Protracted Diarrhea due to Celiac Disease: When And How Should Capsule Endoscopy Be Used?
We present the case of a 68 year-old man with renal failure
and metabolic acidosis due to severe and chronic protracted
diarrhea. Previous examinations, including IgA AGA and
IgA tTG, endoscopy, and duodenal biopsies, were inconclusive.
Wireless capsule endoscopy (WCE) of the small bowel
showed flattened and scalloped folds and a characteristic mosaic
pattern of the entire small intestine, consistent with the
diagnosis of celiac disease (CD), which was also confirmed
with a positive examination for antiendomysial antibodies.
A gluten-free diet led to gradual clinical improvement. The
case underscores the emerging role of WCE in the diagnosis
of celiac disease in light of the recent evidence provided
by relevant studies.