Unknown complicated celiac disease as an unexpected finding in patients investigated with capsule endoscopy for Crohn's disease. A case series.

Atypical symptoms of celiac disease may cause a late diagnosis, revealed by the onset of complications, which may inaccurately be attributed to Crohn's disease, as manifestations frequently overlap. Assessing the entire small bowel mucosa, capsule endoscopy may be an accurate procedure in these challenging situations. We present four Crohn's disease patients diagnosed with ulcerative jejunoilieitis complicating celiac disease after capsule endoscopy procedure. In three of these patients, the ulcerative jejunoileitis led in time to stricture formation, suggesting Crohn's disease. Administration of non-steroidal anti-inflammatory drugs made the diagnosis even more difficult in one case. In patients with Crohn's disease not responding to immunosuppressive or biological treatment, complicated celiac disease should be considered and capsule endoscopy should be performed for reassessing the diagnosis.

Higher titers of anti-Saccharomyces cerevisiae antibodies IgA and IgG are associated with more aggressive phenotypes in Romanian patients with Crohn's disease.

BACKGROUND AND AIMS: Serological markers have been widely used for diagnostic purposes and disease stratification in inflammatory bowel diseases (IBD). The aim of this study was to investigate the seroprevalence and the correlations of anti-Saccharomyces cerevisiae antibodies (ASCA) titers with different clinical phenotypes in Romanian patients with Crohn's disease (CD). METHODS: The study included 107 CD and 86 ulcerative colitis (UC) patients from the Gastroenterology Departments of three University Hospitals, and 60 healthy subjects. ASCA IgA and IgG titers were determined using ELISA test. For CD patients the phenotype was established according to the Montreal classification. The differences in ASCA titers for different CD phenotypes were assessed using the Mann-Whitney U test. RESULTS: ASCA prevalence was 33.6% in CD group, 12.8% in UC group and 6.6% in the control group. Significantly higher IgA (p=0.05) and IgG (p=0.03) titers were found in patients from the Montreal A1+A2 groups (age at onset below 40) compared with the older patients (A3). Higher titers were found in patients with extensive ileo-colonic lesions (L3) and upper gastrointestinal tract involvement (L4) than in patients having only colonic disease (L2). Significantly higher IgA (p=0.03) and IgG (p=0.03) titers were observed in patients with stenosing (B2) and penetrating (B3) disease compared with the nonstricturing, nonpenetrating (B1) phenotype. No correlation between ASCA titers and disease duration was found. CONCLUSION: ASCA seropositivity in Romanian CD patients is lower than in Western Europe. Higher ASCA IgA and IgG titers are associated with a younger age at diagnosis and more aggressive phenotypes.

Ileal neuroendocrine tumor - ultrasonographic and capsule endoscopy appearance: a case report.

We present the case of a female patient admitted for an abdominal tumoral mass corresponding to large liver metastases. The abdominal ultrasonography detected a solid intestinal tumor. The capsule endoscopy showed a vegetative tumor on the terminal ileum. After intestinal and partial liver resection, the histologic examination identified a neuroendocrine tumor. The patient responded incompletely to standard chemotherapy. In the presence of large hypoechoic liver metastases, a neuroendocrine tumor should be suspected.

Colon capsule endoscopy: a new method of investigating the large bowel.

Using the same principles as small bowel capsule endoscopy, a new wireless device has been developed to explore the colon. Colon capsule endoscopy (CCE) is a safe and non-invasive method in visualizing the entire large bowel mucosa. A special preparation of the digestive tract is necessary to ensure the cleanliness of the colon and the progression of the capsule. CCE acquires images with a very good quality and accuracy. The actual experience confirms the possibility of using CCE as a method for screening colorectal polyps and cancer.