Three million Americans suffer from celiac disease — an intolerance to gluten. Untreated, this can lead to intestinal damage and the risk of death.

Now gastroenterologists have a new tool in their armamentarium to help them more effectively treat these patients.

Mayo Clinic (Rochester, Minnesota) researchers reported research finding that capsule endoscopy can provide a magnified view of the intestinal damage caused by celiac disease.

“The standard approach has been upper endoscopy with biopsies,” said Joseph Murray, MD, the study’s lead author and a gastroenterologist at Mayo. “But for patients with celiac disease, the biopsies don’t heal.”

Murray’s study used capsule endoscopy to view intestinal damage in 37 patients with untreated, biopsy-proven celiac disease. Of that group, 92% had visible damage detected by capsule endoscopy, and 22 patients had extensive damage in the duodenum (first portion of the small intestine) and patchy damage throughout the jejunum (the small intestine’s middle portion).

Twelve patients had damage limited to the duodenum; one patient had only patchy damage throughout the jejunum.

No association was shown between the extent of intestinal damage and the patients’ symptoms.

Six months after a gluten-free diet was implemented, capsule endoscopy showed improvement or decreased intestinal damage in most patients.

Given Imaging (Yokneam, Israel) pioneered this less-invasive technique for an optical diagnostic of GI illnesses and has enjoyed an exclusive market in the U.S. until last September, when the EndoCapsule from Olympus (Tokyo) received FDA approval (Medical Device Daily, Nov. 6, 2007).

“Capsule endoscopy allows us to look at the entire 30 feet of the small intestine, not just the first one to two feet that can be visualized with other types of endoscopy,” Murray said.

Patients for whom capsule endoscopy would be appropriate include those who have a suspected case of celiac disease but the patient doesn’t want to undergo sedated endoscopy or for the occasional patient who is not fit for endoscopy.

Primary treatment for patients with celiac disease is to avoid all foods containing gluten, which includes wheat, barely and rye grains. The special diet helps most patients experience a complete reversal of symptoms and complications from the disease.

The capsule is about the size of a large vitamin, and it includes a miniature color video camera, light, battery and transmitter. Patient swallow the capsule and it takes approximately eight hours to move through the small intestine.

As it moves through the digestive tract, images recorded by the video camera are transmitted to sensors attached to the patient’s torso and recorded digitally on a device worn around the patient’s waist. Then, the recording device is removed and its contents are downloaded to a computer for examination.

“This study confirmed our suspicions that the most extensive intestinal damage in celiac disease patients is primarily to the duodenum. However, we were surprised to discover no correlation between extent of intestine damage and patient symptoms,” said Murray.

“Capsule endoscopy will now be another tool to diagnose celiac disease and detect intestinal damage both prior to treatment to assess the extent of damage and following treatment.”

The capsule diagnostic would also be a good tool for patients who have celiac disease previously confirmed and do not get better on a gluten-free diet or those who relapse. “You want to make sure they don’t have a complication of celiac disease such as a malignancy,” Murray said.

“You may also have a patient you suspect has celiac, and you do an endoscopy and the biopsies are negative,” he said. “So the damage may be further down than endoscopy can see and the capsule can find that.”

In other news related to GI diagnostic tools from Mayo:

Researchers there have found that endoscopic ultrasound-guided therapy appears to be an effective treatment for patients with severe GI bleeding for whom conventional therapies have failed.

GI bleeding can be caused by a variety of conditions, most commonly peptic ulcers, esophagogastric varices, arteriovenous malformations, Mallory-Weiss tears, tumors, erosions, and Dieulafoy’s lesion. Rare lesions such as pseudoaneurysms that often result from pancreatic disease can also lead to life-threatening bleeding.

Typically, endoscopic therapies, radio logically guided interventions and surgery are the used to stop GI bleeding. The new ultrasound guided therapy is appropriate for patients who have failed these approaches.

“Despite advances in conventional therapies, recurrent bleeding is common in many patients,” said Michael Levy, MD, author of this study and a gastroenterologist at Mayo. “At times there are no options for patients with severe and refractory bleeding and, unfortunately in this setting, the morbidity and mortality are high.”

The scope used in Levy’s study has an ultrasound on the tip that enables him to look at and through the intestinal walls. He was also able to view vessels that feed the walls. This allows physicians to target therapy to the specific locations to stop the bleeding.

When the site(s) of bleeding are in view, various agents such as 99% alcohol or medical glue were injected to stop the bleeding. Following this therapy, none of the five patients in the study experienced recurrent bleeding and no complications were reported.

Levy said his team will continue to use ultrasound guided endoscopy as a treatment of last resort, but the indication could be expanded for other conditions as they learn more about its potential uses.