Цель исследования. Уточнить показания к проведению видеокапсульной эндоскопии (ВКЭ) у больных целиакией. Материалы и методы. В исследование включено 10 больных целиакией (6 женщин, 4 мужчины) в возрасте от 22 до 69 лет. Средний возраст составил 42,4±17,5 года. Диагноз целиакии установлен на основании гистологического исследования слизистой оболочки (СО) двенадцатиперстной кишки и определения антител к диамидированному пептиду глиадина и к тканевой трансглутаминазе.
У трех больных целиакия диагностирована впервые, у остальных – в сроки от 3 мес до 2 лет. ВКЭ выполняли с помощью систем GivenImaging (Yokneam, Израиль), Olympus (Япония), полученные данные анализировали с использованием Rapid® Reader (версия 7.0). Результаты эндоскопии сравнивали с данными 78 обследованных нами пациентов, у которых показатели соответствовали нормальным критериям ВКЭ. Результаты. У всех больных целиакией выявлены характерные эндоскопические маркеры атрофии СО тонкой кишки: гребешковость, нодулярность, уменьшение высоты и количества складок. Обращала на себя внимание мозаичность поражения в виде «полей атрофии» на фоне малоизмененной СО. У 4 пациентов обнаружены эрозивно-язвенные поражения тонкой кишки. Заключение. Показаниями для назначения ВКЭ у больных целиакией являются отсутствие ответа на лечение, основу которого составляет строгая приверженность аглютеновой диете, предположение об эрозивно-язвенном поражении СО тонкой кишки и рефрактерная форма заболевания. ВКЭ дает возможность установить протяженность атрофии СО тонкой кишки, что позволяет использовать ее для оценки эффективности лечения.
Aim. To clarify the indications for capsular endoscopy (CE) in patients with celiac disease. Materials and methods. The study included 10 patients with celiac disease (6 women, 4 men) aged 22 to 69 years. The median age was 42.4±17.5 years. The diagnosis of celiac disease established on the basis of histological examination of the mucous membrane (MM) of the duodenum and detection of antibodies to diaminononane peptide gliadin and to tissue transglutaminase. In three patients celiac disease was diagnosed for the first time, in others – in terms of 3 months to 2 years. CE was performed using a Given Imaging systems (Yokneam, Israel), Olympus (Japan), the obtained data were analyzed using Rapidr® Reade (version 7.0). The results of the endoscopy were compared with the data of 78 patients examined by us, in which the indicators conformed to the normal CE criteria. Results. All patients with celiac disease showed characteristic endoscopic markers of atrophy from the small intestine: scallop, nodularity, decrease in height and number of folds. Paid attention to the mosaic of defeat in the form of "atrophy fields" against a background of slightly modified MM. Erosive-ulcerative lesions of the small intestine were found in 4 patients. Conclusion. Indications for the appointment of CE in patients with celiac disease is the lack of response to treatment, which is based on strict adherence to gluten-free diet, the assumption of erosive and ulcerative lesions MM of the small intestine and refractory form of the disease. CE makes it possible to establish the extent of atrophy from the small intestine, which allows you to use it to evaluate the effectiveness of treatment.
Keywords: video-capsule endoscopy, extent of lesion of small intestine mucosa, celiac disease.
Список литературы
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1. [Parfenov AI, Bykova SV, Sabelnikova EA, et al. All-Russian Consensus on Diagnosis and Treatment of Celiac Diseasein Children and Addults. Terapevticheskiy Arkhiv. 2017;89(3):94-107 (In Russ.)]. doi: 10.17116/terarkh201789394-107
2. Ciaccio EJ, Lewis SK, Bhagat G, Green PH. Coeliac disease and the videocapsule: what have we learned till now. Ann Transl Med. 2017 May;5(9):197. doi: 10.21037/atm.2017.05.06
3. Parzanese I, Qehajaj D, et al. Celiac disease: Fr om pathophysiology to treatment. World J Gastrointest Pathophysiol. 2017 May 15;8(2):27-38. doi: 10.4291/wjgp.v8.i2.27
4. Pennazio M, Spada C, Eliakim R, Keuchel M, May A, Mulder CJ, Rondonotti E, Adler SN, Albert J, Baltes P, Barbaro F, Cellier C, Charton JP, Delvaux M, Despott EJ, Domagk D, Klein A, McAlindon M, Rosa B, Rowse G, Sanders DS, Saurin JC, Sidhu R, Dumonceau JM, Hassan C, Gralnek IM. Small-bowel capsule endoscopy and device-assisted enteroscopy for diagnosis and treatmentof small-bowel disorders: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Endoscopy. 2015 Apr;47(4):352-76. doi: 10.1055/s-0034-1391855
5. Rondonotti E, Spada C, Cave D, Pennazio M, Riccioni ME, De Vitis I, Schneider D, Sprujevnik T, Villa F, Langelier J, et al. Video capsule enteroscopy in the diagnosis of celiac disease: a multicenter study. Am J Gastroenterol. 2007;102:1624-31. doi: 10.1111/j.1572-0241.2007. 01238.х
6. Murray JA, Rubio-Tapia A, van Dyke CT, et al. Mucosal atrophy in celiac disease: extent of involvement, correlation with clinical presentation, and response to treatment. Clin Gastroenterol Hepatol. 2008;6:186-93. doi: 10.1016/j.cgh.2007.10.012
7. Lidums I, Cummins AG, Teo E. The role of capsule endoscopy in suspected celiac disease patients with positive celiac serology. Dig Dis Sci. 2011;56:499-505. doi: 10.1007/s10620-010-1290-6
8. Kurien M, Evans KE, Aziz I, et al. Capsule endoscopy in adult celiac disease: a potential role in equivocal case of celiac disease? Gastrointest Endosc. 2013;77:227-32. doi: 10.1016/j.gie.2012.09.031
9. Tursi A. Endoscopic diagnosis of celiac disease: what is the role of capsule endoscopy? Gastrointest Endosc. 2013;78:381. doi: 10.1016/j.gie. 2013.02.020
10. Van de Bruaene C, De Looze D, Hindryckx P. Small bowel capsule endoscopy: Wh ere are we after almost 15 years of use? World J Gastrointest Endosc. 2015 Jan 16;7(1):13-36. doi: 10.4253/wjge.v7.il.13
11. Atlas DS, Rubio-Tapia A, van Dyke CT, et al. Capsule endoscopy in nonresponsive celiac disease. Gastrointest Endosc. 2011;74:1315-22. doi: 10.1016/j.gie.2011.05.049
12. Tennyson CA, Green PH. The role of capsule endoscopy in patients with nonresponsive celiac disease. Gastrointest Endosc. 2011;74: 1323-4. doi: 10.1016/j.gie.2011.07.021
13. Rondonotti E, Paggi S. Videocapsule endoscopy in celiac disease: indications and timing. Dig Dis. 2015;33:244-51. doi: 10.1159/000369510
14. Tomba C, Elli L, Bardella MT, et al. Enteroscopy for the early detection of small bowel tumours in at-risk celiac patients. Dig Liver Dis. 2014;46:400-40. doi: 10.1016/j.dld.2013.12.009
15. Spencer M, Baker J, Azeem A, Dickens J, Rice M, Fisher L. Video Capsule Endoscopy in the Evaluation of Celiac Patients with Persistent or Recurrent Symptoms. Who and When? Int J Cel Dis. 2016;4(2):55-60. doi: 10.12691/ijcd-4-2-5
16. [Parfenov AI. Evolyutsiya predstavlenii o rasprostranennosti, klinicheskikh proyavleniyakh i znachimosti etiotropnoi terapii [Celiac disease. Evolution of the notions of prevalence, clinical manifestations and the importance of etiotropic therapy]. Moscow: Anaharsis; 2007. 372 p. (In Russ.)].
17. [Parfenov AI, Akhmadullina OV, Sabelnikova EA, Belostotsky NI, Gudkova RB, Khomeriki SG. Carbohydrase activities may serve as a marker for small intestinal mucosal recovery in patients with celiac disease. Terapevticheskiy Arkhiv. 2015;87(2):24-9 (In Russ.)]. doi: 10.17116/ terarkh201587224-29
18. [Parfenov AI, Krums LM, Sabel'nikova EA, Khomeriki SG. Microscopic colitis is the cause of torpid celiac disease. Terapevticheskiy Arkhiv. 2005;(2):80-1 (In Russ.)]
19. [Parfenov AI, Akhmadullina OV, Sabel'nikova EA, Belostotskii NI, Kirova MA, Khomeriki SG, Bykova SV. Disaccharidase insufficiency and functional bowel disease. Terapevticheskiy Arkhiv. 2017;89(4):45-52 (In Russ.)]. doi: 10.17116/terarkh201789445-52
1 ГБУЗ «Московский клинический научно-практический центр им. А.С. Логинова Департамента здравоохранения Москвы», Москва, Россия;
2 ФГБУ «Федеральный научно-клинический центр физико-химической медицины» ФМБА России, Москва, Россия
1 A.S. Loginov Moscow Clinical Research and Practical Center, Moscow Healthcare Department, Moscow, Russia;
2 Scientific and Research Institute of Physical-Chemical Medicine FMBA of Russia, Moscow, Russia