Tuesday, July 12, 2011

Capsule Endoscopy- Another way to diagnose?

Sometimes when I get into Medscape, I am pleasantly surprised by the findings.
Here is a bit of some current Gastroenterology Continuing Education covering the uses of capsule endoscopy.

Can you guess the correct answer?

Capsule endoscopy infographic www.drjeanlayton.com

Case 2: A 52-Year-Old Woman With Iron-Deficiency Anemia
A 52-year-old woman presented for evaluation of iron-deficiency anemia that required intravenous iron supplementation. She denied any gastrointestinal symptoms. EGD with duodenal biopsies and ileocolonoscopy were performed and were within normal limits. Hence, capsule endoscopy was performed for further evaluation.



Let me help, just a bit, with explanations.
A 52 year old woman went into her doctor for some testing. 
The blood work discovered an iron deficient anemia.
So more testing, s
he had what most people call an Endoscopy and a colonoscopy. Both had visual results within normal limits. But she had this bleeding somewhere because she needed intravenous iron to bring her anemia into control.

What is the most likely finding on capsule endoscopy study?
Normal-appearing small bowel mucosa
Fissuring of the mucosa suggestive of celiac sprue
Inflammatory changes suggestive of Crohn disease
Mucosal changes of nonsteroidal anti-inflammatory drug enteropathy

Give up?


What is the most likely finding on capsule endoscopy study?

Normal-appearing small bowel mucosa
Fissuring of the mucosa suggestive of celiac sprue          Correct Answer
Inflammatory changes suggestive of Crohn disease
Mucosal changes of nonsteroidal anti-inflammatory drug enteropathy


Capsule endoscopy showed multiple patchy areas of fissuring and scalloping of the mucosa proximal to the mid-jejunu.
Antegrade DBE (double ballon enteroscopy) was performed, which was significant for scalloping of the jejunal mucosa .
Biopsies revealed villous atrophy and intraepithelial lymphocytosis, suggesting a diagnosis of celiac sprue.
The diagnosis was confirmed with positive celiac serology (antitransglutaminase antibody).
The patient's anemia improved after initiation of a gluten-free diet, without the need for additional intravenous iron infusion therapy.

This kind of research is why any patient with re-occuring anemia who comes to see me, gets sent for a celiac panel blood draw.

If for some reason you are unable to get your family doctor to order a panel for you, check out this way to do so.

Direct Labs or Health Labs allows you to order your own tests, receive the results in your email and bring them to whichever doctor you care to for evaluation.

The celiac panel is listed under allergy testing.  Yes, I know it isn't an allergy, that is just where they put it.

What I truly love about using this service, the costs.

Most of the time, their costs are lower by 25% compared to the other labs I can use.

Oh, and my next step once the celiac panel comes back?

Lots and lots of education concerning the best way to diagnosis and treat a celiac reaction.

For a lot of my patients running testing is the biggest reason they haven't gone gluten free.
Around Bellingham, an endoscopy and colonoscopy can run you upwards of $4000 .
And if you don't have insurance, you might not want to do that.

After all, a life-long gluten free diet is a very simple solution to lots of complicated problems.

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