BACKGROUND AND AIMS Seronegative villous atrophy (SNVA), raised intraepithelial lymphocytes (IELs), and crypt hyperplasia on duodenal histology can be secondary to celiac disease (CD) or other causes such as medications or infections. Our aims were to assess the role of small-bowel capsule endoscopy (SBCE) in these patients and to ascertain whether findings on SBCE at diagnosis can predict disease outcome. METHODS Patients (n = 177) with SNVA, IELs, ± crypt hyperplasia on duodenal histology were studied. These patients all had an equivocal diagnosis of CD. RESULTS Overall, 56 patients (31.6%) had a positive SBCE. Thirty-three patients (58.9%) had disease affecting the proximal third of the small bowel (SB). The diagnostic yield of SBCE was 40.0% (22 patients), 51.4% (18 patients), 27.0% (10 patients), and 14.0% (7 patients) in patients with an unknown cause for SNVA (SNVA-UO), patients with SNVA who responded to a gluten-free diet (SNVA-CD), patients with a known cause for SNVA, and patients with railed IELs ± crypt hyperplasia, respectively. In SNVA-UO, SBCE at diagnosis was more likely to be positive in patients with persistent SNVA (10, 90.9%) and persistent SNVA with lymphoproliferative features (4, 80.4%) than patients with spontaneous resolution of SNVA (8, 20.5%) (P = .0001). All patients in the SNVA-CD group who eventually developed adverse events had a positive SBCE (P = .022). They also had more extensive SB disease than those without adverse events (50% vs 1% P = .002). More extensive SB disease on SBCE correlated with a higher SNVA-related mortality in patients with SNVA-UO and SNVA-CD (P = .019). Severity of histology did not correlate with mortality (P = .793). CONCLUSIONS A positive SBCE at diagnosis predicts a worse outcome. More importantly, more extensive disease in these patients is associated with poor survival. Targeting patients with extensive disease at diagnosis with more aggressive therapy can help to improve prognosis.

中文翻译：

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在不确定性乳糜泻的情况下使用小肠内窥镜检查。

背景与目的十二指肠组织学上的血清阴性绒毛萎缩症（SNVA），上皮内淋巴细胞升高（IEL）和隐窝增生可继发于乳糜泻（CD）或其他原因，例如药物或感染。我们的目的是评估小肠内窥镜检查（SBCE）在这些患者中的作用，并确定在诊断时SBCE的发现是否可以预测疾病的预后。方法研究十二指肠组织学特征的SNVA，IEL，±隐窝增生的患者（n = 177）。这些患者均对CD有明确的诊断。结果总体而言，有56例（31.6％）的SBCE阳性。33例患者（58.9％）患有影响小肠近端三分之一（SB）的疾病。SBCE的诊断率为40.0％（22例），51.4％（18例），27.0％（10例）和14。SNVA病因不明（SNVA-UO），对无麸质饮食有反应的SNVA患者（SNVA-CD），SNVA病因已知的患者和IEL患病患者的0％（7例） ±隐窝增生，分别。在SNVA-UO中，持续性SNVA（10，90.9％）和持续性SNVA具有淋巴增生特征的患者诊断时SBCE阳性的可能性（4，80.4％）比具有SNVA自发消退的患者（8，20.5％） （P = .0001）。SNVA-CD组中所有最终发生不良事件的患者SBCE均为阳性（P = .022）。与没有不良事件的人相比，他们还患有更广泛的SB疾病（50％比1％P = .002）。SNVA-UO和SNVA-CD患者中SBCE上更广泛的SB疾病与更高的SNVA相关死亡率相关（P = .019）。组织学的严重程度与死亡率无关（P = .793）。结论诊断时SBCE阳性可预示不良结局。更重要的是，这些患者中更广泛的疾病与生存不良有关。针对具有广泛疾病的患者进行更积极的治疗，有助于改善预后。