Green has relationships with Alvine (consultant, advisory committee), Alba Therapeutics (advisory committee). either declined or contraindicated, or when duodenal biopsies are negative and there remains a high index of suspicion. Further study is needed to clarify the role and cost of diagnosing celiac disease with VCE. strong class=”kwd-title” Keywords: Gluten-free diet, Duodenum, Small intestine, Diagnostic techniques, Contraindications Background Esophagogastroduodenoscopy (EGD) with duodenal biopsy is considered the gold standard for the diagnosis of celiac disease. However, the histological lesions characteristic for celiac disease may be missed in cases of patchy duodenal atrophy, even with multiple duodenal biopsies [1,2]. Despite this approach, some patients with a clinical presentation that is highly suggestive for celiac disease may still have a normal appearing EGD and non-diagnostic biopsy. These patients SCH 900776 (MK-8776) are usually not placed on a gluten-free diet because of the lack of pathological confirmation of villous atrophy. In addition some patients may not be candidates for EGD because of relative medical contraindications, such as from a bleeding diathesis, or fear of the procedure. Video capsule endoscopy (VCE) provides high-resolution magnified views of the small intestinal mucosa in a noninvasive manner and has been shown to be sensitive (76C99%) and specific (56C100%) for identifying celiac disease [3]. Some features that can be observed with VCE include reduced duodenal folds; scalloping, layering, or stacking of folds; mucosal fissures, crevices, grooves, nodularity or a mosaic pattern [4]. Currently, VCE is mainly used to evaluate patients with celiac disease in whom their course after diagnosis has been unfavorable and the diagnosis of adenocarcinoma, lymphoma or refractory celiac disease is entertained [5]. VCE allows visualization of the entire small bowel, potentially locating more distal and patchy disease that may be missed by EGD [6]. Because of the high specificity for the presence of villous atrophy when the appropriate mucosal abnormalities are visualized, it has been proposed that VCE may replace EGD with biopsy in selected conditions [5]. These include individuals in whom there is a high medical suspicion (supportive history, positive serologies), but a normal EGD and unremarkable biopsy SCH 900776 (MK-8776) and in those individuals with bleeding diatheses and severe cardiopulmonary disease, or who decrease EGD [5]. There has, however, been no literature supporting this approach. We consequently statement a case series confirming the appropriateness of this SCH 900776 (MK-8776) method. Methods Patients This was a retrospective review of eight individuals seen in the Celiac Disease Center at Columbia University or college Medical Center (CUMC) for an evaluation of possible celiac disease. The Celiac Disease Center is definitely a tertiary referral center that has a cohort of 1 1,285 individuals with celiac disease. Individuals that were included in our evaluation experienced both: 1) suspected celiac disease and 2) either a normal EGD TNFSF8 having a non-diagnostic biopsy, or were unable to undergo EGD with biopsy, either because of medical co-morbidities or personal preference. Patients were considered to have suspected celiac disease if their medical presentation included the presence of at least one of the following: abdominal pain, chronic diarrhea, unexplained anemia, osteoporosis, unexplained neuropathy, and/or unexplained excess weight loss. Individuals also experienced a positive serologic test, preferably either a positive anti-endomysial antibody (EMA) or anti-tissue transglutaminase (tTG) antibody. Individuals were not on a gluten-free diet at the time of evaluation. A normal EGD and non-diagnostic biopsy was defined as possessing a Marsh score of 0. Individuals that were unable to undergo biopsy for.