アレルギーと治療のジャーナル

概要

Capsule Endoscopy Detection of Ileal Mucosa Alterations due to Cow Milk Malabsorption in a Celiac Patient

Raffaele Pezzilli, Giuseppina Liguori and Carlo Calabrese

We report a case of a 77-year-old man suffering from celiac disease admitted as an outpatient to our clinic for the persistence of bloating and diarrhea without macroscopic steatorrhea, weight loss or an increase in circulating carbohydrate antigen 19-9. An esophagogastroduodenoscopy showed H. pylori negative antral gastritis and atrophy of the duodenal mucosa and the results of a colonoscopy were normal. Abdominal contrast-enhanced computed tomography did not show any parenchymal alteration of the liver and pancreas. The patient underwent a capsule endoscopy and the examination showed the presence of villous atrophy with microerosions at the level of the medial jejunum, in the ileum, and some areas of lymphangiectasia. A repeated capsule endoscopy after starting a lactosefree diet showed the normalization of the jejunum-ileum villous atrophy. At present, the patient is in good general health and continues a gluten- and cow milk-free diet. We should be aware that celiac patients may have lactose intolerance that cause malabsorption; the transient increase of CA 19-9 in celiac patients may be due to causes other than the presence of gastrointestinal cancer; the capsule endoscopy is useful in detecting ileal mucosa abnormalities which disappear after going on gluten- and cow milk-free diet.