A family member recently told me she did NOT have Celiac disease, according to her PillCam results. Interesting!
For one, what the heck is a PillCam?! Second, isn’t the “gold standard” of Celiac diagnosis an intestinal biopsy? I was intrigued and did a little digging.
In this Q&A, we cover all you need to know about the PillCam and Celiac diagnosis, with lots of help from Celiac guru Dr. Alessio Fasano, Professor at the University of Maryland School of Medicine and head of the University of Maryland Center for Celiac Research.
What is a PillCam?
The PillCam is a camera in a capsule. Patient swallows the capsule, and the camera inside snaps pictures at set intervals as it works its way down the digestive track. It eventually exits out of, well, you know where. And no, it’s not reusable. You just flush it away. Pictures from the PillCam are wirelessly transmitted to a memory card, which your doctor can retrieve.
Another name for the PillCam procedure is “capsule endoscopy.”
Are PillCams as effective as the “gold standard” intestinal biopsy?
“Absolutely not” said Dr. Fasano. Here’s why: PillCams just don’t give doctors an up-close-and-personal view of the intestine, like the biopsy does.
Nor are PillCams “necessarily” able to rule out Celiac disease, according to Dr. Fasano.
So just how effective is a PillCam in diagnosing Celiac Disease?
A 43-person study conducted by researchers at the University of Milan administered both an upper endscopy biopsy and PillCam to to patients suspected of having Celiac disease.
“Gastroenterologists were blinded to each patient’s upper GI and pathology results when evaluating the capsule endoscopy findings. Authors concluded that 32 patients had mucosal changes compatible with celiac disease. The results showed that the capsule led physicians to make a correct positive diagnosis in 87.5% [blogger's emphasis]of the cases where upper GI had confirmed villous atrophy. Specificity (the ability to avoid a false positive), positive and negative predictive values were 90.9%, 96.5%, 71.4% respectively.”
Where do PillCams fit in the spectrum of testing? (e.g., blood tests, genetic screening, biopsies, etc.)
Dr. Fasano advises that “[t]he pill cam can be supportive of an intestinal biopsy and can give a clue of the extend of the damage beyond the very first part of the intestine (the one that can be reached by the endoscope).”
Indeed, according to a study at the University of Milan, “[C]apsule endoscopy correctly diagnosed celiac disease in one patient where upper endoscopy and biopsy had ruled out disease. What was initially thought to be a “false positive” from CE turned out to be a “false negative” on the part of upper endoscopy and biopsy.”
In conclusion, the PillCam might be helpful in diagnosing Celiac disease, but it is definitely not as effective as the good-old intestinal biopsy.
So, did my family member get bad advice? Probably not. Her doctor used the PillCam in conjunction with her blood tests to rule out Celiac disease.
Don’t be overly concerned if your doctor uses a PillCam to aid in your diagnosis, but do remember that for now, the intestinal biopsy is still the gold standard.
If you found this article helpful, I hope you’ll consider a charitable contribution to the University of Maryland Center for Celiac Research. Without research centers like these, we’d still be in the dark ages, when we thought Celiac was a ‘rare’ disease. (Attention factoid lovers: Dr. Fasano did the original research showing Celiac disease occurs in 1 out of every 133 people!)