Ileoscopy in coeliac disease

Celiac disease is a permanent autoimmune enteropathy that is triggered, in genetically determined individuals, by the ingestion of gluten, an alcohol-soluble protein storage compound present in wheat. The mucosal lesions characteristic of celiac disease can be detected by upper gastrointestinal endoscopy, which also enables biopsy sampling. Definitive diagnosis is based on the findings of villous atrophy, hyperplasia of the crypts, and T-cell infiltration of the lamina propria, along with an increase of intraepithelial lymphocytes. Imaging of celiac disease is nowadays carried out by capsule endoscopy, a non-invasive procedure that enables the study of the entire surface of the gut. In celiac disease, capsule endoscopy demonstrates the extent of the affected bowel segments. New endoscopic modalities that include enhancement of the intestinal mucosa can help the endoscopist to better define the appearance of celiac disease in a particular patient and to appropriately target biopsy sampling. This chapter discusses the use of the main imaging modalities in the diagnosis of celiac disease.