229CELIAC SPRUE IS UNDERDIAGNOSED IN THE VETERANPOPULATIONTejinder Singh, M.D., Vikas Khurana, M.D.*, Raza Anees, M.D.,Charlton Fort. Louisiana State University Health Sciences Center andOverton Brooks VA Medical Center, Shreveport, LA and Overton BrooksVA Medical Center, Shreveport, LA.

Purpose: To assess the prevalence of celiac sprue in 10 Veterans Admin-istration (VA) Hospitals in 5 different states (Louisiana, Texas, Mississippi,Oklahoma and Arkansas) in the United States.Methods: We analyzed the VISN 16 electronic database for patients witha diagnosis of celiac sprue (ICD 579) at 10 different VA hospitals withinthe same VISN system. The VISN system refers to a group of VA Hospitalswithin geographical proximity and is a nationally determined grouping.Data was evaluated on the basis of age, race and sex. The data wascompared for the availability of a gastroenterologist, an academic residencyprogram and a Gastroenterology and Hepatology fellowship program.Results: Results are shown in the graphic below. Electronic records of462,858 veterans were evaluated. This yielded a total of 118 cases ofdiagnosed celiac sprue, resulting in a ratio of 1:4152 diagnosed case ofceliac sprue to patients enrolled. Disease prevalence estimates for celiacsprue have changed because of the availability of new and improvedserological tests. This disease has multi-system manifestations and itscomplications include fractures, anemia, sterility and small bowel lym-phoma. It remains difficult to diagnose in a primary care setting and ideallyrequires a gastroenterologist to diagnose it. This may partly explain thediscrepancy between the expected estimates of prevalence of the diseaseusing anti-endomysial antibody testing (1:133) as compared to our VISN16 ratio of 1:4152.

Conclusions: Celiac sprue is under diagnosed in the Veteran population ofLouisiana, Texas, Mississippi, Oklahoma and Arkansas. The rate of diag-nosis of celiac sprue correlates with GI related educational level, beinghighest in institutions with a GI fellowship program.

230NON-NATURAL EXCRETION (NNE) OF CAPSULEENDOSCOPE (CE) : CLINICAL-PATHOLOGIC CORRELATIONDavid E. Fleischer, M.D.*, Virender K. Sharma, M.D.,Jonathan A. Leighton, M.D., Russell I. Heigh, M.D.,Giovanni de Petris, M.D., James A. Swain, M.D., Jan Post, R.N.,Paula Erickson, R.N. Mayo Clinic Scottsdale, Scottsdale, AZ.

Purpose: To correlate clinical, capsule endoscopy, surgical, and pathologicfindings in patients with non-natural excretion (NNE) of CE.Methods: In all patients in whom non-natural excretion of CE was ob-served, surgery was performed. The clinical and pathologic findings arecorrelated.

Results: Between August, 2001 and May, 2003, 285 CE were performedat our institution. If a patient had symptoms of partial bowel obstruction ora contrast study revealed a stenotic lesion, CE would not be performed. Inthose 285 pts who ingested the CE, X-rays were routinely performed ifpatient did not report passage of capsule after ingestion. In 4 pts (1.4%)passage did not occur and capsule was found on followup abdominal x-ray.Prior to CE, all pts had had SBft or CT showing no evidence of obstruction.All pts had symptoms of partial bowel obstruction that led to surgery;however, in no instances was there acute obstruction and no pt requiredsurgery on an emergency basis. 3 pts used ASA or NSAIDs. In all 4 ptswith NNE, ulcerations with strictures of SI were noted on CE. The meantime between CE ingestion and surgery was 90 days (range 28176 days).At surgery, multiple strictures were observed which were grossly apparent.The retained capsule was identified proximal to a stricture in all cases.Intra-operative endoscopy was performed to further define the abnormal-ities. Pathology findings in all cases revealed: luminal stenoses in severalsegments with ulceration; these diaphragms consisted of thickened submu-cosa and muscularization with overlying erosions/ulcers. Microscopic find-ings revealed focal epithelial ulceration and necrosis with transmural ex-tension of an acute and chronic inflammatory process. No evidence ofCrohns or malignancy. All pts have been asymptomatic since surgery andin all cases the original signs/symptoms resolved.Conclusions: 1) Non-natural excretion occurred 1.4% of patients whounderwent capsule endoscopy 2) In all patients, pre-CE SBft/CT showed noSI abnormality. 3) With NNE of CE, stricturing of SI (diaphragm disease)is the likely diagnosis, particularly in patients on NSAIDs.

231METABOLIC BONE DISEASE IN PATIENTS WITHLYMPHOCYTIC DUODENITISEva U. Sotil, M.D., Ron M. Levy, M.D., Sanjay K. Reddy, M.D.,Shriram M. Jakate, M.D., Susan L. Mikolaitis, R.D.,Mark T. DeMeo, M.D., Ali Keshavarzian, M.D., FACG*. RushUniversity, Chicago, IL.

Purpose: Increased intraepithelial lymphocytes (IEL) are the hallmark ofceliac disease and play a significant role in its pathophysiology. However,the clinical relevance of increased IEL in the absence of villous atrophy isunclear. In order to evaluate this clinical relevance, we analyzed thepresence of metabolic complications as well as the frequency of celiacassociated antibodies in patients with lymphocytic duodenitis, which wasdefined as increased IEL (40/100 cells) in the absence of villous atrophy.Methods: Retrospective chart review was conducted on 20 patients foundto have lymphocytic duodenitis and available DEXA scan data. Presence ofIgG antigliadin, IgA antigliadin, anti-endomysial (EMA) and tissue-trans-glutaminase (t-TG) antibodies were analyzed. Data regarding hemoglobin,MCV, vitamin B12, folate and albumin were also analyzed.Results: 90% of the patients were female and 10% were male. Mean agewas 55 years. 70% of the patients had an abnormal DEXA scan, with 15%having osteoporosis (T-score 2.5) and 55% osteopenia (T-score of1.0 to 2.5). Celiac disease associated antibody data was available in 12patients, of which 42% had at least one antibody positive. 11 patients hadIgA antigliadin antibody data, but only 27% of these were positive. Of the10 patients with IgG antigliadin antibody data, 30% had a positive result.7 patients had data on EMA, but only 14% of these were positive. Of the5 patients with data on t-TG, 40% were positive. Of the 17 patients withHgb data, 41% had anemia. Out of these 7 patients with anemia, 1 hadmicrocytic and 6 had normocytic anemia. 90% of the 10 patients with ironstudies had iron saturation25%. 12 patients had vitamin B12 levels, 17%of these had values 250 pg/ml. 10 patients had folate levels, all of whichwere found to be within normal limits. Of the 10 patients with data onalbumin, 20% had hypoalbuminemia (albumin 3.5 gr/dl).Conclusions: Patients with lymphocytic duodenitis appear to be at risk formetabolic bone disease. They also appear to have high rates of irondeficiency anemia. 42% of patients with lymphocytic duodenitis had pos-itive celiac disease associated antibodies. This data favors the possibility

S79AJG September, Suppl., 2003 Abstracts