Unknown complicated celiac disease as an unexpected finding in patients investigated with capsule endoscopy for Crohn's disease. A case series.

Atypical symptoms of celiac disease may cause a late diagnosis, revealed by the onset of complications, which may inaccurately be attributed to Crohn's disease, as manifestations frequently overlap. Assessing the entire small bowel mucosa, capsule endoscopy may be an accurate procedure in these challenging situations. We present four Crohn's disease patients diagnosed with ulcerative jejunoilieitis complicating celiac disease after capsule endoscopy procedure. In three of these patients, the ulcerative jejunoileitis led in time to stricture formation, suggesting Crohn's disease. Administration of non-steroidal anti-inflammatory drugs made the diagnosis even more difficult in one case. In patients with Crohn's disease not responding to immunosuppressive or biological treatment, complicated celiac disease should be considered and capsule endoscopy should be performed for reassessing the diagnosis.