title: Capsule endoscopy: an alternative to duodenal biopsy for the recognition of villous atrophy in coeliac disease?
abstract: BACKGROUND
  Villous atrophy present on a duodenal biopsy remains the 'gold standard' diagnostic test for coeliac disease. However, endoscopic biopsy may cause morbidity and discomfort. Our aim was to evaluate wireless capsule endoscopy as an alternative test for the recognition of villous atrophy.
  
  
  METHODS
  Twenty-one patients with a positive endomysial antibody referred for endoscopy and duodenal biopsy were also offered a wireless capsule endoscopy to evaluate their small bowel. Concurrently, other patients (n=23) referred for a wireless capsule endoscopy acted as controls. Wireless capsule endoscopy reports were assessed for the presence of villous atrophy by one blinded investigator.
  
  
  RESULTS
  Twenty endomysial antibody positive patients subsequently had villous atrophy on duodenal biopsy. The controls all had normal duodenal biopsies (with a negative endomysial antibody) and no evidence of villous atrophy noted on their wireless capsule endoscopy. Of the 20 endomysial antibody positive patients with confirmed villous atrophy on biopsy, 17 had villous atrophy also detected by wireless capsule endoscopy. The sensitivity, specificity, positive and negative predictive values for wireless capsule endoscopy recognising villous atrophy were 85%, 100%, 100%, 88.9%, respectively.
  
  
  CONCLUSIONS
  Wireless capsule endoscopy may be an option to recognise villous atrophy in patients with a positive endomysial antibody who are unwilling, or unable to have a gastroscopy. However, a negative test should be followed by a biopsy if coeliac disease is to be excluded.
authors.affiliation: Department of Gastroenterology, Royal Hallamshire Hospital, Sheffield, UK. andydhopper@aol.com
authors.forename: A D
authors.initials: AD
authors.lastname: Hopper
authors.forename: R
authors.initials: R
authors.lastname: Sidhu
authors.forename: D P
authors.initials: DP
authors.lastname: Hurlstone
authors.forename: M E
authors.initials: ME
authors.lastname: McAlindon
authors.forename: D S
authors.initials: DS
authors.lastname: Sanders
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001284:Atrophy; D001706:Biopsy; D053704:Capsule Endoscopy / Q000191:economics / Q000379:methods*; D002446:Celiac Disease / Q000473:pathology*; D004386:Duodenum / Q000473:pathology*; D005260:Female; D005773:Gastroscopy / Q000191:economics; D006801:Humans; D007413:Intestinal Mucosa / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012680:Sensitivity and Specificity