title: Video capsule enteroscopy in the diagnosis of celiac disease: a multicenter study.
abstract: OBJECTIVE
  Duodenal biopsy is the current gold standard for diagnosis of celiac disease. Videocapsule endoscopy examines the entire small bowel and allows visualization of mucosal villi. We evaluated the potential of videocapsule endoscopy in assessing the severity and extent of mucosal changes in patients with suspected celiac disease.
  
  
  METHODS
  Consecutive patients with signs/symptoms suggesting celiac disease and positive anti-gliadin and/or anti-endomysial and/or anti-tissue transglutaminase antibodies underwent upper gastrointestinal endoscopy and videocapsule endoscopy. Duodenal biopsies were classified according to modified Marsh's criteria. Capsule findings were evaluated for the presence of lesions compatible with celiac disease (scalloping of duodenal folds, fissures, flat mucosa, and mosaic appearance).
  
  
  RESULTS
  Forty-three patients were studied. Duodenal histology was normal in 11 and compatible with celiac disease in 32. Using duodenal histology as the gold standard, the performance characteristics of capsule endoscopy for the diagnosis of celiac disease were: sensitivity 87.5% (95% CI 76.1-98.9%), specificity 90.9% (95% CI 81.0-100%), positive predictive value 96.5% (95% CI 90.1-100%), negative predictive value 71.4% (95% CI 55.8-87%), positive and negative likelihood ratios 9.6 and 0.14, respectively. Eighteen patients had mucosal changes extending beyond the duodenum, involving the entire small bowel in three. These patients tended to have more severe symptoms, but the difference was not statistically significant. Interobserver agreement for the diagnosis of celiac disease by capsule endoscopy ranged between 79.2 and 94.4%; kappa values ranged between 0.56 and 0.87.
  
  
  CONCLUSIONS
  Videocapsule endoscopy shows good sensitivity and excellent specificity for the detection of villous atrophy in patients with suspected celiac disease.
authors: Department of Medical Sciences, University of Milan and Gastroenterology and GI Endoscopy Unit, Ospedale Maggiore Policlinico, Mangiagalli and Regina Elena Foundation, Milan, Italy.
authors: Emanuele
authors: E
authors: Rondonotti
authors: Cristiano
authors: C
authors: Spada
authors: David
authors: D
authors: Cave
authors: Marco
authors: M
authors: Pennazio
authors: Maria E
authors: ME
authors: Riccioni
authors: Italo
authors: I
authors: De Vitis
authors: David
authors: D
authors: Schneider
authors: Tatiana
authors: T
authors: Sprujevnik
authors: Federica
authors: F
authors: Villa
authors: Jennifer
authors: J
authors: Langelier
authors: Arrigo
authors: A
authors: Arrigoni
authors: Guido
authors: G
authors: Costamagna
authors: Roberto
authors: R
authors: de Franchis
mesh_terms: D053704:Capsule Endoscopy; D002446:Celiac Disease / Q000473:pathology*; D004384:Duodenoscopy / Q000379:methods*; D004386:Duodenum / Q000473:pathology; D006801:Humans; D015588:Observer Variation; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity