Usefulness of endoscopic small intestinal biopsies in children with coeliac disease.

Small intestinal biopsy is the most important diagnostic method in the rout ine evaluation of children with chronic diarrhoea and malabsorption. At pre sent morphological alterations are considered essential in the diagnosis of coeliac disease (CD) and the presence of a normal small bowel biopsy speci men, observed in patients eating a diet containing gluten, rules out the di agnosis of CD. The small intestinal biopsy can be carried out either by bli nd suction capsule or by endoscopic forceps. In everyday clinical practice endoscopic duodenal biopsies, if taken and handled suitably, are accepted a s equivalent to capsule biopsies from the proximal jejunum. In the Study we reported some patients in whom has been possible to demonstrate the presen ce of total villous atrophy in one biopsy, while other duodenal samples tak en in different duodenal portions were normal or showed mild lymphocytes an d plasmacells infiltrations of the lamina propria. In patients with this ty pe of biopsy pathology, wherein flat mucosa has been found even close to no rmal mucosa, the possible explanation is mucosal patchiness. The occurrence of patchly distributed intestinal atrophy in children suffering of CD rais es the question of the validity of using the peroral capsule, widely believ ed to be the best standard for the diagnosis of CD. In our opinion, small i ntestinal biopsies obtained via endoscopy are more reliable than the perora l capsule biopsies in order to identify patchy mucosal atrophy and could be very useful for a correct diagnosis in CD patients.