Traditionally, diagnosis of Lawsonia intracellularis-associated proliferative enteropathy (PE) has depended on necropsy and histology. Since the establishment of the etiologic role of L. intracellularis, a number of specific polymerase chain reaction (PCR) assays have been developed for the detection of DNA in feces. The present article is a systematic review of peer-reviewed publications on the application of L. intracellularis-specific fecal PCR as an antemortem diagnostic test for histologic lesions of PE in pigs. Based on this information, a range of diagnostic sensitivities (36-100%) and specificities (50-100%) of the published tests was calculated. Validity and confidence limits of the estimates varied considerably. The positive and negative predictive values of 6 different PCR assays were calculated for PE prevalence of 15%, 30%, 45%, 60%, 75%, and 90%, using a histologic case definition of PE and based on the reported test sensitivities and specificities. The simulated predictive values suggested that applying the fecal PCR assay as a diagnostic test is more likely to overestimate than underestimate the number of pigs having histologic lesions of PE under field conditions.