title: What is the use of biopsy and antibodies in coeliac disease diagnosis?
abstract: The advent of highly sensitive and specific serological markers has led to some protagonists proposing that coeliac disease can be diagnosed without the need for a biopsy. However, this is an area of controversy. Lack of consensus about diagnostic degrees of histological change, paucity of symptoms, antibody-negative disease and immunodeficiency can make diagnosis difficult even with a biopsy. Conversely, an argument can be put forward for a 'no biopsy' approach based on the large number of patients with typical symptoms and positive serology who experience a diagnostic delay. In addition, endoscopy is not without discomfort. This article discusses the use of antibodies and duodenal biopsy within this context. Finally, we propose a pragmatic diagnostic algorithm for clinicians to use when investigating patients for coeliac disease.
authors: Department of Gastroenterology, Royal Hallamshire Hospital, Sheffield, UK. kate.evans@sth.nhs.uk
authors: K E
authors: KE
authors: Evans
authors: D S
authors: DS
authors: Sanders
mesh_terms: D000465:Algorithms; D001323:Autoantibodies / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D001706:Biopsy; D002446:Celiac Disease / Q000175:diagnosis* / Q000473:pathology; D004386:Duodenum / Q000473:pathology*; D006650:Histocompatibility Testing; D006801:Humans
chemical_list: D001323:Autoantibodies; D015415:Biomarkers