title: Contemporary celiac disease diagnosis: is a biopsy avoidable?
abstract: OBJECTIVE
  The duodenal biopsy is the gold standard for the diagnosis of celiac disease. However, given improvements in the performance of serological testing, the possibility of accurately diagnosing celiac disease without the need of a biopsy has attracted interest. The European Society for Paediatric Gastroenterology, Hepatology and Nutrition has revised its recommendations to include a diagnostic algorithm that includes sequential serological testing and human leukocyte antigen genotyping for symptomatic children which would enable a diagnosis of celiac disease to be made in the absence of a confirmatory intestinal biopsy.
  
  
  RESULTS
  Recent studies have evaluated the ESPGHAN guidelines and have mostly corroborated that celiac disease can be accurately diagnosed in specific pediatric patient populations without the need of a biopsy. However, two cautionary points have been raised that warrant further consideration - the success of this approach is highly dependent targeting a population with a high pretest probability of celiac disease, as well, the performance of serology assays must be established and the appropriate use of cutoffs is essential.
  
  
  CONCLUSIONS
  The duodenal biopsy will remain the gold standard for diagnosing celiac disease in a majority of patients. However, as serology assays evolve and as a greater understanding of the genetic risk factors of celiac disease is achieved, more patients may be accurately diagnosed without the need for a biopsy.
authors.affiliation: aDepartment of Laboratory Medicine and Pathology bDivision of Gastroenterology and Hepatology and Department of Immunology, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: John R
authors.initials: JR
authors.lastname: Mills
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Murray
mesh_terms: D000465:Algorithms; D001323:Autoantibodies / Q000097:blood*; D002446:Celiac Disease / Q000097:blood / Q000175:diagnosis* / Q000473:pathology; D004386:Duodenum / Q000473:pathology*; D005838:Genotype; D006683:HLA-DQ Antigens / Q000097:blood*; D006801:Humans; D007070:Immunoglobulin A / Q000097:blood*; D017410:Practice Guidelines as Topic; D011237:Predictive Value of Tests; D012698:Serologic Tests / Q000379:methods / Q000639:trends
chemical_list: D001323:Autoantibodies; D006683:HLA-DQ Antigens; C053186:HLA-DQ2 antigen; C109756:HLA-DQ8 antigen; D007070:Immunoglobulin A