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Nat Rev Gastroenterol Hepatol. 2018 Jan;15(1):60-66. doi: 10.1038/nrgastro.2017.121. Epub 2017 Oct 11.

Coeliac disease: to biopsy or not?

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Celiac Disease Center at Columbia University, 180 Fort Washington Avenue, New York 10032, USA.
Hans Christian Andersen Children's Hospital, Odense University Hospital and University of Southern Denmark, 29 S√łndre Boulevard, DK-5000 Odense C, Denmark.
Academic Unit of Gastroenterology, Royal Hallamshire Hospital, Glossop Road, Sheffield, South Yorkshire S10 2JF, UK.


Coeliac disease is increasingly recognized as a global problem in both children and adults. Traditionally, the findings of characteristic changes of villous atrophy and increased intraepithelial lymphocytosis identified in duodenal biopsy samples taken during upper gastrointestinal endoscopy have been required for diagnosis. Although biopsies remain advised as necessary for the diagnosis of coeliac disease in adults, European guidelines for children provide a biopsy-sparing diagnostic pathway. This approach has been enabled by the high specificity and sensitivity of serological testing. However, these guidelines are not universally accepted. In this Perspective, we discuss the pros and cons of a biopsy-avoiding pathway for the diagnosis of coeliac disease, especially in this current era of the call for more biopsies, even from the duodenal bulb, in the diagnosis of coeliac disease. In addition, a contrast between paediatric and adult guidelines is presented.

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