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Date: | Tue, 30 Mar 2004 10:51:18 -0600 |
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<<Disclaimer: Verify this information before applying it to your situation.>>
A reply to a post from a reader was this:
Dr. Holland,
While I absolutely agree with what it is that you stated, how does that
then vary when a patient has negative biopsy but positive blood tests?
Jennifer
So I wrote:
Oh, there is a group to worry about. The data is unclear on this.
There are problems of under read biopsies. There are also false
positive tests. I do this: The biopsy is sent out for a reading at
Mayo clinic. Since Dr. Murray has been there I have been very
comfortable using their pathology lab. The labs are reviewed and
repeated. I make sure there is no IgA deficiency. I review the
response to a gluten free diet and look for other problems like fat
malabsorption and anemia. I consider the following: IgG anti-gliadin
is prone to false positives. Anti-TTG is pretty reliable. Did the
patient improve? How did the patient do on rechallenge? What did the
pathology second opinion conclude? Is there a family history? I may
get HLA-DQ markers. After all that I come up with a judgement call.
Steve Holland, M.D.
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