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A question for the community:I am a blood test & biopsy official celiac (2012). My brother finally got tested and the blood test has come back positive. When he called to let me know I immediately asked if he was going to get an endoscopy. He said that physician assistant didn't mention it. I encouraged him to talk to her about an endoscopy and additional vitamin and mineral blood tests and then sent him links to celiac.org and beyondceliac.org about the biopsy.
He reached out to her via email after our conversation and she said "it is not really indicated at this time. We would proceed with endoscopy if we didn't already know you have celiac disease; meaning if we were questioning if you had the disease." He is now conflicted between the info I have given him and medical advice and unnecessary medical procedures.  I don't think she provided the correct response. My research online is that the biopsy is the gold standard. I'm happy that she finally got the blood test because others in the practice hadn't taken him seriously. So she gets points for authorizing the test but I'm not sure she really knows what the next step is.
I'm concerned about the following:
-possible (but unlikely) false positive by only doing blood test. He has not had any GI issues, but I'm a "silent" celiac so he could be as well.-that he will want the endo after going GF and so the biopsy will come back negative-lack of certainty down the road of the diagnosis for some reason. We both live in the Bay Area and when I wanted to get into Stanford's small celiac and digestive disorder clinic I had to have my medical files (including both endos) reviewed to make sure I was a "true" celiac before I could see a professor/physician there. He wouldn't have such medical records to provide if he wanted go there as well.
So who is "right" me or the PA? Should he go through with the endo or is the blood work and genetic predisposition enough? Maybe he should ask for a referral to a gastroenterologist at this point?
(I'm also a little bit of a different case because celiac came out of the blue for me due to persistent GERD and so I did the endo and they found the celiac and did a biopsy. Then I got the blood test. As celiac wasn't on the board originally it was all a little backward. I was also working with a gastroenterologist at the time and he's seeing just a GP.)

Thanks for your help,AllisonSanta Clara, CA

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