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Thanks for the numerous responses everyone! I received 20+ responses to my question about whether my brother should proceed to a biopsy after getting a positive blood test. The vast majority (14 or so) said that yes, a biopsy is required for diagnosis and the blood test should be seen more as a screening for who should get a biopsy. Having biopsy results may help determine the level of damage/baseline, provide conclusive results for insurance company & medical studies. A respondent from the University of Chicago provided the following PDF about biopsy: http://www.cureceliacdisease.org/wp-content/uploads/FactSheet7_Diagnosis-of-Celiac-Disease.pdf <http://www.cureceliacdisease.org/wp-content/uploads/FactSheet7_Diagnosis-of-Celiac-Disease.pdf>

A few respondents (about 7) didn’t feel the biopsy was necessary given my own diagnosis (1st blood relative). There is a study that says if the blood test results are 3.6x higher than normal than a biopsy isn’t necessary: http://www.ncbi.nlm.nih.gov/pubmed/26928588 <http://www.ncbi.nlm.nih.gov/pubmed/26928588>

But almost everyone agreed that he needs to be referred to a qualified gastroenterologist before going GF (in case he needs the biopsy). So I provided a similar summary to him and said the best step would be to see a GI and sent him the directory link from celiac.org <http://celiac.org/> to find someone near Berkeley to help him make that decision. I think the physician assistant is not the best person to do that but a GI would, especially one who is knowledgeable about celiac and can review his lab results.

Thanks again,
Allison
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