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I read the comments that people had on a gluten challenge.  As a
gastroenterologist who does this quite a lot, I would like to make some
comments.

Firstly, this illustrates the need to test for celiac disease prior to
the institution of a gluten free diet.  This is an issue not so much for
patients as it is for doctors to realize and test for it at an earlier
stage of some one's  problems.  If a person thinks they may have it,
please they should ask for test before they start on gluten reduction.

Regarding doctors who have CD and whether they get biopsied, they should
follow what they recommend for patients, rather than the other way
around.

Most experts do not require a second biopsy to prove healing in younger
patients though in older patients it may be helpful . Exceptions to this
include very young infants ( undr the age of one) and populations where
other disease that can mimic celiac disease occur)  In patients who are
not doing well then a biopsy is essential to the investigation of those
patients. It is helpful to have the first one to compare it with.

The techniques for biopsy have improved to the point that they should be
a routine outpatient test in both adults and children.  I would advocate
that all biopsies should be done by experienced gastroenterologists in
the case of adults and Pediatric trained gastroenterologists in
children.

Regarding diagnosing people already on a gluten free diet for a long
time who are now symptoms free but had a terrific history of severe
reactions I carefully access the risk.  If there is a history of
anaphylaxis, suicidal tendencies I am very loathe to try it at all.
Other issues relate to relative risks such as nutritional status,
associated diseases, like insulin dependent diabetes can all make it a
little more risky to do it.

In the end it is the patient that should decide on a gluten challenge,
with the doctors agreement.  (i will occasionally put a patient off the
challenge due to some of the concerns above)

This a short comment on what is a very complex issue.
This is not medical advice and should not be used as such.

Joseph A Murray, MD
Coordinator, Celiac Disease Clinic,
Associate Professor of Medicine,
Division of Gastroenterology/Hepatology,
University of Iowa,
200 Hawkins Drive,
Iowa City, IA 52242