<<Disclaimer: Verify this information before applying it to your situation.>> Hello Larry & Tania, and welcome to the list. Before the biopsy became the gold standard test, immediate positive response to the gluten free diet was considered enough for a firm diagnosis. Each person of course has to decide for themselves (or parents must decide) and since the gluten free diet can be difficult to maintain (especially for small children) some people choose the biopsy, or two or even three biopsies spaced out over a few years. That seems excessive to me, and not worth the pain and suffering or the expense. The usual disclaimers apply here: I'm not a doctor, but have been gluten free 13 years. I was still very sick when my diagnosis was confirmed by biopsy; I've never even considered a "challenge." Feeling good is good enough. Best regards to all for Easter and Passover. John Argue [log in to unmask] > problems with 15 minutes).