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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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