<<Disclaimer: Verify this information before applying it to your situation.>>

At the Canadian Celiac Conference in Montreal in 1996, it was noted that
8-15% of  biopsies might (I emphasize 'might')  produce false negative
results.  According to my doctor, this lack of sensitivity is a sampling
error, ex. the doctor not taking a sufficient number of samples and/or
not sampling in the appropriate area of the jejunum.  This biopsy
sampling error, however, places the combination of antibody tests in good
stead.

The problems associated with both methods places the definitive diagnosis
of gluten-sensitive enteropathy in the (1) hands of a doctor with
inadequate procedure, (2) possibly relying on an accuracy problem with
the biopsy method itself and/or (3) relying on the accuracy of laboratory
performance and the probability of the sensitivity and specificity of the
antibody tests.

I think all of us who have been diagnosed -- with whatever "standard" --
are lucky.  We know we have celiac disease.  The ones I worry about are
the ones who were told in error that they were not celiacs.

I can get the name of the doctor who presented the figures in a seminar
but  I do not have the medical journal references.  The facts are that
doctors do acknowledge the possibility of a false negative result with a
biopsy and, statistically, it has to be considered as probable.  My only
purpose for bringing these comments to the listserv is to remind you that
any method of diagnosis can be lacking sensitivity and/or specificity.
Also, a logical corollary means that going on a gluten-free diet prior to
any diagnostic method only complicates the diagnosis with added variable
condidtions and, thereby, enhances the probability of an inaccurate
determination, if any.

Joanne Hameister
East Aurora (outside Buffalo) NY