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As a medical professional I have a different perspective on whether a
biopsy is needed.  About 1 in 5 of patients that comes to me regarding
celiac disease present with the question if they were accurately
diagnosed in the first place.  These are patients who have improved on
wheat free diet, but may have worsened or find that the diet is
stringent and want to know if it really needed long term.  The problem
in this situation is that putting a patient back on wheat is not well
characterized in terms of how much wheat is needed and for how long.
When the biopsy comes back negative after wheat rechallenge there is
always the question of whether there was enough wheat in the diet to
cause a positive biopsy.

There are two major types of wheat problem:  Celiac disease and wheat
intolerance.  If there is really Celiac disease the avoidance of wheat
must be very stringent and follow up testing includes checks of
antibody levels yearly, as well as surveillance for diabetes, thyroid
disease, neuropathy, lymphoma, and other autoimmune disease.  If it is
only wheat intolerance then the diet only needs to be sufficient to
avoid symptoms and extensive follow up is not needed.

Since biopsy testing after a wheat restricted diet is not reliable the
biopsy should be done immediately when the diagnosis is suspected,
before wheat restriction.

Stephen Holland, M.D.
www.napervillegi.com

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