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serological testing has been a very useful tool in identifying potential
patients with celiac disease.  However my enthusiasm for these tests is
tempered by my experience,  These tests are not universally reliable, and
are subject to occasional errors.  both false positive and false negative
occur with all of the tests.  The studies that were done were all done in
research labs on serum samples that were saved and run together.  How
good these tests will be when done in commercial labs on an ongoing basis
will be the proof of how good it is going to be in clinical practise.  in
the US there is no standard version or methodology of how these tests
should be run.  the EMA tests is very much interpretor dependent in that
it requires an immunopathologist to look for a particular pattern of
staining which can be difficult to call on occassion.  This is done in a
dark room looking down a microscope at multiple samples.  it is not hard
to imagine that there may be some fatigue if one is doing a large number
of samples at the same time.

With regard to the number of biopsies required for diagnosis unless I'm
wrong the European pediatric Gastro and Nutrition assoc. has modified
their criteria to require only one biopsy in most instances so long as
the patient has good clinical repsonse to the diet.  I will occassionally
do biopsies subsequently if questions remain regarding the original
biopsy or to monitor reponse.  All decisions need to individualised to a
particular patients needs and circumstances and these comments do not
represent medical advice.

It interesting to me that the diagnostic criteria for celiac disease are
set by the EUropean pediatric group while the majority of patients are
been diaggnosed in adulthood where the differential diagnosis may be
quite different.