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

My youngest brother expected to be celiac, but the biopsy was
negative.  How reliable is a negative biopsy?  And if we don't
believe the result of the biopsy, why have one?

My grandfather had bowel problems all his life, and my mother was
often bloated.  I have 4 brothers:
- The eldest has no problem
- The second eldest (age 44) is chronically underweight
- I was recently diagnosed by biopsy
- The 2nd youngest was diagnosed at age 9 with classic childhood
symptoms and positive biopsy
- The youngest (age 30) had a negative biopsy.

The reason I had a biopsy done was that the youngest and I noticed we
were having similar digestive problems, primarily bloating, though  I was
just slightly constipated and he was the opposite, and I was
gradually gaining weight and he was losing weight.  Mine had been
gradually building for nearly 10 years but his came on rather suddenly
in the past 8 months.  He had more obvious celiac-like symptoms but I
was the one with the positive biopsy.

With this much evidence of celiac in the family we still consider it
likely that his problems are from gluten.  Should he go on a trial GF
diet at this point?

Some salient points in the previous article are quoted below.
I was diagnosed in Canada, and he was tested in the States,
if that has any bearing on it.

Stuart
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>                        A     B    C    D    E   F     G
> Symptoms               +     +    +    -    -   +     -
> Serology/immunology    +     ?    +    +    +   ?     -
> Biopsy                 +     +    ?    +    ?   ?     +
> Response to diet       +     +    +    +    +   +     +
>
>      The group [E] is a theoretical possibility. If the serology
> positive during a screening test  but the biopsy is not conclusive
> there are two options. First,  to perform sophisticated tissue culture
> and immunhistochemical studies on the biopsy specimens to prove
> the gluten sensitivity. Alternatively, a trial with a gluten-free diet
> and a following the changes in serology  titers can be considered.
>
>
>      I would like to emphasize that there are no 100% perfect tests
> in the medicine. The diagnosis of every disease requires several
> different laboratory and other diagnostic procedures.

>      There is still  a possibility of inconclusive results if
> multiple biopsies are obtained  and  the histological interpretation
> is appropriate (see again: Picarelli A et al: Gluten sensitive disease
> with mild enteropathy. Gastroenterology 1996;111:608-616). All disease
> has a developmental process. It means  that it takes time for the
> pathological changes to be evident. There  are cases when  the symptoms
> suggest  CD,  however, the histology  is  not conclusive. This problem
> occurs in only few of  the cases. A  repeated biopsy may be necessary
> after a period of higher gluten challenge. However, if  the
> antiendomysium antibody test is positive  and the histology is not
> conclusive a gluten-free diet is recommended.