<<Disclaimer: Verify this information before applying it to your situation.>> The necessity for a biopsy to diagnose celiac disease is currently without an alternative. The risk of a biopsy when carried out by a well qualified physician is extremely low. The issue of whether a patient needs to be on a gluten challenge is one that needs to be discussed with the doctor beforehand. How much gluten, for how long and when to do the biopsy should all be discussed well ahead of the biopsy. Please bring up the topic if the doctor does not mention it. I agree that the decision is the patients in all matters related to their health. the doctor has to agree to do something if he feels that it is reasonable and indicated. At a recent meeting meeting in Baltimore it was agreed by all the professional participants that a biopsy isa required to make the diagnosis of celiac disease. Not medical advice Joe Murray