<<Disclaimer: Verify this information before applying it to your situation.>> I read the comments that people had on a gluten challenge. As a gastroenterologist who does this quite a lot, I would like to make some comments. Firstly, this illustrates the need to test for celiac disease prior to the institution of a gluten free diet. This is an issue not so much for patients as it is for doctors to realize and test for it at an earlier stage of some one's problems. If a person thinks they may have it, please they should ask for test before they start on gluten reduction. Regarding doctors who have CD and whether they get biopsied, they should follow what they recommend for patients, rather than the other way around. Most experts do not require a second biopsy to prove healing in younger patients though in older patients it may be helpful . Exceptions to this include very young infants ( undr the age of one) and populations where other disease that can mimic celiac disease occur) In patients who are not doing well then a biopsy is essential to the investigation of those patients. It is helpful to have the first one to compare it with. The techniques for biopsy have improved to the point that they should be a routine outpatient test in both adults and children. I would advocate that all biopsies should be done by experienced gastroenterologists in the case of adults and Pediatric trained gastroenterologists in children. Regarding diagnosing people already on a gluten free diet for a long time who are now symptoms free but had a terrific history of severe reactions I carefully access the risk. If there is a history of anaphylaxis, suicidal tendencies I am very loathe to try it at all. Other issues relate to relative risks such as nutritional status, associated diseases, like insulin dependent diabetes can all make it a little more risky to do it. In the end it is the patient that should decide on a gluten challenge, with the doctors agreement. (i will occasionally put a patient off the challenge due to some of the concerns above) This a short comment on what is a very complex issue. This is not medical advice and should not be used as such. Joseph A Murray, MD Coordinator, Celiac Disease Clinic, Associate Professor of Medicine, Division of Gastroenterology/Hepatology, University of Iowa, 200 Hawkins Drive, Iowa City, IA 52242