Seronegative coeliac disease: Are they coeliac? When biopsy in adult can be avoided?

Recent studies by the Derby team on the value of serology and narrowing the indications for small bowel biopsy generated a significant interest and opened a new chapter in improving the diagnostic policies for Celiac Disease (CD) in particular for children (1, 2). In this issue of GHFBB (3), the authors claim the new policy will not only simplify the diagnosis of CD for affected individuals, but also it has significant safety implications and cost reduction for health care systems. The novel new algorithm is particularly important for the young children who require general anaesthesia for their gastroscopy and duodenal biopsies, in keeping with recommendations from the European Society of Paediatric Gastroenterology and Nutrition (ESPGHAN), and it is incorporated in ESPGHAN guidelines (2, 4).