British Society of Gastroenterology guidelines on the diagnosis and management of coeliac disease

The British Society of Gastroenterology (BSG) guidelines1 on diagnosis and management of coeliac disease (CD) contain much useful information, but in our opinion are badly misleading on the important topic of diagnosis and the relative merits of small intestinal biopsy and serology tests. The authors recommend that a duodenal biopsy is essential for diagnosis in all patients and cannot be replaced by serology alone even in a subset of patients. Other studies have now confirmed earlier work showing that using an appropriate cut-off for IgA-class anti-tissue transglutaminase antibody (IgA-tTG), the diagnosis can be made with a positive predictive value …