The duodenal biopsy, long the cornerstone of a celiac disease diagnosis, has lost some of its luster in recent years. As data emerged that the specificity of tissue transglutaminase (TTG) IgA for duodenal villus atrophy increases in accordance with the degree of antibody elevation in children, in 2012 the European Society for Pediatric Gastroenterology and Nutrition adopted a biopsy-free pathway for the diagnosis of celiac disease in symptomatic children who met stringent criteria, including a ≥10-fold TTG IgA elevation and an elevated endomysial antibody on a separate blood draw.
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