Non-invasive diagnosis needed

doi:10.1136/bmj.b1070

Published 17 March 2009, doi:10.1136/bmj.b1070
Cite this as: BMJ 2009;338:b1070

Letters

Coeliac disease

Non-invasive diagnosis needed

The first 150 words of the full text of this article appear below.

My personal story of self diagnosed gluten intolerance is similarto that of Jocelyn Anne Silvester—if you omit the bariuminvestigations and substitute cholecystectomy (probably unnecessary).¹I had a positive family history of presentation in the mid-fortiesand a negative endomysial antibody test, and after several deliberateand inadvertent gluten challenges I decided not to proceed witha biopsy as I did not want to suffer needlessly for a test whichwould adhere to the guidelines but not alter my management.I, too, would have needed to take time off work if I had resumeda gluten diet. Fortunately, I had a specialist who supportedme in this decision.

As a general practitioner, I am identifying more cases thanpreviously, and more patients are presenting with self diagnosis.However, I feel a hypocrite when I reiterate the current recommendation—toremain on a normal diet until biopsy—knowing that thisoften entails . . . [Full text of this article]

Pat Hoddinott, senior clinical research fellow and general practitioner¹

¹ Public Health Nutrition Research Group, University of Aberdeen, Aberdeen AB25 2ZP

p.hoddinott@abdn.ac.uk