Rapid responses are electronic letters to the editor. They enable our users to debate issues raised in articles published on thebmj.com. Although a selection of rapid responses will be included online and in print as readers' letters, their first appearance online means that they are published articles. If you need the url (web address) of an individual response, perhaps for citation purposes, simply click on the response headline and copy the url from the browser window. Letters are indexed in PubMed.
The article is on over or under diagnosis of coeliac disease, but nowhere in the article is the word "biopsy" mentioned.
The author does write the following:
"Centres of excellence performing endoscopy in children are limited in number, and experienced pathologists perhaps even more so, but making a diagnosis of coeliac disease with lifelong ramifications based on a borderline serology report is definitely not acceptable."
Biopsy is the gold-standard in Coeliac disease, but the absence of this word in the article makes it confusing and its usage is left to us to imagine it.