Editor,—We noted in the guidelines for the management of iron deficiency anaemia (Gut2000;46(suppl IV):iv1–iv5) that it is recommended that small bowel biopsies should be taken in all patients presenting with iron deficiency anaemia. This has been the subject of much discussion between the pathology department and ours recently.

Antiendomysial antibodies (EMAs) give at best close to 100% sensitivity and specificity1 ,2 although other studies suggest around 95% sensitivity with much lower values for specificity depending on the exact criteria for gluten sensitive enteropathy adopted.3 ,4 This has been discussed at both the recent British Society of Gastroenterology (BSG) meeting (Ciclitira PJ. State of the Art Lecture: Coeliac Disease—pathogenesis and prevention. BSG Annual Meeting, March 2000) and the American Gastroenterology Association (AGA) meeting (Schuppan D.Sprue: new insights into pathogenesis and management. AGA Postgraduate Course, May 2000).

A possible reason for these differences in sensitivity and specificity in the literature is that standards vary between different pathology departments in the techniques of anti-EMA assessment.5Most hospital biochemistry departments perform the tests using monkey oesophagus tissue bought from commercial suppliers; on the market at present there are 19 different suppliers of monkey oesophagus and 23 different suppliers of the enzyme immunoassay (EIA) (United …