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We were interested to read the reply to our letter1 by Kurien et al2 but consider that they have not made the case for performing a small bowel biopsy in all patients with coeliac disease (CD) to establish the diagnosis. Further support for our view that duodenal biopsy can be avoided in some patients was recently provided by Tortora et al.3 Kurien et al have also responded to that paper and their two responses suggest a fundamental misunderstanding of the data on which a ‘biopsy avoidance strategy’ is based.
It is incorrect of them to assert that their 2008 study4 ‘clearly refutes’ our suggestion. First, it is essential to use an assay with high specificity (>97%) but the IgA-class antitissue transglutaminase …