[Should] testing [be done] through LabCorp or Quest to confirm celiac? I thought gastro referral and colonoscopy was necessary for diagnosis of celiac.

Basically, an endoscopy, because celiac is going to affect the small bowel. I would say that you can pretty much make a diagnosis of celiac if you have a genetic predisposition and if you have positive antibodies 2, anti-endomysial antibodies, deamidated antigliadin, and tissue transglutaminase. I think if all those come back positive, your genetic predisposition, the antibody panel that we use is that classic diagnosis, I don’t see a need to do a small bowel biopsy or an upper endoscopy. Because an upper endoscopy with small bowel biopsy is an invasive procedure. You’re putting [in] a scope, basically, and doing a biopsy of the small intestine. It’s generally a very safe procedure, but there’s still a non-zero probability of bowel perforation, so you need to really think about what is the added value of doing that endoscopy. I would say it’s pretty reasonable to make the diagnosis of celiac based on the blood work alone. You could probably get into a debate with some of the gastroenterologists as to whether or not the small bowel biopsy is really worth it. But I think the other question you would need to [ask] is, if you can be pretty certain of celiac, what’s the added value of the small bowel biopsy, and is that really going to change the management? I mean, it’s a valid question, but for me, I don’t recommend an upper endoscopy with small bowel biopsy if we have all those other markers, but yes, really good question.