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Coeliac disease (CD) is a chronic inflammatory enteropathy induced by dietary gluten in genetically susceptible individuals.1 CD has a worldwide distribution with a very high prevalence, and since undiagnosed adult patients entail a fourfold increased risk of death,2 a flawless diagnostic workup would be needed. At present, although current guidelines state that duodenal biopsy remains essential for the diagnosis of adult CD,3 4 expert opinions are rather heterogeneous and confusing. Actually, the two opposing lines of thought space from establishing a diagnosis only relying on CD serology,5 as already happens in paediatric CD when the transglutaminase 2 antibodies are 10 times over the upper limit of normal,6 to the careful and detailed morphometric evaluation of duodenal biopsy specimens,7 without clearly specifying the clinical settings in which such opposite strategies should be applied. The range of possibilities is even wider if we consider that the ‘fresh’ analysis of duodenal biopsies with a dissecting microscope is provided by high sensitivity and specificity for the detection of severe villous atrophy, the recognition of which would not require any detailed grading system.8 However, it is clear that this unsophisticated method cannot replace traditional histology, particularly in the cases of infiltrative or milder lesions or in the diagnosis of the complicated …
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