Currently coeliac serological testing is not reliable enough to eliminate the need for small bowel biopsy. Recent guidelines from the European Society for Paediatric Gastroenterology and Hepatology and Nutrition (ESPGHAN), have recommended that if the TTG-IgA is >10XULN, and EMA +ve, and HLA DQ2 or 8 +ve, and history is consistent, then a small bowel biopsy is not required. This has not however been followed by USA/Canada and some parts of Australia currently. The ESPGHAN do recommend that these guidelines are dependent on the reliability of local testing.
However, these guidelines may be adopted sometime in the future, but studies of our local assays need to be performed, to determine if the ULN values are going to be consistently reliable. We need to be mindful that coeliac disease is a lifelong condition, and therefore it is very important that the diagnosis is established with certainty.