Refer for endoscopy for biopsy

You discuss the results with Davina’s parents. You explain that the antibody tests show that she has antibody’s against gluten, which is a protein found in wheat, so is present in bread, pasta, biscuit. This finding, combined with her poor weight gain, is suggestive of coeliac disease, which is an allergic condition of the small intestine. In this condition, the lining of the intestine becomes inflamed because of the gluten in the diet. The consequence of this is that the intestine does not absorb nutrients properly.

The parents are not sure about this information.

First, however, a biopsy is needed to establish for certain whether Davina has coeliac. It would not be appropriate to make a lifelong change to her diet without being completely sure of the cause.

You explain that, once the diagnosis is made, she will need to go on a diet without gluten. Then her gut will stop being inflamed and start absorbing properly again. The new diet will need to continue lifelong. They ask you why she is not being referred to a dietician instead of this invasive biopsy.

Davina’s parents tell you that they cannot make a decision immediately and need some time to think.

You book them into the clinic in one week’s time.