Coeliac disease is increasingly recognized as a global problem in both children and adults. Traditionally, the findings of characteristic changes of villous atrophy and increased intraepithelial lymphocytosis identified in duodenal biopsy samples taken during upper gastrointestinal endoscopy have been required for diagnosis. Although biopsies remain advised as necessary for the diagnosis of coeliac disease in adults, European guidelines for children provide a biopsy-sparing diagnostic pathway. This approach has been enabled by the high specificity and sensitivity of serological testing. However, these guidelines are not universally accepted. In this Perspective, we discuss the pros and cons of a biopsy-avoiding pathway for the diagnosis of coeliac disease, especially in this current era of the call for more biopsies, even from the duodenal bulb, in the diagnosis of coeliac disease. In addition, a contrast between paediatric and adult guidelines is presented.

乳糜泻在儿童和成人中日益被认为是全球性问题。传统上，诊断需要在十二指肠活检样本中发现的绒毛萎缩和上皮内淋巴细胞增多的特征性变化的发现。尽管仍建议活检对成人乳糜泻的诊断是必要的，但欧洲针对儿童的指南提供了保留活检的诊断途径。血清学检测的高度特异性和敏感性已使该方法成为可能。但是，这些准则未被普遍接受。在此观点中，我们讨论了避免进行活检的方法来诊断乳糜泻的利弊，特别是在当前要求进行更多活检的时代，即使是从十二指肠球进行活检，在乳糜泻的诊断中。此外，还提出了儿科和成人指南之间的对比。