Guidelines may or may not be followed; it all depends on the physician’s judgment in each individual case. Most doctors won’t do a biopsy with a negative test because the test is about 98% accurate. However, by definition, 2% of those with celiac disease do have a negative test, so experienced physicians must handle each case with skill, expertise and balance.
A biopsy may have been helpful in some cases. If discovered that the villi are normal, a patient could be classified as having “non-celiac gluten sensitivity
.” March, 2016