The following options can be discussed with your patient:
Recommend a gluten challenge. One option is to recommend 8-10g gluten per day (for adults) for 6 weeks prior to testing. This is equivalent to approximately 4 slices of wheat-based bread per day. Our fact sheet, Gluten Challenge, has more information.
If your patient is reluctant or unable to complete a gluten challenge, offer HLA-DQ2/8 gene testing. If HLA DQ2/8 gene testing is negative, coeliac disease can be safely excluded. If it is positive, then option 1 is the only feasible diagnostic approach.