Your first bloodwork was neither here nor there. Your second bloodwork was positive. At that point, you rightly earned a biopsy. The biopsy is the definitive diagnosis, unless you had been on a wheat-free diet prior to the biopsy (which would cause the duodenum to return to normal). That wasn't the case, right?
Now, the interpretation of the biopsy might not be great. Have you considered asking your GI to send it to (somewhere else of your choosing) to get a second opinion?
Edit For some reason, your other posts seemed to convey that your GI was not very confident in her biopsy of your duodenum. This does make me a bit nervous. This is why it's hard to play doctor over the internet. If we were in real life, I could probably get a much better sense of whether or not to trust the biopsy. Hopefully her biopsy is at least good enough to prove to an outside reader that she did indeed biopsy the duodenum...
I actually did go gluten-free for about 7 days prior to the biopsy (yeah, that was dumb). When I had my GI appointment, she had me go back on gluten for 3 weeks prior to the procedure, which I dutifully did.
She said I was extremely uncomfortable during the procedure, more so for the colonoscopy than the endoscopy/biopsy. I don't think she said outright that it prevented her from getting good samples, but she did say that it might make sense to repeat the procedure in a few months if the genetic test comes back positive, or if the gluten-free diet produces a positive result (of course with appropriate gluten-challenge beforehand). She said that if we do that she'd give me full anesthesia so that she can get further into the tract for samples.
I would certainly consider asking for another interpretation of the biopsy. Do they actually keep them around for that kind of thing? Where would I request it to be sent?
Not dumb — in fact totally understandable — but yeah, that may confound interpretation of the test. Does your GI doc know this?
I'm not fully versed in the art of asking for another opinion, but I think it would be reasonable to get your doc involved. You could basically say that you appreciate the care she's given you and want to keep her as your GI doc (if true) but you'd also like to get another person to take a look at the biopsy sample, since it is obviously a very valuable and hard to get piece of tissue. I'm sure she could recommend another person to interpret the samples for you. I'm not positive that Celiac biopsy samples are kept, but I know that many other biopsy samples are, which is why I suspect that these are, too. At the very least, they should have images of the samples. Based on her apparent discomfort with the procedure, I'm half wondering if there was a misinterpretation, and I'm half wondering if she was unable to biopsy the right tissue; both of these concerns could be resolved by a third party. It wouldn't be cheap, but it has a small chance of saving you from having to do another biopsy.
That said, in the setting of a one week wheat deprivation diet, interpretation probably won't be totally clear even if you did have Celiac, so a second opinion on these samples may well not be worth it.
Now, the interpretation of the biopsy might not be great. Have you considered asking your GI to send it to (somewhere else of your choosing) to get a second opinion?
Edit For some reason, your other posts seemed to convey that your GI was not very confident in her biopsy of your duodenum. This does make me a bit nervous. This is why it's hard to play doctor over the internet. If we were in real life, I could probably get a much better sense of whether or not to trust the biopsy. Hopefully her biopsy is at least good enough to prove to an outside reader that she did indeed biopsy the duodenum...