The short answer to this is, ‘No’. Having said that the traditional gold standard for diagnosing coeliac disease is the identification of subtotal villous atrophy on a small bowel biopsy, observing the histology return to normal on a strict gluten free diet and then demonstrating deterioration again once gluten is reintroduced into the diet. This approach is rarely taken in adults although at times in children this is necessary.
As a general rule if an adult has subtotal villous atrophy on small bowel biopsy, elevated tissue transglutaminase (TTG) antibodies and a good response to gluten elimination from their diet with resolution of symptoms and normalisation of antibodies and abnormal blood tests, then a repeat small bowel biopsy may not be necessary. If symptoms persist or blood tests remain abnormal, a repeat biopsy will be required to determine if the failure to respond is due to resistant Coeliac disease or other causes. Having said this, the most common cause for failed response is continued exposure to gluten. These patients need to be more fully investigated by a Gastroenterologist with thorough dietary history by a dietitian, review of the evidence for the diagnosis including HLA typing to determine if they have a compatible phenotype for Coeliac Disease and exclusion of other conditions such as small bowel lymphoma.