What steps, additional information would you obtain before proceeding with a gastroscope? This is a 2-year-old male. Neurology and Endocrinology suggesting GI specialist scope. This all stands from his huge head and tiny body, frontal bossing and misshaped head, wide-spaced eyes, disproportionate upper body to lower body ratio. Comprehensive stool test normal with exception of high red blood cells and acid stool, unvaccinated. Breastfed until 20 months, baby Zantac for short skin, had nonpainful, protruding umbilical hernia. No formula, processed food. No sugar. Completely organic and now nongluten and dairy-free for about a month. Has had a few colds and really sick.

Chris: Well, if they’re considering celiac disease, then obviously there is serum testing that can be done initially to assess probability of that. Cyrex Array 3X is a really good choice. It is less invasive than the scope, although given the symptoms and what’s going on, even if the test results were positive, if she had positive transglutaminase 2 and alpha gliadin or gliadin transglutaminase antibodies on Cyrex, that would still need to be followed up and confirmed with a scope. A scope is definitely invasive, but there are some pretty significant symptoms present, and given that celiac is certainly one possibility for this kind of presentation, I wouldn’t rule it out.