Sakhuja S, Holtz LR., et al. - Since a subset of patients with serology indicating celiac disease have an initially negative biopsy but then develop histopathologic celiac disease, researchers conducted a retrospective analysis to describe patients with potential celiac disease who progress to celiac disease. The sample consisted of children, aged 0 to 18 years, with biopsy-confirmed celiac disease seen at St. Louis Children’s Hospital between 2013 and 2018. Data revealed that 4% of biopsy-confirmed celiac patients had a negative biopsy at first but developed histopathologic celiac disease later. Because no surveillance algorithm was in place, this is most likely an underestimation. Repeat testing is advised in children whose serology suggests celiac disease despite a normal small bowel biopsy.