The doctor was correct--if you are gluten-free the blood panel for celiac disease will not work, you would need to go on gluten challenge in order to be tested. Here is more info about how to do a gluten challenge for a celiac disease blood panel, or for an endoscopy: and this recent study recommends 4-6 slices of wheat bread per day:   This article might be helpful. It breaks down each type of test, and what a positive results means in terms of the probability that you might have celiac disease. One test that always needs to be done is the IgA Levels/Deficiency Test (often called "Total IGA") because some people are naturally IGA deficient, and if this is the case, then certain blood tests for celiac disease might be false-negative, and other types of tests need to be done to make an accurate diagnosis. The article includes the "Mayo Clinic Protocol," which is the best overall protocol for results to be ~98% accurate.    

It could, but it could also mean that gluten still not being fully eliminated. It's important to get a celiac disease blood panel to help figure this out. For people with celiac disease hidden gluten in their diets is the main cause of elevated Tissue Transglutaminase IgA Antibodies (tTG-IgA), but there are other conditions that can cause damaged villi:    

Some Mod asked me about blood tests. Dr said no need, nowhere to go as I am gluten-free alreay. He threw around terms like: TTG  2P DQH. not sure if it relates to gluten-free but he removed a polyp in 2022 and will recheck in 27. so my conclusion is that I am mostly gluten-free but not strict. Much obliged, Jeff

When the small intestine does not heal, does that indicate refractive celiac

Lactase is the enzyme that breaks down lactose. Lactase is produced in the small intestine. It is not produced in the pancreas. https://cymbiotika.com/blogs/health-hub/understanding-what-organ-produces-most-digestive-enzymes   "Lactase is found in the brush border of the small intestine of humans and other mammals." https://en.wikipedia.org/wiki/Lactase Studies have shown through micro analysis that the small bowel lining from those with celiac disease may never completely heal, even after years of gluten free living. There is healing at the macro level but not all cellular functions may be restored.