Scot M. Lewey, DO, FACG, FASGE, AGAF
Clinical Professor of Medicine
This page has endoscopic photos demonstrating the classic visual features seen in Celiac disease when patient has an endoscopy. The features include "cobblestone" and/or "fissured" appearance of the mucosa (surface lining) as well as "scallopping" or notches in the folds. These visual signs are typical of Celiac disease but not specific for it but in the right context with abnormal blood tests and classic biopsy features (see separate page demonstrating biopsy features) the disease is confirmed. Treatment is lifelong gluten free diet.
This endoscopic photo of the small bowel (duodenum) shows the classic fissuring or cobblestoning of the surface as well as "scalloping" of the folds in Celiac disease.
This endoscopic photo was taken with special light technique called Narrow Band Imaging (NBI). It brings out some of features of atrophy, fissuring or cobblestone appearance of the mucosa (surface lining) and the "scalloping" of the folds seen in Celiac disease.
These endoscopic photos show some of the most classic features of Celiac disease seen visually during endoscopy. Biopsies of the mucosa (surface lining) demonstrated the typical microscopic features of Celiac as depicted on the biopsy page of this website.
The folds are flattened and the mucosa in this patient with Celiac.
Pronounced scalloping of folds is seen in this patient with Celiac.
This photo demonstrates liner ulcerations in a serpiginous pattern seen in some patients with Celiac disease. This patient had HLA DQ2 genetics; classic positive blood tests and areas of intestine biopsied had near total villus atrophy as noted to right.
This is what the small intestine looks like under the microscope when the mucosa is injured like the left photo shows. The villi are essentially flat and numerous lymhocytes are near the surface lining.
Classic scalloped folds of Celiac disease
Deep scalloped or notched fold with atrophic appearing mucosa and fold that are "blunted" in Celiac disease
The above endoscopic photos illustrate the variation in endoscopic appearance in Celiac disease. The classic features should not be missed by an endoscopist but sometimes are and the real tragedy is the failure to obtain biopsies, including multiple samples from the duodenum (first portion of small intestine). The microscopic changes can be patchy but when present in the context of symptoms that improve with gluten restriction and confirmatory blood antibodies on an unrestricted diet are diagnostic.