Celiac Disease
Celiac Disease

Video Endoscopic Sequence 1 of 6.

Duodenal Mucosa in Celiac Disease.

This video endoscopy sequence shows magnifying endoscopy that displayed the mucosa of the duodenum with flat or absent microvillis.

Celiac disease (CD) is a genetic disorder. In people with CD, eating certain types of protein, called gluten, sets off an autoimmune response that causes damage to the small intestine. This, in turn, causes the small intestine to lose its ability to absorb the nutrients found in food, leading to malnutrition and a variety of other complications..

The offending protein, gluten, is found in wheat, barley, rye, and to a lesser extent.

Characterized by damage to the mucosal lining of the small intestine which is known as villous atrophy. responsible for the malabsorption of nutrients resulting in malnutrition.

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Celiac disease

Video Endoscopic Sequence 2 of 6.

Celiac disease endocopic video. Mosaicism and fold scalloping in duodenum.

Celiac disease has a 95 percent genetic predisposition and, thus, it is frequently associated with autoimmune conditions such as diabetes mellitus type 1 and thyroid disease. Untreated patients have an increased incidence of osteoporosis and intestinal lymphoma. Excellent diagnostic screening tests are now available, including those that detect antigliadin and antiendomysial antibodies. Therapy with a gluten-free diet is effective, resulting in complete resolution of symptoms and secondary complications in almost all patients.


Celiac disease

Video Endoscopic Sequence 3 of 6.

The only treatment for celiac disease is to follow a gluten-free diet.


Celiac disease

Video Endoscopic Sequence 4 of 6.

The changes seen in celiac disease include:

1. Reduced or absent duodenal folds

2. Scalloping of folds

3. Mosaic pattern to the mucosa

4. Mucosal fissures or cracks

5. Visible vessels


Celiac disease

Video Endoscopic Sequence 5 of 6.

Celiac sprue primarily involves the mucosa of the small intestine. The submucosa, muscularis, and serosa are usually not involved. The villi are atrophic or absent with a decreased villous-to-crypt ratio (normal ratio, 4-5:1) and crypts are hyperplastic. The cellularity of the lamina propria is increased with a proliferation of plasma cells and lymphocytes. The number of intraepithelial lymphocytes per unit length of absorptive epithelium is increased (normal intraepithelial lymphocyte to epithelial cell ratio, 1:10).

Celiac disease

Video Endoscopic Sequence 6 of 6.

Histologically, duodenal biopsies can be graded into the following 5 stages:

ˇ Stage 0 - Normal

ˇ Stage 1 - Increased percentage of intraepithelial lymphocytes (>30%)

ˇ Stage 2 - Characterized by an increased presence of inflammatory cells and crypt cell proliferation with preserved villous architecture

ˇ Stage 3 - Mild (A), moderate (B), and subtotal to total (C) villous atrophy

ˇ Stage 4 - Total mucosal hypoplasia


Celiac disease

Video Endoscopic Sequence 1 of 7.

This is a 71 year-old male, who had suffered almost all his life with cramping abdominal pain, is evaluated with an endoscopy found in the duodenum nonspecific signs of inflammation, few erosions, shortening of micro villi with absence of some Kerkring folds of the duodenum.

Using under-water or emersion techniques, noting the absence and shortening of micro villi confirming with the biopsies.

The patient responded to gluten-free diet.


Celiac disease

Video Endoscopic Sequence 2 of 7.

Celiac disease can be defined as a small bowel disorder characterized by mucosal inflammation, villous atrophy, and crypt hyperplasia, which occur upon exposure to dietary gluten and which demonstrate improvement after withdrawal of gluten from the diet. However, the availability of serologic testing for celiac disease and the common use of upper endoscopy has complicated the definition, since these tests have identified patients who appear to have the disease but have variable degrees of histopathologic changes and/or symptoms. Thus, several categories of celiac disease have emerged. Whether these phenotypes are clinically useful remains to be determined.


Celiac disease

Video Endoscopic Sequence 3 of 7.

Villi can in fact be visualized using under-water oremersion techniques and/ or chromo-endoscopy.

Upper endoscopy with at least 6 duodenal biopsies is considered the criterion standard to help establish a diagnosis of celiac disease. Serology and endoscopy should be considered, especially in patients presenting with classical symptoms, evidence of malabsorption, and endoscopic findings, including mucosal fold scalloping, reduced mucosal folds, and mosaic pattern.


Celiac disease

Video Endoscopic Sequence 4 of 7.

Mucosal fissures or cracks

Recognition of Celiac Disease at Endoscopy.

An increasingly important mode of presentation is the recognition of endoscopic signs of villous atrophy in individuals who undergo endoscopy for symptoms not associated typically with celiac disease. These endoscopic signs include a decrease in duodenal folds, scalloping of folds, and the presence of mucosal fissures. The indications for upper-gastrointestinal endoscopy include dyspepsia, upper abdominal pain, or gastroesophageal reflux.





Celiac disease

Video Endoscopic Sequence 5 of 7.

The classical form, characterized by fully developed villous atrophy and features of intestinal malabsorption. The atypical form, characterized by fully developed villous atrophy in the setting of milder clinical features such as iron deficiency, osteoporosis, short stature, and/or infertility

Despite the historical title of "atypical", this form is the most common. The silent form in which villous atrophy is found after testing asymptomatic patients (eg, because of a family history of celiac disease or during an upper endoscopy performed for another reason). A potential form in those who have never had a biopsy consistent with celiac disease, but show serologic and/or immunologic abnormalities characteristic for the disorder. This is most often detected in patients with a family history of celiac disease. A latent form in patients who had a previous diagnosis of celiac disease that responded to gluten withdrawal but retained normal villous architecture after gluten reintroduction. The latent form also refers to patients with elevated IgA tTG serology but normal intestinal mucosa who may subsequently develop celiac disease.




Celiac disease

Video Endoscopic Sequence 6 of 7.

Celiac disease

Video Endoscopic Sequence 7 of 7.

Celiac disease

Video Endoscopic Sequence 1 of 3.

This is 31 year-old, male with weight loss of 31 Pounds and chronic diarrhea. The endoscopy pictures and the biopsies are compatible with celiac disease.

Celiac disease

Video Endoscopic Sequence 2 of 3.

Endoscopy with immersion in water, displays irregularity in the distribution and flattening of microvilli.



Celiac disease

Video Endoscopic Sequence 3 of 3.

Weight loss of 31 lbs. Patient improve with gluten free diet

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