Endoscopic dye-spraying in the diagnosis of coeliac disease

Endoscopic dye-spraying enables the visualization. in vivo, of the surface morphology throughout the duodenal cap. Examination of the duodenal bulb after dye-spraying in 19 untreated coeliac patients revealed the absence of villi and their replacement with a mosaic pattern. Villi were present in all 35 non-coeliac patients examined. Mucosal biopsies taken at endoscopy demonstrate that the morphological, histological and biochemical changes found in coeliac disease are similar in the proximal duodenum and in the jejunum. The presence of villi in the duodenal cap precludes a diagnosis of untreated coeliac disease. The absence of villi in the duodenal cap at endoscopy, is highly suggestive of a diagnosis of coeliac disease.