Here are some other examples of the sometimes very subtile mucosal changes in coeliac sprue.

The mucosal changes in the descending duodenum are quite patognomonic, and when seen once, they are easy to recognize.

These pictures are from a patient with treated coeliac disease. The mucosal pattern is clearly visible although the microscopic findings had partly normalised.

In Finland, subtotal villous atrophy nearly always indicates coeliac disease. In tropical countries, flat mucosa is also seen in tropical sprue.

High resolution image: In advanced cases the mucosal pattern can be detected also in the duodenal bulb.