Endoscopy of the duodenum up to the aboral part of the descending arm may reveal macroscopic alterations suggestive of celiac sprue. These changes include: Kerkring’s folds reduced in height and number or absent, scalloping of folds, a mosaic pattern of mucosa and visible underlying blood vessels. Sensitivity, specificity, positive and negative predictive values of these parameters differ in relation the characteristics of the examined series of probands. Duodenoscopy may be the first examination arising suspicion of celiac sprue, particularly in subjects with atypical symptomatology. Upper endoscopy is frequently a part of the basic diagnostic programme in these subjects. For this reason it is mandatory that during this procedure aboral duodenum should be scoped in a standardized and detailed manner. Biopsy of the aboral duodenum is an acceptable alternative to jejunal biopsies for histological diagnosis of celiac sprue. Push enteroscopy is preferable in refractory sprue, particularly if ulcerative jejunitis is suspected. Early diagnosis of celiac sprue is necessary for introduction of the gluten-free diet as well as for the reduction of complications and associated autoimmune diseases.

        Key words: celiac sprue, duodenoscopy, push enteroscopy, macroscopic changes, histology