Introduction: Celiac disease (CD) is a chronic, immune-mediated disorder that affects the small intestinal mucosa. The prevalence of CD has steadily increased with a higher ratio in females compared to males. There is a lower prevalence in the afro-caribbean population relative to people originating in Europe who have a higher genetic predisposition. Diagnosis of CD is made with endoscopic visualization, histopathology, serology and genetic testing; histopathology being the gold standard including endoscopic visualization of villous mucosa changes and erythematous mucosa. Histopathology biopsy findings may include intraepithelial lymphocytosis, crypt hyperplasia and villous changes. Our study was designed to report on associations between endoscopy and histopathology within patients from a single, small community hospital. Patients were screened and samples were collected from December 2020 until March 2023. Method: We performed a randomized, prospective study consisting of seventy-eight patients with persistent clinical symptoms and medical history suspicious for celiac disease. We followed strict IRB protocol guidelines for inclusion and exclusion of patients. Patients reporting clinical symptoms of CD or who met the criteria for screening were included in the study. Patients were excluded if they were not willing to give consent, who are going for an emergent therapeutic Upper endoscopy, or were previously diagnosed with CD. Multiple logistic regression was used to find predictors of villous atrophy. The covariate showing the closest statistically significant to 0.05 were included in the multivariable model and analysis was performed using Stata/BE 17.0. P-values for categorical comparisons were calculated with Pearson’s chi-squared test. Multiple logistic regressions were performed to identify independent predictors of persistent villous atrophy were performed using Stata Release 13. Results: Our study examined seventy-eight patients, of which 64% were female and 36% were male. Patients were selected for study based on presenting symptoms and suspicion for CD. Amongst our study population the most common presenting symptoms were: abdominal pain, fatigue, weight loss, and bloating. Approximately 38% of patients reported abdominal pain, followed by fatigue (19%) and weight loss (15%). Of the patients, 50% were African-American or Hispanic, 14% were Central American/Puerto Rican, and 8% were white/Caucasian. Blunting of villi visualized via endoscopy was associated with an increased likelihood of histopathologic changes indicative of CD, however; a p-value of 0.919 on univariate analysis was seen. In addition, villous blunting seen on endoscopy was found to be correlated with erythematous duodenitis (p-value = 0.224). Conclusion: Our study showed a comparatively lower prevalence of CD and did not show any statistically significant relationship between endoscopic macroscopic and histopathological microscopic villous atrophy. Our study was inconclusive and did not find a statistically significant relationship between the severity of endoscopic mucosa and alterations in histopathology