The presence of celiac disease on colonoscopy is not serious if it is caused by inflammation. However, if it is caused by abnormal cell differentiation or tissue-occupying hyperplasia, it is a serious disease. The presence of localized erosions on colonoscopy can generally be considered as erosions of intestinal tissues caused by damage or inflammation of the mucosa of the gastrointestinal tract, mostly caused by inflammatory cells or dietary stimulation. This type of celiac disease is a common gastrointestinal disorder that does not cause direct damage to health or longevity, and therefore is not considered a serious disease. Some of the celiac disease observed on colonoscopy may also be triggered by abnormal cellular differentiation or space-occupying lesions in the mucosa or surrounding tissues within the intestinal tract. Tumor growth or malignant lesions in the gastrointestinal tract can also lead to erosion of the mucosal surface, and tissue biopsy or biochemical examination is required to determine the specific cause of the disease. Celiac disease caused by tumors or malignant lesions is a serious disease that may directly affect the digestive function or life and health. After colonoscopy reveals the presence of celiac disease, further examination should be carried out to determine the specific cause of the disease, and choose the appropriate treatment plan according to the doctor’s advice.