CELIAC-DISEASE - HOW COMMON IS JEJUNOILEAL FOLD PATTERN-REVERSAL FOUND AT SMALL-BOWEL FOLLOW-THROUGH

OBJECTIVE. Celiac disease, or nontropical sprue, is a cause of mucosal malabsorption. A decreased number of jejunal folds and an increased n umber of ileal folds (jejunoileal fold pattern reversal) found at smal l-bowel follow-through have been reported for patients with celiac dis ease. We asked three questions regarding jejunoileal fold pattern reve rsal found at small-bowel follow-through in patients with celiac disea se. (1) How often is it present, either partially or completely? (2) H ow often is it associated with other findings of malabsorption? (3) Ho w reliably can it be distinguished from the normal pattern? MATERIALS AND METHODS. Twenty-eight small-bower follow-through examinations perf ormed on 25 adult patients with celiac disease (confirmed by character istic small-bowel biopsy and clinical response to a gluten-free diet) were reviewed retrospectively by two authors, who agreed by consensus on partial or complete jejunoileal fold pattern reversal and on other findings of malabsorption. Two methods were used to control for retros pective bias. (1) The prospective and retrospective readings of fold p attern reversal were compared for agreement. (2) The author who had no t participated in the retrospective review was asked to distinguish, o n the basis of the presence or absence of fold pattern reversal, 24 ca ses of celiac disease (all of which showed partial or complete fold pa ttern reversal on retrospective review) from 25 normal control cases ( patients with diarrhea) (confirmed by normal small-bowel biopsy). RESU LTS. Partial or complete jejunoileal fold pattern reversal was identif ied retrospectively in 24 of the 28 small-bowel examinations (86%) per formed on patients with celiac disease. One-half lacked other findings of malabsorption. The prospective and retrospective readings of fold pattern reversal agreed in 21 of the 28 examinations (75%). Forty-four of 49 examinations (90%) were correctly identified by the third autho r on the basis of fold pattern reversal. CONCLUSION. In patients with celiac disease, partial or complete jejunoileal fold pattern reversal discovered at small-bowel follow-through is common, is often not assoc iated with other findings of malabsorption, and can be reliably distin guished from the normal pattern. Identification of jejunoileal fold pa ttern reversal found at small-bowel follow-through should prompt an ap propriate clinical evaluation for celiac disease.