Radiology and adult celiac disease. Current indications of small bowel barium examinations.
OBJECTIVE
To evaluate the current role of small bowel (SB) radiologic barium examinations in adult celiac disease (ACD).


METHODS
Retrospective review of 61 SB barium examinations in 280 ACD patients. Sixty-one examinations in 61 patients were performed: 7/61 with small bowel ''follow-through'' (SBFT) method, and 54/61 with small bowel double-contrast enteroclysis (SBE). Radiological criteria for ACD diagnosis were divided in four groups: 1) definite ACD (reversal of jejuno-ileal fold pattern); 2) possible ACD (malabsorption pattern and ileal jejunization); 3) malabsorption (fluid, dilatation, ''moulage'', flocculation); 4) complicated ACD (irregular, thickened, nodular folds; wall thickening; masses).


RESULTS
In 49/61 patients RX examinations were performed before ACD diagnosis. In this group, clinical presentations included one or more of the following: diarrhea, weight loss, malabsorption, anemia, abdominal pain; 7/49 had a SBFT, and 42/49 a SBE. All 7 SBFTs showed pattern 3, and 8/42 SBEs showed pattern 2 (suspected ACD). In 34/42 patients SBE allowed a definite ACD diagnosis (pattern 1); however, 6/34 were also false-positive for complicated ACD (pattern 4). Ten out of sixty-one patients were clinically suspected of having complicated ACD, correctly excluded (8/8) or confirmed (2/2) by SBE. None of these 59/61 patients had a radiologic diagnosis of normal' SB. The last 2/61 patients with ACD, examined for persisting chronic anemia, had a normal SBE.


CONCLUSIONS
This study confirm that SB radiology may be of value either in ACD diagnosis or in excluding complications: SBE is currently the most accurate examination. SBE alone is however less accurate in confirming complicated ACD; further imaging techniques are always needed in this clinical context.
La Seta
Francesco
F
Servizio di Radiologia, A.O.V. Cervello, Palermo. flaset@tin.it
Buccellato
Antonio
A
Albanese
Maddalena
M
Barbiera
Filippo
F
Cottone
Mario
M
Oliva
Lorenzo
L
Agricola
Antonino
A
Costanzo
Giuseppe Sergio
GS
Lagalla
Roberto
R
D000293:Adolescent; D000328:Adult; D000368:Aged; D001466:Barium Sulfate; D002446:Celiac Disease / Q000150:complications / Q000175:diagnosis / Q000000981:diagnostic imaging*; D003287:Contrast Media; D003937:Diagnosis, Differential; D004733:Enema; D005260:Female; D006801:Humans; D007421:Intestine, Small / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012189:Retrospective Studies
D003287:Contrast Media; D001466:Barium Sulfate