Barlow J M, Johnson C D, Stephens D H
Diagnostic Radiology, Salt Lake Clinic, Salt Lake City, UT 84102, USA.
AJR Am J Roentgenol. 1996 Mar;166(3):575-7. doi: 10.2214/ajr.166.3.8623630.
Celiac disease, or nontropical sprue, is a cause of mucosal malabsorption. A decreased number of jejunal folds and an increased number of ileal folds (jejunoileal fold pattern reversal) found at small-bowel follow-through have been reported for patients with celiac disease. We asked three questions regarding jejunoileal fold pattern reversal found at small-bowel follow-through in patients with celiac disease. (1) How often is it present, either partially or completely? (2) How often is it associated with other findings of malabsorption? (3) How reliably can it be distinguished from the normal pattern?
Twenty-eight small-bowel follow-through examinations performed on 25 adult patients with celiac disease (confirmed by characteristic 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 retrospective bias. (1) The prospective and retrospective readings of fold pattern reversal were compared for agreement. (2) The author who had not participated in the retrospective review was asked to distinguish, on the basis of the presence or absence of fold pattern reversal, 24 cases of celiac disease (all of which showed partial or complete fold pattern reversal on retrospective review) from 25 normal control cases (patients with diarrhea) (conformed by normal small-bowel biopsy).
Partial or complete jejunoileal fold pattern reversal was identified retrospectively in 24 of the 28 small-bowel examinations (86%) performed 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 author on the basis of fold pattern reversal.
In patients with celiac disease, partial or complete jejunoileal fold pattern reversal discovered at small-bowel follow-through is common, is often not associated with other findings of malabsorption, and can be reliably distinguished from the normal pattern. Identification of jejunoileal fold pattern reversal found at small-bowel follow-through should prompt an appropriate clinical evaluation for celiac disease.
乳糜泻，即非热带性口炎性腹泻，是黏膜吸收不良的一个病因。据报道，在小肠造影检查中，乳糜泻患者空肠皱襞数量减少，回肠皱襞数量增加（空回肠皱襞模式反转）。我们针对乳糜泻患者小肠造影检查中发现的空回肠皱襞模式反转提出了三个问题。（1）其部分或完全出现的频率如何？（2）其与其他吸收不良表现相关的频率如何？（3）与正常模式相比，其鉴别可靠性如何？
对25例成年乳糜泻患者（经特征性小肠活检及对无麸质饮食的临床反应确诊）进行的28次小肠造影检查进行回顾性分析，两位作者对部分或完全空回肠皱襞模式反转及其他吸收不良表现达成共识。采用两种方法控制回顾性偏倚。（1）比较空回肠皱襞模式反转的前瞻性和回顾性读片结果是否一致。（2）要求未参与回顾性分析的作者根据空回肠皱襞模式反转的有无，从25例正常对照病例（腹泻患者）（经正常小肠活检证实）中鉴别出24例乳糜泻病例（所有病例回顾性分析均显示有部分或完全皱襞模式反转）。
在对乳糜泻患者进行的28次小肠造影检查中，回顾性分析发现24例（86%）存在部分或完全空回肠皱襞模式反转。其中一半患者没有其他吸收不良表现。28次检查中有21次（75%）空回肠皱襞模式反转的前瞻性和回顾性读片结果一致。第三位作者根据空回肠皱襞模式反转正确鉴别出了49次检查中的44次（90%）。
在乳糜泻患者中，小肠造影检查发现的部分或完全空回肠皱襞模式反转很常见，通常与其他吸收不良表现无关，且可与正常模式可靠鉴别。小肠造影检查发现空回肠皱襞模式反转应促使对乳糜泻进行适当的临床评估。
