Radiodiagnostic Problems in Malabsorption

Abstract

1. Radiological signs are present in the majority of cases of tropical sprue of both endemic and epidemic forms. 2. In a series of 32 cases, the radiological signs of increased jejunal calibre, slow jejunal transit time, thickness of transverse mucosal folds, and flocculation of “non-flocculating” media show little correlation with haemoglobin levels, vitamin B₁₂, folic acid, xylose and fat absorption, or with jejunal biopsy findings. 3. In one case where there was a radiological appearance of thickened mucosal folds in the jejunum, post-mortem showed marked oedema of the submucosa including the primary mucosal folds. 4. The exclusion, by radiological methods, of minimal strictures and other lesions of the ileum that might cause malabsorption is a slow and tedious procedure. The time taken cannot be shortened by any known means, but the quality of radiographs of the ileum can be improved by use of special barium suspensions and by preliminary “cleansing” agents. By means of cinefluorographic methods more adequate records can be obtained with minimal radiation hazard. 5. Absence of propulsive peristaltic movements in the jejunum is a feature of sprue. In three cases parasympathomimetic drugs restored only contractile movements but did not restore propulsive movements. 6. Further studies of the phenomena of flocculation of barium suspension in the gut and of the action of various drugs on the neuromuscular mechanisms of the jejunum may lead to greater understanding of the pathological physiology of sprue.