CT Bests Barium in Adult Celiac Disease Diagnosis

Improvements in computed tomography (CT) resolution of the small bowel, colon, and mesenteric lymph nodes have pushed CT scans ahead of traditional barium examinations in the diagnosis of celiac disease, according to a new study in the journal RadioGraphics.

The study, led by Francis Scholz, MD, a radiologist in the Lahey Clinic in Burlington, Mass., reviewed CT findings from more than 200 cases of celiac disease from 1996 to 2009. The CT scans highlighted abnormal structural changes known to result from the disease, and in more detail than possible with a traditional barium examination, Scholz and colleagues said.

Findings of malabsorption at barium examination. (a) Image shows duodenitis with nodularity in a fold-free duodenum (arrow). (b) Image shows flocculation (within oval at upper right), dilution (single arrow), and dilatation (double arrow). (c) Image shows moulage (within oval), which is a featureless bald appearance of the jejunum caused by atrophy of folds and wall edema. (d) Image shows reversal of the fold pattern (within oval), with more prominent folds in the ileum than in the jejunum. (courtesy RadioGraphics)

Celiac disease is a chronic autoimmune disorder induced in genetically susceptible individuals after ingestion of gluten proteins, which are found in wheat, rye, barley, and certain other grains.

About one in 200 Americans suffer from celiac disease, but less than 10 percent of cases are currently diagnosed, the authors said. Diagnosis of celiac disease takes an average of more than 10 years from the onset of symptoms.

The small bowel mucosa is primarily affected, resulting in progressive degrees of villus inflam¬mation and destruction with resulting induction of crypt hyperplasia, the authors said. The destruction be¬gins in the duodenum and over time progresses distally to the ileum. Loss of villi, which absorb fluid, and hypertrophy of crypts, which produce fluid, result in chronic fluid excess in the small bowel lumen. Chronic excess fluid and its effects on bowel wall structure and tone create the small bowel malabsorption pattern (MABP), which was described long ago in barium studies of patients with celiac disease, the authors said.

While celiac disease will remain difficult for radiologists to diagnose, the authors said a pattern of small bowel and colonic findings with mesenteric lymph node prominence at CT should suggest celiac disease. A simple blood test costing less than $100 usually allows confirmation of the diagnosis, they added.