Radiographic indicants of adult celiac disease assessed by double-contrast small bowel enteroclysis.

The number of folds and lumen diameter of the proximal jejunum and distal ileum were retrospectively measured in 40 double-contrast small bowel enteroclysis studies of patients with a biopsy-proven diagnosis of adult celiac disease (ACD) and in 46 healthy control subjects. For both parameters an inverse radiographic pattern was found in celiacs compared to control subjects, in whom the number of folds and lumen calibers are physiologically greater in proximal jejunum than in the distal ileum. Mean differences in the jejuno-ileal number of folds (-7.1) and lumen calibers (-1.3 cm.) were in fact negative in ACD patients, in whom the values of both the parameters are less in the proximal jejunum than in the distal ileum. Particularly, the sign of "reversal of jejuno-ileal caliber" was both sensitive and specific for diagnosis of ACD in this retrospective series. Double-contrast small bowel enteroclysis can play an important role in excluding or confirming the presence of ACD, provided that an assessment of reproducibility and a prospective re-evaluation of operative characteristics of such radiographic signs are performed.     

Experience with double-contrast examination of the small intestine

Experiences and results of 600 small bowel examinations in double-contrast technique are reported. Pathologic lesions were found in 40%. The double-contrast technique has proved to be an efficient method in detecting small bowel pathology. Its specific value lies in precise delineation of pattern, extent and intensity of disease.     

Primary lymphoma of the small intestine: clinico-radiological correlations

From 1987 to 1989, 7 patients were diagnosed as having a primary lymphoma of the small bowel. The patients, 5 men and 2 women aged 14-66 years (average: 45), were studied by means of small bowel enema and CT. Using small bowel enema, our findings were: masses related to a loop, stenosis, mucosal patterns with thick, irregular, and nodular folds, and bowel walls thickening. In nearly all cases CT showed not only small bowel lesions but also mesenteric lymphadenopathy. Five of seven patients had lymphomas, 1 had IP-SID lymphoma (immunoproliferative small intestinal disease related lymphoma), and 1 had IPSID associated with a late prelymphomatous stage. The diagnosis of IPSID is very important in patients with malabsorption syndrome, which may or may not be related to alpha heavy chain disease, because IPSID may evolve into lymphoma but its prelymphomatous stage can be treated and cured. We have therefore reported the different features seen with enteroclysis and CT, comparing the results obtained in the various forms of lymphoma of the small bowel. The importance is stressed of an accurate diagnosis of IPSID forms, however uncommon in our Country.     

Personal experience with examination of the small intestine using the enteroclysis method

Enteroclysis is rightly included to modern diagnostic methods for detecting damage to alimentary canal. It enables to visualize even small morphological changes on the mucous membrane of intestine, to prove fistulas if present and to evaluate functional changes if correctly applied. It significantly contributes to establishing early diagnosis in affections of the intestine and consequent use of adequate therapy. The authors in their communication summarized their experience, obtained in the examination of one hundred patients. They selected a modified procedure of examination according to Herlinger with the use of Prontobarium suspension and methyl cellulose. The application was made with a controlled duodenal probe from the Nicholas Company, introduced by nose. The average duration of one examination was 44 minutes.     

Value of small intestine transit by enteroclysis in obstructive syndromes of the small intestine. Apropos of 212 examinations

During seven years, 212 small bowel examinations are made on patients with suspected small bowel obstruction by barium infusion. We find all the main small bowel pathology: Crohn's disease (16.5%), carcinomatosis (14.6%), neoplasia (10.3%), vascular disease (17.8%), actinic enteritis (9.5%) and miscellanous (18%). The small bowel infusion is normal in 15%. Surgery is avoided in 51% of the cases. There is non complications associated with the examination but in 12% of the cases, the examination is unsuccessful.     

Crohn disease of the small intestine: accuracy and relevance of enteroclysis.

The accuracy and clinical relevance of enteroclysis in the evaluation of 138 patients referred for enteroclysis for suspected Crohn disease of the small intestine are reported. The original prospective interpretations of enteroclysis results were assessed after a clinical follow-up period of 2 or more years. With all patients considered, enteroclysis had a sensitivity, specificity, and accuracy of 100%, 98.3%, and 99.3%, respectively, with only one false-positive diagnosis and no false-negative diagnoses. Thirty-one percent (n = 43) of the patients had lesions of early Crohn disease. All patients who required surgery (n = 23) had advanced lesions of the disease, according to enteroclysis criteria. Clinical evidence of Crohn disease did not develop in the 58 patients in whom enteroclysis revealed no abnormality. There were no complications related to the procedure. It is concluded that enteroclysis is an accurate method for diagnosis and exclusion of Crohn disease of the small intestine and provides detailed structural information relevant to appropriate management of the disease.     

Use of double-contrast examination of the small intestine in children

Results of 28 double-contrast examinations of the small intestine in 19 children are described together with the technique employed. Pathological findings are seen in children with Crohn's disease. The radiological criteria of the healthy small intestine and the findings in case of Crohn's disease are described. This method should be used in children with suspicion of a morphological disease of the small intestine, especially in Crohn's disease, for first diagnosis and for follow-up, since it enables accurate interpretation of the findings. The double-contrast technique can help to largely avoid false-positive and false-negative x-ray findings. This justifies the relatively high effort.     

Amyloidosis of the small intestine: findings on double-contrast radiographs

The appearance of the small intestinal mucosa on double-contrast barium examinations was studied in 26 patients with proved intestinal amyloidosis. Findings included innumerable fine granular densities 1-3 mm in diameter (16 patients), multiple nodular densities 3-4 mm in diameter (four patients), multiple polypoid protrusions 4-10 mm in diameter (three patients), irregularities of Kerckring folds (12 patients), and multiple erosions (eight patients). The multiple nodular densities and erosions disappeared after the patients were treated with total parenteral nutrition. The other abnormalities remained unchanged on follow-up examinations. Our results indicate that double-contrast radiographic findings of the small intestine in patients with amyloidosis include mucosal abnormalities that vary according to the pathologic type of amyloid deposition.     

Detailed per-oral small bowel examination vs. enteroclysis. Part II: Radiographic accuracy

Accuracy of the detailed per-oral small bowel series and enteroclysis was compared in 134 patients known to have (or not have) disease of the small bowel. Overall sensitivity of the per-oral examination was 92% and specificity 94%, compared to 94% and 89%, respectively, for enteroclysis. There was no difference between the two in Crohn disease, adhesions, and metastatic disease; however, enteroclysis was thought to be more effective in delineating peritoneal adhesions in patients with obstruction. The authors conclude that while the per-oral study and enteroclysis are equally valid methods of examining the small bowel, the per-oral study is preferable as a screening examination because it requires less time, has fewer side effects, and involves a lower radiation exposure.     

Non-Hodgkin lymphoma of the small intestine

The authors present a simplified radiographic classification of non-Hodgkin lymphoma involving the small intestine. The classification system is based on radiographic findings in 22 pathologically proved cases of lymphoma involving the small bowel and consists of three major forms: primary, lymphoma complicating celiac disease, and mesenteric nodal. In this series, small bowel lymphoma was evenly distributed in the jejunum and ileum. The most common radiographic patterns were circumferential lesion (seven cases), cavitary lesion (four cases), and mesenteric nodal disease invading the small bowel (seven cases). Obstructive symptoms were usually encountered with the mesenteric nodal form. Lymphoma complicating celiac disease was typified by multiple, thickened, nodular folds involving a segment of proximal small intestine.     

Double-contrast study of the small intestine using enteroclysis. Considerations on the results in 250 patients

The value of double contrast small bowel enema via duodenal intubation using barium sulphate and methylcellulose as contrast media was assessed in 250 patients. In cases of small bowel obstruction it represented the first-line investigation after a plain abdominal film. It was performed electively in patients of painful bowel syndrome, in cases of malabsorption, in cases of endoscopically or radiologically diagnosed colitis and in patients with Crohn's disease. On the basis of our results we believe double contrast small bowel enema to be the most reliable investigation in the localization and identification of small bowel lesions.     

口服肠溶气钡胶囊法在小肠双对比造影中的研究

目的：研究一种新的、简便易行的小肠双对比造影法—口服肠溶气钡胶囊法小肠气钡双对比造影。方法：采用零号肠溶空心胶囊,装入不同比例的产气粉和医用硫酸钡粉,制成Ⅰ号、Ⅱ号、Ⅲ号3种＂肠溶气钡胶囊＂（以下简称胶囊）。通过数字胃肠机直接动态观察并记录Ⅰ号、Ⅱ号、Ⅲ号胶囊在各段小肠内的定位崩解的过程以及释放CO2气体的情况,最终获得各段小肠的最佳的气钡双对比造影图像。对120名志愿者行小肠造影,随机分为研究组（60例）和对照组（60例）。研究组采用胶囊法,对照组采用传统口服钡剂法。结果：研究组49例效果满意或基本满意,11例未观察到明显双对比效果,总有效率81.67%;对照组均为单钡剂造影效果。结论：口服胶囊法小肠气钡双对比造影能形成良好的气钡双对比影像,所获图像效果较传统口服钡剂法有明显提高。