The two-film barium meal in the exclusion of coeliac disease

Prospective experience over five years is described in assessing the two-film barium meal as a test for the exclusion of untreated celiac disease in children in order to try to make jejunal biopsy unnecessary. 287 meals were examined in children between 3 months and 10 years of age with a variety of gastro-intestinal symptoms and signs that might be attributed to celiac disease. From the two-film barium meal the calibre and transverse mucosal folds of the upper small bowel were measured. In 48 children with untreated coeliace disease there were only three (6%) with negative two-film barium meals. In 45 children with malabsorption from causes other than coeliac disease, there were four (9%) with negative two-film barium meals. It is concluded that the two-film barium meal is a reasonably reliable test for the exclusion of untreated coeliac disease in children. It is simple, cheap, safe and economical of radiological time, and it compares favourably in accuracy with other screening tests, other than jejunal biopsy.