Computed tomography of the small bowel in adult celiac disease: the jejunoileal fold pattern reversal

The aim of this retrospective study was to establish whether the distinctive intestinal fold pattern of celiac disease (CD), known by barium studies as jejunoileal fold pattern reversal (JFPR) may be recognized at CT. The number of intestinal folds per 2.5 cm, seen at CT, were counted in the jejunum and in the ileum of 22 adult patients with CD and compared with the folds of 30 consecutive subjects in whom an intestinal disease had been excluded. The results were submitted to statistical analysis by Students t-test. In the control group the number of folds -2.5 cm were 4.88 (SD +/- 0.78) in the jejunum and 2.84 (+/- 0.62) in the ileum; in the CD group the number of folds were 2.42 (+/- 1.61) in the jejunum and 5.11 (+/- 11.24) in the ileum. There was a statistically significant difference in the number of jejunal and ileal folds between the CD patients and the control group (in both cases p < 0.001). The JFPR was seen 15 patients with CD (68.2 %) but in none of the controls. Our study shows that JFPR is not a normal finding and can be demonstrated by CT in the majority of patients with CD.