The X-ray Diagnosis of Coeliac Disease

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Abstract
Much of the modern conception of the behaviour of barium sulphate suspensions in the small intestine dates from the work of Frazer, French and Thompson (1949). Previously, it had been a general belief that the contrast medium faithfully recorded the shape of the lumen of the bowel. Thus, in the socalled “deficiency pattern”, it was considered that segments of dilated bowel, with deficient or altered mucosal folds, were interspersed with segments that were narrowed or spastic (Golden, 1945). Frazer and his colleagues, however, were able to induce similar changes in normal subjects by giving a variety of substances in addition to a simple aqueous barium sulphate suspension. Amongst these substances were fatty acids and hypertonic solutions of sodium chloride, sodium bicarbonate and glucose. Corresponding studies were made in vitro and it was found that alimentary mucus was a potent cause of clumping. When a simple barium sulphate suspension was mixed with mucus in an autopsy specimen of small intestine, clumping could be demonstrated radiographically; the pattern obtained bore no relationship to the true shape of the bowel and could not have been due to the presence of alternating segments of spasm and dilatation. From this, it was suggested that hypertonic solutions and fatty acids induced clumping by stimulating the production of an excess of mucus in the small intestine and that a similar excess also occurred in steatorrhoeas such as the sprue syndrome.