Adaptation of the ileum in nontropical sprue: reversal of the jejunoileal fold pattern

Seven cases of nontropical sprue (gluten enteropathy) are described in which there was an increase in the ileal fold pattern depicted on barium examination of the small bowel. In five of these patients there was a decrease in the jejunal fold pattern. This combination created a reversed appearance of the normal small-bowel radiographic pattern. This is a distinctive pattern for nontropical sprue and reflects the chronic inflammation and atrophy of the jejunum and compensatory hypertrophy (adaptation) of the ileum. This usually indicates long standing disease and should heighten awareness to potential malignant complications.