The relationship between hypoalbuminaemia and the radiological appearances of the jejunum in tropical sprue.

Hypoalbuminaemia has been implicated as a possible cause of the radiological abnormalities of the small intestine in tropical sprue. Barium follow-through examination was performed in 35 southern Indian patients with documented tropical sprue, and jejunal width and fold pattern abnormalities were compared with those of a local age-matched control group. Although hypoalbuminaemia was present in 66% of patients with tropical sprue, in only one case was an increase in jejunal calibre associated with a serum albumin concentration below 27 g/l, the threshold below which jejunal dilatation occurs in hypoalbuminaemia alone. These findings suggest that other factors, such as the extent of the mucosal injury, are likely to be more important than hypoalbuminaemia in producing jejunal dilatation in this condition. Abnormalities of fold pattern occurred more frequently than increase in jejunal calibre and appear to be a more sensitive indicator of disease.