Radiological changes of the ileum in children with coeliac disease: is "intestinal adaptation" a specific radiographic sign?

We retrospectively reviewed the radiographic findings of 86 children with chronic diarrhoea and/or short stature. Radiographic small intestine examination showed morphologic changes characteristic for the malabsorption syndrome in 58 children with coeliac disease on a gluten-containing diet. In addition, 32 (55%) of these children showed "intestinal adaptation" or "jejunalization" (increase in the number and thickness of the folds). In the control group (28 children, cross-matched) 11 (39%) presented non specific radiological changes while the others presented a normal mucosal pattern. No features of "intestinal adaptation" were noted. No significant differences between CD patients with and without "intestinal adaptation" were found in the evaluation of the nutritional status, including serum levels of albumin, iron, transferrin, ferritin and zinc, and in the results of the one-hr xylose test and 72-hr faecal fat absorption test, and anti-gliadin antibody levels (IgA and IgG). No significant correlation was noted between the duration of gluten-containing diet and the presence of "intestinal adaptation". It appears that "intestinal adaptation" lends specificity to the radiographic small intestine examination, also in paediatric practice.