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The barium enema showed free flow of barium from the rectum to the caecum with no colonic lesion. Barium is shown to reflux into the terminal ileum, which shows increased number and thickness of folds in keeping with the appearance of “jejunisation” (as shown in fig 2). The diagnostic procedure was a duodenal biopsy, which showed severe villous blunting and numerous intraepithelial lymphocytes consistent with coeliac disease.

Reversal of the normal fold character between the ileum and jejunum often occurs in coeliac disease. Whereas there are fewer jejunal folds per unit length, the number and thickness of the folds in the ileum increases (that is, “jejunisation of the ileum”). This is seen in our case due to reflux of the barium into the terminal ileum. This change is thought to be due to the ability of the ileum to assume functions normally performed by the jejunum, a process of adaptation.

Figure 2

 “Jejunisation” of the ileum.

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