The small bowel barium follow-through versus jejunal biopsy in the diagnosis of coeliac disease

Masterson and Sweeney (1976) recommend a barium follow-through as the initial investigation of patients suspected of having coeliac disease. The age of their patients is not stated; they may well have been adults but I think few paediatricians will agree with their statement. Many screening tests have been advocated in the hope of avoiding jejeunal biopsy but an accurate diagnosis can only be made on histological grounds. The full diagnostic criteria for coeliac disease should be the demonstration of an abnormal small intestinal mucosa by biopsy followed by a histological response to a gluten-free diet and finally the demonstration of a histological relapse following a gluten challenge.