Abnormalities of the Small Intestine in Nutritional Disturbances: Some Observations on their Physiologic Basis

Abstract

TO the Radiological Society of North America I wish to express my keen appreciation of the invitation to give the Carman lecture at this meeting and of the honor of the introduction by the dean of Ohio radiology, Dr. Walter C. Hill. When our President, Dr. Nichols, extended this invitation he suggested that the topic for discussion be some phase of gastrointestinal radiology, the field in which Russell Carman was particularly interested and to which he contributed much. The subject under consideration is one in which I am sure Carman would be intensely interested, were he alive to-day, and to which a very important early contribution came from the department at the Mayo Clinic which he directed. When the history of the present medical age is written, the investigation of the problems of nutrition will stand out as a major achievement. Much evidence has been accumulated that, even in this land of plenty, malnutrition in its various forms is far from uncommon and that its clinical manifestations are greatly varied. Numerous writers have testified to the frequency of gastro-intestinal disturbances in malnutrition. Its early recognition and correction are of great importance. To this end roentgen methods of examination seem to be making an increasingly important contribution. In this lecture I shall attempt to discuss the disturbances in the physiology and morphology of the small intestine which are associated with abnormal nutritional conditions, and their manifestations on roentgen-ray examination. This will include a presentation of the available evidence concerning the pathologic anatomy and physiology of the intestine and an exploration of the possibilities of correlating these with the abnormalities demonstrable by roentgen methods. The term “deficiency state” will be used in a broad sense to imply a lack of some important factor necessary for the proper functioning of the organism, for example vitamin or protein, although the exact nature of the deficiency or deficiencies may not be known. Literature The first mention of the use of the barium meal in sprue was by Pillai and Murthi (1931) in India.1 In American literature, Mackie (1933) mentioned abnormalities of the small intestine in a case of sprue, and Snell and Camp (1934) published a thorough study of the changes in the small intestine demonstrable by roentgen methods in a number of cases of “chronic steatorrhea.” Mackie and Pound (1935) showed the same findings in tropical sprue, and Mackie, Miller, and Rhoads (1935) described them in association with severe chronic colitis. The writer (1936) pointed out similar disturbances in the small intestine in cases of infantile celiac disease. Snell and Camp remarked that the changes they observed were probably not specific and predicted that they would be found in other conditions. As will be shown in a later section, this prediction was correct.