Mucosal enzyme activity as a quantitative index of early functional improvement in the management of coeliac disease and other small intestinal diseases.

Abstract

Summary: The levels of alkaline phosphatase and the three disaccharidases, sucrase, lactase and maltase, have been measured in biopsy specimens from jejunal mucosa. Patients with small intestinal diseases have been compared with a control population consisting of patients and volunteer subjects. This quantitative index of mucosal function has been used to assess the early response to specific therapy of small intestinal diseases, including coeliac disease, giardiasis and Whipple's disease. Biopsies from 13 patients with untreated coeliac disease showed a marked reduction of all enzymes studied. In most of these patients the results were well outside the normal range. Lactase concentration was most severely reduced. In eleven patients studied following commencement of a gluten free diet, mucosal enzyme levels were significantly higher and frequently within the normal range. Lactase levels, although higher than in untreated patients, usually remained below normal values. In eight patients with coeliac disease, mucosal biopsies were compared before and after commencement of a gluten free diet. The repeat biopsies were taken as early as six weeks following commencement of treatment. In all patients mucosal enzyme levels were significantly increased although histological changes were frequently difficult to recognize.