Small Intestinal Mucosal Biopsies Research Articles

Protracted diarrhea of infancy treated by intravenous alimentation. II. Studies of small intestinal biopsy results.

Small intestinal mucosal biopsies were performed on 11 of 16 infants treated with intravenous alimentation. Histologic alterations varied from severe (six of 11) to relatively normal (two of 11). The disaccharidase activities correlated well with histologic appearance. Unusual features included increased eosinophilic infiltration (seven patients), which was associated with the high incidence of intestinal allergy. Response of the small intestinal mucosa to intravenous nutrition varied widely. Histologic and disaccharidase recovery ranged from four weeks to over 18 months. The clinical response to intravenous alimentation occurred more rapidly than recovery as seen on intestinal biopsy.

A method for the quantitation of small intestinal biopsy specimens.

A simple method is described for the quantitative examination of small intestinal mucosal biopsies involving the determination of an index related to the surface-to-volume ratio of the mucosa. The method is of value in distinguishing minor degrees of villous abnormality and will prove useful in comparing serial changes in a given patient. It will also allow comparisons to be made between biopsies taken in different medical centres.

Small intestinal morphology in aboriginal children.

Summary: Small intestinal morphology of 44 small intestinal mucosal biopsies taken from Australian aboriginal children were examined histologically, and also freshly with the dissecting microscope. The findings were compared with similar observations made in 91 biopsies from control Australian children of European descent. The morphological appearances using each method of examination were placed into grades or groups and the two methods compared.An increased prevalence of abnormal mucosae was found in the biopsies from aboriginal children as compared to biopsies from the controls, yet only one had the typical appearances found in coeliac disease. Six aboriginal children, however, appeared to respond to a gluten‐free diet. In three this intolerance to gluten appeared to be transient, but in the remainder appeared to be more permanent. Further observation is necessary to establish the diagnosis of coeliac disease in these children.Histological assessment and examination with the dissecting microscope complement each other, however, a particular histological grade did not correspond always to a particular dissecting microscope group, but rather to a range.

LACTASE DEFICIENCY IN PATIENTS WITH CYSTIC FIBROSIS

Disaccharidase (lactase, maltase, sucrase, and palatinase) assays were performed on small intestinal mucosal biopsies obtained from 28 patients with cystic fibrosis and 90 controls. Seven patients with cystic fibrosis showed a significant reduction in lactase activity with normal values for sucrase, maltase, and palatinase. In the remaining 21 patients the enzymatic activities, expressed in units per gram of wet weight of tissue and per gram of protein, were comparable with the 90 controls. The mucosal histology showed normal villous structure. Oral tolerance tests for glucose revealed excellent absorption in all cases tested. Patients with cystic fibrosis having normal lactase activity also had good lactose absorption. However, in the patients with lactase deficiency, flat oral lactose tolerance tests were found. Five of the seven patients with lactase deficiency were able to tolerate some lactose, whereas two others were very intolerant and required elimination of lactose from their diet. This study brings out the high incidence of intestinal lactase deficiency in patients with cystic fibrosis and suggests that the lactase deficiency may be a primary genetic disorder. At present no explanation for this genetic association is available.

Small Intestinal Biopsies

We wish to comment on the last two paragraphs of R. R. Townley's excellent article, "Quantitative Assay of Disaccharidase Activities of Small Intestinal Mucosal Biopsy Specimens in Infancy and Childhood." Although our experience with the biopsy procedure is somewhat less (176 biopsies) than that of Dr. Townley and his associates in Victoria and Boston, it has been collected entirely with the Crosby-Kugler capsule. We believe we are correct that many, if not the majority, of the 500 biopsies composing the composite series mentioned in Dr. Townley's paper were obtained with the Rubin biopsy tube, since that is the instrument most extensively used in Victoria and in Boston until relatively recently.

Gluten Enteropathy Appearing After Gastric Surgery

Four patients with severe malabsorption syndrome precipitated by gastric surgery are described. The clinical features were diarrhea, steatorrhea, and a dramatic weight loss promptly following surgery. Laboratory determinations were consistent with malabsorption syndrome. Small intestinal mucosal biopsy demonstrated villous atrophy and inflammatory cell infiltration. In each instance, a gluten-free diet led to clinical improvement and a return toward normal of the laboratory measures of absorptive function. The appearance of the proximal intestinal mucosal histology improved in 3 cases. These findings indicate that evaluation of small bowel function should be undertaken prior to gastric surgery in patients with a family or past history of celiac disease, or symptomatology suggestive of an absorptive defect. Furthermore, this study emphasizes the importance of adequate evaluation of the small intestine in patients with steatorrhea following gastric surgery. Although malabsorption in the postgastrectomy patient may result from disruption of intraluminal digestive processes, the recognition of a concomitant gluten enteropathy can lead to lifesaving dietary therapy.

Enteritis and gastritis in young asymptomatic Pakistani men.

In a study of peroral gastric and small-intestinal mucosal biopsies from 50 asymptomatic young men in a West Pakistan institution, a mild-to-moderately-severe chronic enteritis was seen in all specimens of small intestinal mucosa. Of 41 subjects studied, 29 had chronic superficial gastritis, and of 29 subjects, all had antral gastritis. No specific cause for these lesions was demonstrated. These studies seem to exclude hookworm infection as the cause of the lesions.