SUMMARY To assess the course of recovery ofgluten sensitive enteropathy in adults, histological and functional recovery was studied in 22 patients, aged 20-79 years. Biopsy specimens taken at the time of diagnosis were studied in 20; after adhering to a gluten free diet for nine to 19 (mean 14) months in 14; and after adhering to the same diet for 24-48 (mean 34) months in 10 patients. Histological recovery was assessed morphometrically in the proximal jejunum. Mucosal linings significantly improved over time, but did not completely return to normal with a gluten free diet: at diagnosis the surface:volume ratio was 22% of normal, increasing to 48% and 66% after nine to 19 and 24-48 months, respectively, ofa gluten free diet. Disaccharidase activities progressively increased. After 24-48 months maltase, sucrase, and isomaltase had returned to normal in the proximal jejunum; they were still significantly decreased in the distal duodenum. Duodenal and jejunal lactase activities were both below normal after 24 to 48 months.It is concluded that recovery of the intestinal mucosa of adults with gluten sensitive enteropathy during a gluten free diet continues beyond nine to 19 months and is still incomplete after two to four years. The recovery of disaccharidase activities extends from the distal to the proximal part of the small intestine, and is aligned to histological recovery.Gluten sensitive enteropathy or coeliac sprue is characterised by severe villous atrophy of the small intestinal mucosa; it responds favourably to the withdrawal of dietary gluten. Gross villous architecture and absorptive cells are severely damaged, and many enzymes, necessary for the digestive-absorptive process, are severely depleted. This is especially true for brush border enzymes like the disaccharidases maltase, sucrase, isomaltase, and lactase. To what degree the mucosa will recover during a gluten free diet is still a matter ofcontroversy: morphological changes occur and disaccharidases increase after gluten withdrawal. Most investigators have found that although some patients show complete histological and functional recovery during the diet, most still show some degree of histological and functional damage, even after adhering to the diet for several years.'Within days or weeks of starting a gluten free diet a clinical response can be detected. This is also true for some of the histological and functional abnormalities: soon after gluten withdrawal the height ofthe mucosal surface cells increases6 and partial return to normal of organelles is observed.7 The recovery of the villous Accepted for publication 17 March 1988 architecture is known to occur much more slowly, but so far no studies have emphasised the course of this slow recovery. Little is known with certainty about the rate and course of recovery of the disaccharidases and other brush border enzymes.There is good evidence to suggest that the most severe histological damage is found in the proximal small intestine in untreated coeliac disease28 and that during treatment, t...
Injury to the small bowel is one of the tragic complications of radiotherapy. We performed a retrospective analysis of patients operated upon for stenosis, perforation, fistulization, and chronic blood loss of the small bowel after radiotherapy for multiple malignant diseases. In the period 1970 to 1982 in the Department of General Surgery of the St. Radboud University Hospital, Nijmegen, and the Department of Surgical Oncology of the State University, Groningen, 27 patients were treated surgically. Twenty patients presented with obstruction. In 17 patients a side-to-side ileotransversostomy was performed; in three the injured bowel was resected. Of the five patients with fistulization, three underwent a bypass procedure; in two cases the affected bowel was resected. In one patient with perforation, a resection was performed, as in a patient with chronic blood loss. Two of the 20 patients (10 per cent) in whom the diseased bowel was bypassed died postoperatively. Of the seven patients whose affected bowel was resected four (57 per cent) died of intra-abdominal sepsis. Management of the patient with chronic radiation enteritis is discussed. We conclude, on the basis of our experience, that in patients with obstruction and fistulization, a bypass procedure of the affected bowel is a safe method of treatment. In case of resection, the anastomosis should be performed during a second operation.
Two double-blind, placebo-controlled studies were performed successively to demonstrate the efficacy of Eburnamonine. In the first study, the efficacy of 12 weeks of administration of 3 X 60 mg Eburnamonine per day (n = 25) was investigated in 49 inpatients with cerebrovascular disorders. In the second, the effect of 12 weeks of therapy with 1 X 60 mg Eburnamonine per day (n = 25) was investigated in 50 patients of the same diagnostic category. Results related to the efficacy were analyzed on the basis of the physician's global rating of therapeutic effect, and evaluated by the x2-test. Global therapeutic effect was confirmed and illustrated by effects on specific variables (List of Cerebral Symptoms, function test, NOSIE) evaluated by analysis of covariance. Under the influence of both dosages, therapeutic improvement was observed more frequently than under placebo. The incidence of gastrointestinal side effects was higher under the dose of 3 X 60 mg than under placebo. No effects were observed with respect to parameters of clinical chemistry. In the quasi-experimental comparison of 3 X 60 mg and 1 X 60 mg Eburnamonine, the higher dose was found to yield more therapeutic improvement, but also more frequent side effects than the lower dose, which, in this respect, did not differ from placebo.
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