Clinicopathological analysis allowed distinct disease groups to be identified, allowing a provisional classification to be made. This straightforward approach forms a basis for future research in this exceptionally difficult paediatric condition.
SUMMARY
Background: Recent studies have shown both interleukin 2 (IL‐2) and interferon gamma (IFN) to be elevated in patients with active Crohn's disease compared to ulcerative colitis or non‐inflammatory bowel disease controls. However the effect of treatment on these lymphokines has not been studied.
Patients and methods: Using a reverse haemolytic plaque assay the percentage of lymphokine‐secreting cells was determined in the intestinal mucosa of children with Crohn's disease before and after 8 weeks of treatment with either enteral nutrition, cyclosporin or steroids.
Results: Before treatment, a high percentage of cells isolated from mucosal biopsies secreted IL‐2 or interferon‐gamma. Eight weeks’treatment with the immunosuppressive agents cyclosporin, or with corticosteroids, produced a significant reduction in the percentage of IL‐2 secreting cells, although only for the former was there also a reduction in interferon‐gamma secreting cells. Enteral nutrition however, produced a reduction in lymphokine‐secreting cells equivalent to cyclosporin and produced the best histological and clinical improvement.
Conclusion: Enteral nutrition and cyclosporin can down‐regulate lymphokine secretion in the gut in Crohn's disease.
1. Biochemical estimates of lactase, sucrase and maltase activities, carried out on intestinal biopsies appearing histologically normal, were compared with those obtained from children suffering from coeliac disease, cow's milk protein intolerance/postenteritis syndrome and the intractable diarrhoea syndrome of infancy. Lactase deficiency in these children was found to be more pronounced than sucrase or maltase deficiencies. 2. Quantitative cytochemical investigations showed characteristic disease-induced changes in the ability of enterocytes to express alpha- and beta-glucosidases, but not alkaline phosphatase activities, during migration along stunted villi. 3. Separate estimates of the time course describing hydrolase development in normal and coeliac tissue showed the initial rate of lactase appearance to be halved in coeliac patients, while that for alpha-glucosidases remained constant and that for alkaline phosphatase increased by a factor of four. Enteroblastic replacement of mature enterocytes cannot provide a general explanation for hydrolase deficiency in diseased intestine.
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