Morphology and functional cytology of the small intestinal mucosa in malabsorptive disorders and other diseases

Abstract

SYNOPSIS Small intestinal biopsies from 98 patients have been studied macroscopically, histologically, and histochemically, and the results correlated with laboratory and clinical observations. Neither a convoluted nor a flat mucosa can be considered diagnostic for any specific disease. A flat mucosa was found in one adult with intestinal Hodgkin's disease and in another following total gastrectomy.Histochemically all specimens from subjects with coeliac disease and idiopathic steatorrhoea showed a deficiency of succinic dehydrogenase in the epithelial cells, and the histochemical test for this enzyme, although not specific, may be a useful aid to diagnosis, since the degree of deficiency in these diseases was usually grosser than that in any other conditions. Other but variable enzyme deficiencies that may be present in these two diseases showed no correlation with the reduction of succinic dehydrogenase activity, nor was there any correlation between reduced enzyme activities and the severity or otherwise of the clinical features.A number of specimens from patients with conditions other than coeliac disease and idiopathic steatorrhoea that had a normal macroscopic appearance showed some reduction of intracellular enzyme activities histochemically. This was not so in the control group, and if these deficiencies can be confirmed biochemically, then histochemical tests may give an earlier indication of disordered function than macroscopical or routine histological examination.At present neither the macroscopic appearance nor any single histological or histochemical test on the biopsy specimen is diagnostic for a particular disease. These findings must be considered with the clinical details and results of other investigations in establishing a diagnosis.The fact that there are morphological changes in the mucosa of the small intestine in primary malabsorptive disorders, i.e., idiopathic steatorrhoea, coeliac disease, and tropical sprue, is now well established (e.g.

Metabolic abnormalities of gastrointestinal mucosa in celiac disease: An in vitro proton nuclear magnetic resonance spectroscopy study

“…Succinate is an intermediate metabolite of Krebs cycle and is converted to fumarate through dehydrogenation reaction, which is catalyzed by the enzyme succinate dehydrogenase. Histochemical studies have documented a deficiency of succinate dehydrogenase in the enterocytes of patients with CeD and idiopathic steatorrhea . A reduction of succinate dehydrogenase might lead to a decrease in mitochondrial activity and decreased energy.…”

The effect on jejunal mucosa of withdrawing and adding dietary gluten in cases of idiopathic steatorrhoea

“…Observation of the changes described may be particularly useful in clarifying aetiology in the patient suffering from idiopathic steatorrhoea whose clinical state and steatorrhoea do not improve on a gluten-free diet. Such measurements may also be of value in elucidating the nature of jejunal mucosal changes in patients who have other disease (Townley, Cass, and Anderson, 1964;Johnstone and Adams, 1964;Creamer, 1964 andGjone, Myren, and Refsum, 1965;Lee, 1966;Fry and McMinn, 1966;Marks, Shuster, and Watson, 1966;Shuster, Watson, and Marks, 1968 The biopsies were taken in three treatment periods, I, II, and III, as well as in the pretreatment period, P, andin the gluten loading period, G. The changes in the mucosa were analysed for the intervals from P to each of I, II, III, and G; from I to II; and from III to G. None of the patients had a biopsy in every one of the five periods and some patients had more than one biopsy in a given period. These replicates were deleted so that, at most, one biopsy was recorded in each period, the dates being chosen so as to equalize the time intervals as much as possible.…”

Enzyme histochemistry of the small intestine in inherited ichthyosis

“…cases, and also some morphological alterations of the intestinal mucosa for some patients from the same group. Fry & McMinn (7) suggested that the histochemical suc cinic dehydrogenase te t may be useful to detect metabolic activity alterations in the inte tina! epi thelial cell!>, especially as an aid in the diagnosis of idiopathic steatorrhea.…”