Peroral Jejunal Mucosal Biopsy in Dermatological and Some Non-Diarrhoeal Diseases

Abstract

By the use of the Crosby-Kugler capsule jejunal mucosal biopsies have been obtained from patients with various skin disorders and non-diarrhoeal gastrointestinal diseases. A preliminary report is presented regarding the correlation between stereomicroscopic and light microscopic findings.Cutaneous manifestations of internal disease are well known topics of common interest and scientific investigation. The subject interests not only dermatologists, but also workers of other disciplines of medicine. Much interest is currently being evinced on the inter-relationship between skin manifestations and alimentary disorders and there is much speculation as to whether these conditions are causally related or coincidental. Wells (1962) was probably the first to publish in recent times a review of skin diseases in relation to malabsorption. He relates a number of dermatoses -• including eczema, acrodermatitis enteropathica, exfoliative dermatitis, psoriasis and pigmentation-to small bowel disorders. Watson et al. (1965) observed abnormal jejunal mucosae in 33% of patients with rosacea. Sinister and Marks (1965) demonstrated that widespread skin disease could be associated with steatorrhaja which is reversible on clearing up the skin disease to which they gave the name "dermatogenic enteropathy". Hindle and Creamer (1965) suggested that a common cause may operate for both the skin and intestinal changes at the same time.The mucosa of the small intestine has since been extensively studied by Fry et al. (1966) in eczema, psoriasis and ichthyosis; Sinister et al. (1967) in psoriasis andMarks et al. (1966) in dermatitis herpetiformis. It is of interest that in a subsequent publication Marks and Sinister (1970) commented that contrary to their earlier recordings, the frequency of the abnormal small intestinal mucosal appearance observed at stereomicroscopy in psoriasis is not significantly different from that observed in a control group.Apart from the study of the morphology of the jejunal mucosa, there has always been the difficulty of finding a simple and reliable screening test for malabsorption in office practice, particularly so, in skin diseases. Knowles et al. (1963) have pointed out that FIGLU test is frequently positive in patients with skin disease, the folic acid deficiency being probably due to the increased demand for the substance by the skin rather than due to