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

Pollock, D. J.; Nagle, R. E.; Jeejeebhoy, K. N.; Coghill, N. F.

doi:10.1136/gut.11.7.567

Cited by 19 publications

(14 citation statements)

References 29 publications

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“…It is now accepted that the fundamental criterion as to whether a patient is remaining on a strict glutenfree regime is the response of the intestinal mucosal histology (Pollock, Nagle, Jeejeebhoy, and Coghill, 1970). Thus the clear histological differences demonstrated between the gluten-free and nongluten-free diet groups on repeat biopsy in this study (figs 2a, b, and c) confirms the accuracy of the dietary history obtained in the group as a whole (fig 1).…”

Section: Discussionsupporting

confidence: 79%

Coeliac disease during the teenage period: The value of serial serum folate estimations

Weir¹,

Hourihane²

1974

Gut

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SUMMARY A group of teenage coeliac patients has been followed at three monthly intervals in the Outpatient Department to assess their progress and also to monitor their ability to maintain a gluten-free diet. After a follow-up period of four to six years a detailed reassessment was carried out in hospital on 10 patients, only five of whom had persevered with a gluten-free diet. The jejunal mucosal histology of those patients who did not persist with a gluten-free diet remained 'flat' although these patients appeared to have remitted clinically. Those subjects who did persist with a gluten-free regime had a normal or near normal mucosal histology. It was difficult on the basis of clinical, haematological, or biochemical criteria to separate the two groups. The best single assessment of whether these patients were maintaining a gluten-free diet was serial serum folate estimations. It is often extremely difficult to say whether teenage coeliac patients are keeping to their diet unless repeated jejunal biopsies are obtained, and this study suggests that serial serum folate estimations can act as a reasonable criterion of whether subjects are maintaining a gluten-free regime.It is now apparent that the sensitivity of the jejunal mucosa to gluten in coeliac patients is not confined to the paediatric period but is probably present throughout life (Sheldon and Tempany, 1966;Mortimer, Stewart, Norman, and Booth, 1968;Sheldon, 1969). Accordingly it is in the best interest of these patients that they should remain on a glutenfree diet both from the point of view of their general health and because the 'flat' intestinal mucosa which results from a gluten challenge in these subjects is a premalignant lesion (Gough, Read, and Naish, 1962;Harris, Cooke, Thompson, and Waterhouse, 1966;Austad, Comes, Gough, McCarthy, and Read, 1967;Brunt, Sircus, and MacLean, 1969). It is probable that withdrawing gluten from the diet on a permanent basis will protect them from the tendency to malignant change (Harris, Cooke, Thompson, and Waterhouse, 1967

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Section: Discussionsupporting

confidence: 79%

Coeliac disease during the teenage period: The value of serial serum folate estimations

Weir¹,

Hourihane²

1974

Gut

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“…This method should be regarded as more reliable than the linear measurements used in some of the previous studies [13,25] which involve the subjective decision as to where the villus ends and the crypt begins [7]. High degrees of subjective involvement imply high levels of interobserver variation [6], which could explain the discrepancy on mean villous height among the controls quoted by Webster and Leaning [25] and those of the more recent studies mentioned above [18,20,22].…”

Section: Discussionmentioning

confidence: 57%

“…The main villous height in their sixteen geriatric pa tients was 371 pm, significantly lower than the mean (471 pm) of previously reported villous height values for healthy adult con trols. However, more recent studies [18,20,22] reported mean villous height values in healthy adult subjects very close to those of the geratric patients studied by Webster and Leeming [251.…”

Section: Discussionmentioning

confidence: 99%

Ageing and Small-Bowel Mucosa: A Morphometric Study

Frazzoni¹,

Gatto²,

Gasbarrini³

1986

Gerontology

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A direct effect of ageing in reducing mucosal surface area of the small intestine is still disputed. The aim of this study was to morphometrically evaluate a panel of jejunal biopsy specimens obtained from 16 elderly patients and 22 younger controls, all complaining of abdominal symptoms but without evidence of malabsorption and/or malnutrition in either group. Quantitative histology was performed by calculating the surface area to volume ratio of jejunal mucosa and the mean enterocyte height. The mean of surface to volume ratios in geriatric patients (97.6 ± 18), although slightly reduced, did not significantly differ from that of younger controls (107.6 ± 26) and no significant correlation was found between surface to volume ratio and age in years. The mean enterocyte height in the elderly group (30.1 ± 1.2 μm) did not significantly differ from that of younger controls (31.3 ± 2.3 μm). In conclusion, the frequent finding of malnutrition due to malabsorption in the elderly should not be attributed to a reduction of jejunal surface area as a mere consequence of age.

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“…The morphometric data for these treated gluten-free coeliacs is similar to the controls. This suggests that dietary exclusion of gluten heals the lesion, at least in children (Anderson, 1960;Pollock et al, 1970).…”

Section: The Patientsmentioning

confidence: 95%

“…Quantitation of serial biopsies in coeliac individuals reflects the effects of gluten challenge (figs 7 and 8), useful diagnostically and for monitoring of progress (Pollock et al, 1970;Meeuwisse, 1970;Anderson, Gracey, and Burke, 1972). Sixteen children with suspected coeliac disease had been treated empirically by gluten-free diet for at least two years.…”

Section: The Patientsmentioning

confidence: 99%