The pathology of malabsorption: current concepts

Owens, Scott; Greenson, Joel K.

doi:10.1111/j.1365-2559.2006.02547.x

Cited by 89 publications

(68 citation statements)

References 206 publications

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“…Biopsies display a spectrum of features ranging from increased numbers of intraepithelial T lymphocytes with normal villous architecture to severe villous shortening and crypt hyperplasia that produce a flat mucosal surface. [8][9][10][11] Intraepithelial lymphocytosis with preserved villous architecture occurs in individuals with 'latent' gluten sensitivity and asymptomatic relatives of patients who have the disease, but it is also believed to represent an early histologic feature of gluten-sensitive enteropathy. Most of the intraepithelial lymphocytes have a CD4-negative/CD8-positive phenotype and a few are CD4-negative/CD8-negative, whereas lymphocytes in the lamina propria are mostly CD4-positive and negative for CD8.…”

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Immunohistochemical stains for CD3 and CD8 do not improve detection of gluten-sensitive enteropathy in duodenal biopsies

2013

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Patients with gluten-sensitive enteropathy usually have increased numbers of duodenal intraepithelial lymphocytes even if the villous architecture is normal. Some authors advocate the use of CD8 and CD3 immunohistochemical stains to improve detection of intraepithelial lymphocytosis, yet the added value of immunohistochemistry when biopsies appear normal remains unproven. The purpose of this study was to evaluate the utility of CD3 and CD8 immunostains in detecting intraepithelial lymphocytosis among duodenal biopsies originally interpreted to be normal based on routine evaluation. We identified 200 duodenal biopsies from 172 patients, all of which were accompanied by a clinical question of gluten-sensitive enteropathy. Five well-oriented villi from each biopsy were assessed. Intraepithelial lymphocytes present in hematoxylin and eosin (H&E)-stained slides were counted and compared with the number of CD3 and CD8 immunopositive cells present in the villous epithelium. Results were expressed as the mean number of intraepithelial lymphocytes or immunopositive cells present per 20 villous tip enterocytes. Review of H&E-stained slides revealed a mean of 2.1 ± 0.1 intraepithelial lymphocytes, compared with 3.2 ± 0.1 CD3-positive and 2.1 ± 0.1 CD8-positive intraepithelial cells (P ¼ o0.001 and 1, respectively), although none of the cases displayed sufficient numbers of intraepithelial lymphocytes to be considered abnormal (ie, Z12/20 enterocytes) by any method. The number of intraepithelial lymphocytes detected by H&E evaluation or immunohistochemistry did not correlate with results of serologic studies for markers of gluten sensitivity. We conclude that immunostains for T cell markers do not improve detection of gluten-sensitive enteropathy when H&E-stained sections are normal.

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confidence: 99%

Immunohistochemical stains for CD3 and CD8 do not improve detection of gluten-sensitive enteropathy in duodenal biopsies

2013

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“…Numerous diseases are responsible for this syndrome, and according to their etiology, they can be classified into three groups: (i) alterations of the digestive process caused by deficit of enzymes and bile acids such as in chronic pancreatitis, cystic fibrosis, and cholestatic liver diseases; (ii) alterations in uptake and transport caused by a damage of absorptive surface such as in celiac disease, CrohnЈs disease, and autoimmune enteropathy; and (iii) microbial causes such as bacterial overgrowth and parasitosis (1). The major cause of defective intraluminal digestion is pancreatic exocrine insufficiency caused by chronic pancreatitis and cystic fibrosis.…”

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Pancreatic exocrine insufficiency in LXRβ ^−/− mice is associated with a reduction in aquaporin-1 expression

Gabbi

Kim

Hultenby

et al. 2008

Proc. Natl. Acad. Sci. U.S.A.

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Liver X receptors (LXRs) ␣ and ␤ are nuclear oxysterol receptors with a key role in cholesterol, triglyceride, and glucose metabolism. In LXR␤ ؊/؊ mice on a normal diet, there is a reduction in size of perigonadal fat pad and, on high-fat diet there is resistance to obesity. In the present study, we investigated the reason for the resistance of LXR␤ ؊/؊ mice to weight gain. In LXR␤ ؊/؊ mice we found pancreatic exocrine insufficiency with reduced serum levels of amylase and lipase, reduced proteolytic activity in feces, chronic inflammatory infiltration, and, in the ductal epithelium, an increased apoptosis without compensatory proliferation. Electron microscopy revealed ductal dilatation with intraductal laminar structures characteristic of cystic fibrosis. To investigate the relationship between LXR␤ and pancreatic secretion, we studied the expression of LXR␤ and the water channel, aquaporin-1 (AQP1), in the ductal epithelium of the pancreas. In WT mice, ductal epithelial cells expressed LXR␤ in the nuclei and AQP1 on the plasma membrane. In LXR␤ ؊/؊ mice neither LXR␤ nor AQP1 was detectable. Moreover, in WT mice the LXR agonist (T2320) increased AQP1 gene expression. These data demonstrate that in LXR␤ ؊/؊ mice dietary resistance to weight gain is caused by pancreatic insufficiency and that LXR␤ regulates pancreatic exocrine secretion through the control of AQP1 expression. Pancreatic exocrine insufficiency is the main cause of malabsorption syndrome responsible for weight loss in adults and growth failure in children. Several genes are known to be involved in the pathogenesis and susceptibility to pancreatic insufficiency. LXR␤ should be included in that list.pancreas ͉ malabsorption ͉ cystic fibrosis ͉ amylase ͉ lipase

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“…These conditions are characterized by chronic allergic reaction to common cereal proteins that causes inflammation of the small intestine (Owens & Greenson, 2007). This chronic inflammation can lead to underlying malabsorption and malnutrition.…”

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Formulation and Sensory Evaluation of Gluten-Free Muffins Containing Flax

Woodyard

Tidwell

Schilling

et al. 2012

Journal of the Academy of Nutrition and Dietetics

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Celiac disease is characterized by an allergic reaction to gluten that causes inflammation of the small intestine and can lead to malabsorption and malnutrition.Gluten-free products are being developed that meet dietary needs of individuals with celiac disease. However, these products often lack whole grains and fiber. Fortification of gluten-free products with flax can increase nutritional value and alleviate inflammation. Sensory analysis (N=152) was conducted to evaluate the acceptability of gluten-free muffins with moderate (3.8%) and high (7.4%) amounts of added flax.Results indicated that consumers preferred (p<0.05) the muffin without flax or the highflax muffin more than the muffin with the moderate-flax treatment. The high-flax and control treatments were rated 6.7, between like slightly and moderately like; the muffins from the moderate-flax treatment were rated 6.4 on a nine-point hedonic scale. Producers of gluten-free products could potentially formulate muffins that include flax and are acceptable to consumers.ii ACKNOWLEDGEMENTS

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The pathology of malabsorption: current concepts

Cited by 89 publications

References 206 publications

Immunohistochemical stains for CD3 and CD8 do not improve detection of gluten-sensitive enteropathy in duodenal biopsies

Immunohistochemical stains for CD3 and CD8 do not improve detection of gluten-sensitive enteropathy in duodenal biopsies

Pancreatic exocrine insufficiency in LXRβ ^−/− mice is associated with a reduction in aquaporin-1 expression

Formulation and Sensory Evaluation of Gluten-Free Muffins Containing Flax

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The pathology of malabsorption: current concepts

Cited by 89 publications

References 206 publications

Immunohistochemical stains for CD3 and CD8 do not improve detection of gluten-sensitive enteropathy in duodenal biopsies

Immunohistochemical stains for CD3 and CD8 do not improve detection of gluten-sensitive enteropathy in duodenal biopsies

Pancreatic exocrine insufficiency in LXRβ −/− mice is associated with a reduction in aquaporin-1 expression

Formulation and Sensory Evaluation of Gluten-Free Muffins Containing Flax

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Pancreatic exocrine insufficiency in LXRβ ^−/− mice is associated with a reduction in aquaporin-1 expression