SMALL-INTESTINAL AND GASTRIC ABNORMALITIES IN ULCERATIVE COLITIS

A case of small-intestinal mucosal atrophy

A patient is described with a severe malabsorption syndrome which failed to respond to a gluten-free diet. Although subtotal villous atrophy was present in the jejunal mucosa, histological features of subepithelial fibrosis and apparently normal enterocytes were not suggestive of coeliac disease. The findings of decreased mucosal thickness, of a normal mitotic rate in the crypt cell population, and of the decreased rate of loss of epithelial cells further suggested that the disease process producing the ;flat' mucosa was not that of coeliac disease. The condition was complicated by ileal ulceration and active tuberculosis.

Small intestinal mucosal abnormalities in relatives of patients with dermatitis herpetiformis

Jejunal biopsy has been carried out in 19 relatives of patients with dermatitis herpetiformis and stereomicroscopic abnormalities have been found in seven. The majority of the relatives in whom these abnormalities were found had no bowel symptoms: one had the rash of dermatitis herpetiformis. All but one of the propositi of the relatives in whom were found small intestinal mucosal abnormalities themselves had the coeliac syndrome. It is concluded that a genetic factor is involved in the production of the enteropathy of dermatitis herpetiformis as in other forms of the coeliac syndrome.

Incidence and clinical significance of lactose malabsorption in ulcerative colitis and Crohn's disease

The incidence of lactose malabsorption was investigated in 85 patients with ulcerative colitis and 71 patients with Crohn's disease by means of lactose tolerance tests and disaccharidase determinations in small intestinal mucosa. Eight patients with ulcerative colitis (9%) and four with Crohn's disease (6%) had lactose malabsorption. A control group displayed a similar incidence. It is concluded that lactose malabsorption is not particularly common in ulcerative colitis and Crohn's disease. If it is present, its aetiology seems to be unrelated to the intestinal disease. Transitional lactose malabsorption was detected in two cases during a relapse of ulcerative colitis. Institution of a lactose-free (or lactose-poor) diet was an important supporting measure in seven patients who were unaware of their milk intolerance, in particular in two with ileostomy. Therefore, it is recommended that a lactose tolerance test should always be performed in patients with ulcerative colitis or Crohn's disease.Twenty-one patients with ulcerative colitis and nine with Crohn's disease, none of whom had lactose malabsorption, were placed on milk-free diets. A beneficial effect was noticed in five of the patients with ulcerative colitis, and in three of those with Crohn's disease. The mechanism is unknown. Evidence is presented that milk allergy is not responsible for the beneficial effect of a lactosefree diet in patients with associated lactose malabsorption.

Dermatogenic enteropathy

Steatorrhoea has been found in a large proportion of patients with inflammatory dermatoses, especially eczema and psoriasis. It is due to the rash itself and disappears rapidly after topical treatment of the skin. This particular enteropathy, unlike that associated with dermatitis herpetiformis, is not accompanied by an alteration in the stereomicroscopic appearance of the small bowel mucosa. The mechanism is not known. It is important to differentiate dermatogenic enteropathy from gluten sensitivity which has produced a rash, as in the former condition a gluten-free diet is not indicated.

Small-intestinal mucosal abnormalities in various skin diseases--fact or fancy?

Two-thirds of patients with dermatitis herpetiformis have been found to have a flat or convoluted mucosa but no special association has been found in the other dermatoses studied with structural alterations in the small bowel mucosa. The frequency distribution of the predominant and individual small intestinal mucosal features is the same in the patients in the present series with eczema, psoriasis, and rosacea as in the local control population. A predominantly convoluted mucosa has been found in the upper small intestine in 8% of these patients and in 8% of subjects without a rash. The presence of convolutions in patients with these dermatoses is merely a reflection of the incidence in the normal population of Newcastle upon Tyne. Different findings in the same skin disease in different parts of the country are explicable on the basis of variations in the normal mucosa between one geographical region and another. The increased incidence of a convoluted mucosa in the north east of England requires further study to determine whether it is indicative of an increased incidence of the coeliac syndrome in the region, or whether it results from a minor population difference or a local peculiarity of diet.

Jejunal transport of electrolytes and water in intestinal diseases

The role of decreased absorption of electrolytes and water by the jejunum in the pathogenesis of diarrhoea was examined in patients with intestinal scleroderma, ileocolitis, gastric hypersecretion, or extensive ileal resection. Absorption of electrolytes and water from a 20-cm segment of jejunum was compared in 10 patients and six healthy volunteers. Malabsorption of electrolytes and water by the jejunum may contribute to diarrhoea in scleroderma, regional enteritis, and gastric hypersecretion. After ileal resection, jejunal absorption was normal.

Hypogammaglobulinemia, thymoma and ulcerative colitis

Images