Small intestinal biopsy in childhood coeliac disease

Histological studies of small-intestinal biopsies from infants with low rate of weight gain

Eighty-one children aged 4-18 months with unsatisfactory weight gain were investigated for organic diseases; the investigation included small-intestinal biopsy. Sixteen had total villous atrophy, in most cases due to gluten intolerance. Transient disease, e.g. cow's milk protein intolerance, was probable in 7 children with subtotal atrophy. In 18 children the only abnormal finding was an increased number of inflammatory cells in the mucosa, a finding which was probably of no clinical significance. Planimetric measurement showed good agreement between the mucosal surface/volume ratio and an ordinary histological grouping of the mucosa. A significant correlation was found between the rate of weight gain during the period preceding investigation and mucosal surface/volume ratio.

Morphological and histochemical changes in the mucosa of the continent ileostomy reservoir 6--10 years after its construction

Morphological and histochemical changes in the mucosa of the continent ileostomy reservoir were studied in 13 patients who had been provided with a continent ileostomy reservoir 6--10 years before the investigation. Biopsy specimens were taken for evaluation of basal morphology, morphometry, and enzyme histochemical analyses. The villi were predominantly finger-like, but the villus height was reduced compared with normal. The crypt layer and the number of cells in each crypt were increased. The number of mitoses was normal or slightly subnormal. In comparison with biopsies taken 1 year after construction of the reservoir, there was an increase in villus height and mucosal volume and a decrease in the number of mitoses, whereas the number of cells per crypt was unchanged. The surface to volume ratio decreased progressively during the 6- to 10-year period. This decrease was partly caused by an increase of the mucosal volume. The epithelial cell layer was intact, and no changes were seen in the microvillus layer. No alarming changes in terms of dysplasia, fibrosis, or progressive atrophy were found. Histochemical investigation showed a high enzymatic activity in the epithelial cells as concerns both the oxidative metabolism and the secretory function.

Gluten challenge in treated coeliac disease

Thirty-two children with a past diagnosis of coeliac disease were reinvestigated by means of gluten challenge. They had received a gluten-free diet for a mean period of 6-5 years (range 0-25-11-0) before gluten challenge, and had a mean age of 9-9 years (range 3-0-15-3) at the onset of challenge. Small intestinal biopsies were performed before and after the gluten challenge (at least 10 g natural gluten per day for 3 months in the majority) and, as judged by light microscopy and morphometric techniques, coeliac disease was confirmed in 25 (78%) of the 32 patients; challenge was continued in the remaining 7 for a total period of 2 years when biopsies were repeated in 6 children and all were normal. Serum and RBC folate, serum iron, Hb level, and clinical symptoms were unpredictable variables in identifying children who developed gluten-induced enteropathies. The social and emotional effects of gluten challenge are discussed. The results highlight the importance of gluten challenge and intestinal biopsy in the diagnosis of coeliac disease and strongly suggest that a normal biopsy after a 3-month gluten challenge (as described above) excludes coeliac disease.