PMCCPMCCPMCC

Search tips
Search criteria 

Advanced

 
Logo of jclinpathJournal of Clinical PathologyVisit this articleSubmit a manuscriptReceive email alertsContact usBMJ
 
J Clin Pathol. 1988 August; 41(8): 886–891.
PMCID: PMC1141622

Slow and incomplete histological and functional recovery in adult gluten sensitive enteropathy.

Abstract

To assess the course of recovery of gluten sensitive enteropathy in adults, histological and functional recovery was studied in 22 patients, aged 20-79 years. Biopsy specimens taken at the time of diagnosis were studied in 20; after adhering to a gluten free diet for nine to 19 (mean 14) months in 14; and after adhering to the same diet for 24-48 (mean 34) months in 10 patients. Histological recovery was assessed morphometrically in the proximal jejunum. Mucosal linings significantly improved over time, but did not completely return to normal with a gluten free diet: at diagnosis the surface: volume ratio was 22% of normal, increasing to 48% and 66% after nine to 19 and 24-48 months, respectively, of a gluten free diet. Disaccharidase activities progressively increased. After 24-48 months maltase, sucrase, and isomaltase had returned to normal in the proximal jejunum; they were still significantly decreased in the distal duodenum. Duodenal and jejunal lactase activities were both below normal after 24 to 48 months. It is concluded that recovery of the intestinal mucosa of adults with gluten sensitive enteropathy during a gluten free diet continues beyond nine to 19 months and is still incomplete after two to four years. The recovery of disaccharidase activities extends from the distal to the proximal part of the small intestine, and is aligned to histological recovery.

Full text

Full text is available as a scanned copy of the original print version. Get a printable copy (PDF file) of the complete article (819K), or click on a page image below to browse page by page. Links to PubMed are also available for Selected References.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • BOLT RJ, PARRISH JA, FRENCH AB, POLLARD HM. ADULT COELIAC DISEASE. HISTOLOGIC RESULTS OF LONG-TERM LOW GLUTEN DIET. Ann Intern Med. 1964 Apr;60:581–586. [PubMed]
  • MACDONALD WC, BRANDBORG LL, FLICK AL, TRIER JS, RUBIN CE. STUDIES OF CELIAC SPRUE. IV. THE RESPONSE OF THE WHOLE LENGTH OF THE SMALL BOWEL TO A GLUTEN-FREE DIET. Gastroenterology. 1964 Dec;47:573–589. [PubMed]
  • Welsh JD, Zschiesche OM, Anderson J, Walker A. Intestinal disaccharidase activity in celiac sprue (gluten-sensitive enteropathy). Arch Intern Med. 1969 Jan;123(1):33–38. [PubMed]
  • Berg NO, Dahlqvist A, Lindberg T, Nordén A. Intestinal dipeptidases and disaccharidases in celiac disease in adults. Gastroenterology. 1970 Oct;59(4):575–582. [PubMed]
  • Peña AS, Truelove SC, Whitehead R. Disaccharidase activity and jejunal morphology in coeliac disease. Q J Med. 1972 Oct;41(164):457–476. [PubMed]
  • KALANT H, SERENY G, CHARLEBOIS R. Evaluation of tri-iodothyronine in the treatment of acute alcoholic intoxication. N Engl J Med. 1962 Jul 5;267:1–6. [PubMed]
  • Peters TJ, Jones PE, Wells G. Analytical subcellular fractionation of jejunal biopsy specimens: enzyme activities, organelle pathology and response to gluten withdrawal in patients with coeliac disease. Clin Sci Mol Med. 1978 Sep;55(3):285–292. [PubMed]
  • Stewart JS, Pollock DJ, Hoffbrand AV, Mollin DL, Booth CC. A study of proximal and distal intestinal structure and absorptive function in idiopathic steatorrhoea. Q J Med. 1967 Jul;36(143):425–444. [PubMed]
  • Dunnill MS, Whitehead R. A method for the quantitation of small intestinal biopsy specimens. J Clin Pathol. 1972 Mar;25(3):243–246. [PMC free article] [PubMed]
  • Corazza GR, Frazzoni M, Dixon MF, Gasbarrini G. Quantitative assessment of the mucosal architecture of jejunal biopsy specimens: a comparison between linear measurement, stereology, and computer aided microscopy. J Clin Pathol. 1985 Jul;38(7):765–770. [PMC free article] [PubMed]
  • Dahlqvist A. Assay of intestinal disaccharidases. Anal Biochem. 1968 Jan;22(1):99–107. [PubMed]
  • DAHLQVIST A, AURICCHIO S, SEMENZA G, PRADER A. Human intestinal disaccharidases and hereditary disaccharide intolerance. The hydrolysis of sucrose, isomaltose, palatinose (isomaltulose), and a 1,6-alpha-oligosaccharide (isomalto-oligosaccharide) preparation. J Clin Invest. 1963 Apr;42:556–562. [PMC free article] [PubMed]
  • Dissanayake AS, Truelove SC, Whitehead R. Jejunal mucosal recovery in coeliac disease in relation to the degree of adherence to a gluten-free diet. Q J Med. 1974 Apr;43(170):161–185. [PubMed]
  • O'Grady JG, Stevens FM, Keane R, Cryan EM, Egan-Mitchell B, McNicholl B, McCarthy CF, Fottrell PF. Intestinal lactase, sucrase, and alkaline phosphatase in 373 patients with coeliac disease. J Clin Pathol. 1984 Mar;37(3):298–301. [PMC free article] [PubMed]

Articles from Journal of Clinical Pathology are provided here courtesy of BMJ Group