PMCCPMCCPMCC

Search tips
Search criteria 

Advanced

 
Logo of gutGutView this articleSubmit a manuscriptReceive email alertsContact usBMJ
 
Gut. 1976 December; 17(12): 984–992.
PMCID: PMC1411232

Patchiness and duodenal-jejunal variation of the mucosal abnormality in coeliac disease and dermatitis herpetiformis.

Abstract

The incidence and degree of patchiness of mucosal abnormality in both coeliac disease (CD) and dermatitis herpetiformis (DH) is documented. As judged by both stereomicroscopy and subjective histology, patchiness occurred frequently in both CDand DH patients. In most cases the difference of abnormality was of only one grade, but in approximately 25% as assessed by stereomicroscopy and 10% as assessed by histology the difference was of two or more grades. In control subjects with normal small bowel mucosa the variation of the mucosal appearance between the duodenum and proximal jejunum was studied. Contrary to popular belief, no significant difference of villous and crypt measurements or of apparent villous "bridging" and "branching" between these two sites was found, if only well-orientated sections were studied. The stereomicroscopic appearances were also similar at these two sites, although villi tended to be broader in the duodenal biopsies. The duodenal-jejunal variation was also studied in CD and DH patients and although by both stereomicroscopy and subjective histology the appearances were similar in most patients, in approximately 33% the duodenal abnormality was the most severe and, surprisingly, the jejunal abnormality was more severe in approximately 15%. It is concluded that multiple, precisely located biopsies of both the duodenum and proximal jejunum are invaluable in the investigation of small bowel disease and in assessing response to treatment.

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 (2.0M), or click on a page image below to browse page by page. Links to PubMed are also available for Selected References.

Images in this article

Click on the image to see a larger version.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • BAKER SJ, HUGHES A. Multiple-retrieving small-intestinal biopsy tube. Lancet. 1960 Sep 24;2(7152):686–687. [PubMed]
  • Booth CC. Enterocyte in coeliac disease. 1. Br Med J. 1970 Sep 26;3(5725):725–731. [PMC free article] [PubMed]
  • BRANDBORG LL, RUBIN GE, QUINTON WE. A multipurpose instrument for suction biopsy of the esophagus, stomach, small bowel, and colon. Gastroenterology. 1959 Jul;37(1):1–16. [PubMed]
  • Broitman SA, McCray RS, May JC, Deren JJ, Ackroyd F, Gottlieb LS, McDermott W, Zamcheck N. Mastocytosis and intestinal malabsorption. Am J Med. 1970 Mar;48(3):382–389. [PubMed]
  • Weinstein WM, Brow JR, Parker F, Rubin CE. The small intestinal mucosa in dermatitis herpetiformis. II. Relationship of the small intestinal lesion to gluten. Gastroenterology. 1971 Mar;60(3):362–369. [PubMed]
  • FLICK AL, QUINTON WE, RUBIN CE. A peroral hydraulic biopsy tube for multiple sampling at any level of the gastro-intestinal tract. Gastroenterology. 1961 Jan;40:120–126. [PubMed]
  • Gebhard RL, Falchuk ZM, Katz SI, Sessoms C, Rogentine GN, Strober W. Dermatitis herpetiformis. Immunologic concomitants of small intestinal disease and relationship to histocompatibility antigen HL-A8. J Clin Invest. 1974 Jul;54(1):98–103. [PMC free article] [PubMed]
  • Girdwood RH, Williams AW, McManus JP, Dellipiani AW, Delamore IW, Kershaw PW. Jejunal biopsy in patients with malabsorptive disease. Scott Med J. 1966 Oct;11(10):343–355. [PubMed]
  • HOLMES R, HOURIHANE DO, BOOTH CC. Dissecting-microscope appearances of jejunal biopsy specimens from patients with "idiopathic steatorrhoea". Lancet. 1961 Jan 14;1(7168):81–83. [PubMed]
  • HOURIHANE DO. DIARRHOEA OF SMALL BOWEL ORIGIN. THE HISTOLOGY OF INTESTINAL BIOPSIES. Proc R Soc Med. 1963 Dec;56:1073–1077. [PubMed]
  • Jeffries GH, Steinberg H, Sleisenger MH. Chronic ulcerative (nongranulomatous) jejunitis. Am J Med. 1968 Jan;44(1):47–59. [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]
  • Robinson DC, Watson AJ, Wyatt EH, Marks JM, Roberts DF. Incidence of small-intestinal mucosal abnormalities and of clinical coeliac disease in the relatives of children with coeliac disease. Gut. 1971 Oct;12(10):789–793. [PMC free article] [PubMed]
  • Roy-Choudhury D, Cooke WT, Tan DT, Banwell JG, Smits BJ. Jejunal biopsy: criteria and significance. Scand J Gastroenterol. 1966;1(1):57–74. [PubMed]
  • RUBIN CE. Malabsorption: celiac sprue. Annu Rev Med. 1961;12:39–54. [PubMed]
  • RUBIN CE, BRANDBORG LL, PHELPS PC, TAYLOR HC., Jr Studies of celiac disease. I. The apparent identical and specific nature of the duodenal and proximal jejunal lesion in celiac disease and idiopathic sprue. Gastroenterology. 1960 Jan;38:28–49. [PubMed]
  • Rubin CE, Dobbins WO., 3rd Peroral biopsy of the small intestine. A review of its diagnostic usefulness. Gastroenterology. 1965 Dec;49(6):676–697. [PubMed]
  • SCOTT GB, WILLIAMS MJ, CLARK CG. COMPARISON OF JEJUNAL MUCOSA IN POST-GASTRECTOMY STATES, IDIOPATHIC STEATORRHOEA, AND CONTROLS USING THE DISSECTING MICROSCOPE AND CONVENTIONAL HISTOLOGICAL METHODS. Gut. 1964 Dec;5:553–562. [PMC free article] [PubMed]
  • SPIRO HM, FILIPE MI, STEWART JS, BOOTH CC, PEARSE AG. FUNCTIONAL HISTOCHEMISTRY OF THE SMALL BOWEL MUCOSA IN MALABSORPTIVE SYNDROMES. Gut. 1964 Apr;5:145–154. [PMC free article] [PubMed]
  • Stevens FM, Lloyd R, Egan-Mitchell B, Mylotte MJ, Fottrell PF, Wright R, McNicholl B, McCarthy CF. Reticulin antibodies in patients with coeliac disease and their relatives. Gut. 1975 Aug;16(8):598–602. [PMC free article] [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]
  • Thompson H. Coeliac disease. The small intestine at autopsy. Clin Gastroenterol. 1974 Jan;3(1):171–181. [PubMed]
  • Weinstein WM. Latent celiac sprue. Gastroenterology. 1974 Apr;66(4):489–493. [PubMed]

Articles from Gut are provided here courtesy of BMJ Group