Cell kinetics in the jejunal crypt epithelium in malabsorption syndrome with cow's milk protein intolerance and in coeliac disease of childhood.

Abstract

(CMI) and 12 of these on a cow's milk free diet were compared with 47 children with untreated coeliac disease, with 15 of these on a gluten free diet, and with 15 controls. The total number of cells in the crypts of the patients with CMI was 1 8 times (p<0.001) and in patients with coeliac disease 2-4 times (P < 0.001) that seen in the controls. During the elimination diet the total number of cells in the crypts returned to the level seen in the controls. The mitotic indices, both crude and corrected, were significantly higher (P < .001) in untreated patients with CMI and those with coeliac disease than in the controls. During dietary treatment the indices fell, but not quite to the level of the controls. These small differences between the two groups may be due to the difference in the causative agents or to the different ages of the patients.Cell renewal in the healthy normal human small intestine was studied by Bertalanffy and Nagy.3 From counts of mitoses in adults these workers calculated that the whole epithelium lining the human duodenum is completely renewed in about two days. In adult coeliac disease the mitotic index in the jejunal epithelium of the small intestinal mucosa was found to be increased two-fold45 During the elimination diet the mitotic index returned to the level seen in the normal small intestinal mucosa.5In 1973 Wright et al.2 described a new method for analysing cell kinetics in the small intestinal crypts from sections of peroral biopsy specimens. They showed that, in adult and childhood coeliac disease and in adults with gluten-sensitive enteropathy of dermatitis herpetiformis, there was a marked increase in the number of the proliferating cells per crypt as well as in the mitotic index in the 'flat' mucosa. These findings are consistent with Booth's6 suggestion that the characteristic changes in crypt morphology are a direct consequence of 'enteroblastic hyperplasia' compensating for excessive loss of surface enterocytes.

Small intestinal mucosa in coeliac disease and cow's milk protein intolerance: Morphometric and immunofluorescent studies

“…Thus, villus/crypt-ratio (CD: 0.2 • 0.1, CMPI: 0.8 • 0.9) and crypt depth (CD: 360• CMPI: 217• p<0.015) were shown to be statistically different in CD and CMPI of equal biopsy grading. In CMPI, crypt hyperplasia appeared to be less prominent than in CD, although it cannot be decided from our data if this difference is merely age-dependent, or if it reflects some pathogenetic difference in morphogenesis and cell kinetic changes occuring in CD and CMPI, as has been suggested recently [11,14,40]. In contrast to previous studies [34], there was no morphometric difference found between CD on a gluten-free diet and controls.…”

“…Differences between IEL counts in CD (793+173) and CMPI (320___143) were statistically highly significant Co < 0.001), even when only biopsies of equal enteropathy grading were analysed. IEL data in CMPI have been inconsistently reported [14,30]. This might be due to different grades of the enteropathies in patient and control groups which have been taken into account by this study.…”

“…Sections cut tangentially or not containing muscularis mucosae were excluded. The following variables were measured [14,28,44]: enterocyte height, mucosal height, villous height, crypt depth, villus/crypt-ratio. Intraepithelial lymphocyte counts were expressed per 1000 epithelial cells [4].…”

“…Recent observations, however, have indicated some differences in the enteropathies of CD and CMPI. Thus, patchy lesions tend to occur in non-coeliac conditions [21], intraepithelial lymphocyte counts are lower in CMPI than in CD [30], and there are differences in crypt cell kinetics [14] and in ultrastructural features [40] of the small intestinal mucosa. Up to now immunohistochemical studies have failed to show differences between relative proportions of IgA-, IgM-, and IgG-containing cells of lamina propria in CD and CMPI [12,35,36].…”

Occlusive and Non-Occlusive Gastrointestinal Ischaemia: a Clinical Review with Special Emphasis on the Diagnostic Value of Tonometry

“…Using light microscopy it is possible to see that the surface epithelial cells in biopsy specimens of patients with untreated CD are flattened, their cytoplasm shows vacuolization and the brush border and basement membrane are damaged (6). Similar increase in cell kinetics is, however, observed in other types of disease with crypt hyperplastic villous atrophy, such as in severe cow's milk allergy (9). In crypt epithelial cells, the frequency of mitoses is increased.…”