Jejunal mucosal morphometry in children with and without gut symptoms and in normal adults.

Penna, F J; Hill, Ivor D.; Kingston, David G. I.; Robertson, K; Slavin, G; Shiner, Margot

doi:10.1136/jcp.34.4.386

Cited by 39 publications

(29 citation statements)

References 29 publications

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“…25 não detectaram diferença entre os grupos. No entanto, a comparação entre 24 com histologia "normal" e 18 com atrofia vilosa parcial (34,1 ± 3,4 µm e 28,9 ± 4,7 µm, respectivamente) mostrou diferença estatisticamente significante entre os grupos.…”

Section: Discussionunclassified

“…25 naqueles com atrofia vilosa parcial, bem como àqueles detectados por Wood e colaboradores 26 que, ao avaliarem pacientes adultos, observaram diferença estatisticamente significante entre pacientes brancos ingleses (30,2 µm) e imigrantes indianos (28,3 ± 2,7 µm) e afro-caribenhos (27,2 ± 2,7 µm). Estes autores propõem que tais achados "...refletem a morfologia 'normal' de pacientes imigrantes, determinada por fatores ambientais".…”

Section: Discussionunclassified

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Digital morphometric and stereologic analysis of small intestinal mucosa in well-nourished and malnourished children with persistent diarrhea

Pires¹,

Silveira²,

Silva³

2003

J Pediatr (Rio J)

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Objectives: to test the hypothesis that the proximal small intestines of children with persistent diarrhea present morphometric and stereologic changes proportional to their nutritional status, using microscope images stored in a computer.Methods: cross-sectional study with 65 pediatric patients, whose ages ranged from 4 months to 5 years, with persistent diarrhea for over 14 days. The nutritional assessment was performed according to the z-scores for weight/age (W/A), weight/height (W/H) and height/age (H/A) ratios, divided into: well-nourished = z >2SD and malnourished = z <2SD; wellnourished = z >2SD, nutritional risk = z <-1SD and malnourished = z <-2SD; and continuously, in descending order, using the NCHS charts. After obtaining the computer images using the software Scion Image, villous height, crypt depth, mucosal thickness, total mucosal thickness, and villous/crypt ratio were measured in the fragments of the small intestinal mucosa, enlarged 100 times. When images were enlarged 500 times, enterocyte height, nuclear height and brush-border height were measured. Stereologic analysis was performed using cycloid arcs.Results: for W/A, W/H and H/A z-scores, divided into two nutritional status categories, no statistically significant difference was observed in regard to villous height, crypt depth, mucosal thickness, total mucosal thickness and villous/crypt ratio. Enterocyte height presented the most significant difference between well-nourished and malnourished groups, for W/A and W/H ratios, with a 500x enlargement, although this difference was not statistically significant. When z-scores were subdivided into three nutritional status categories, a digital morphometric analysis showed a statistically significant difference for villous/crypt ratio between the wellnourished and slightly malnourished group and the well-nourished and mild to severe malnourished group (p = 0.048). The villous/crypt ratio was higher among well-nourished children. Using the Spearman coefficient, the variables enterocyte height, height of enterocyte nucleus and brushborder height presented a clear association with the W/A ratio (r = 0.25; p = 0.038), W/H ratio (r = 0.029; p = 0.019). The height of the enterocyte and the brush-border height were associated with W/H ratio.Conclusions: the observed associations between nutritional status and the analyzed small intestinal mucosa variables showed a positive correlation with patients' weight. Although these associations were of a slight to moderate magnitude, we observed a tendency of enterocyte size reduction, as well as a reduction in the size of its nucleus and brush-border, as the level of malnutrition increases. ResumoObjetivos: testar a hipótese de que a mucosa do intestino delgado proximal de crianças com diarréia persistente apresenta alterações morfométricas e estereológicas proporcionais ao estado nutricional, utilizando captura de imagens através de microscópio acoplado ao computador.Métodos: estudo transversal incluindo 65 pacientes pediátricos, com idade entre quat...

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Section: Discussionunclassified

Digital morphometric and stereologic analysis of small intestinal mucosa in well-nourished and malnourished children with persistent diarrhea

Pires¹,

Silveira²,

Silva³

2003

J Pediatr (Rio J)

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“…[Previous work (29) has shown that partial villous atrophy occurs frequently in children, even those with no gastrointestinal symptoms.] But the presence of ACC did not correlate with histologic abnormality either in the patient group or in the control group, and neither did it correlate with the IgA plasma cell count (Fig.…”

Section: Resultsmentioning

confidence: 99%

“…They were divided into at least two portions, which were fixed immediately, one for routine histology and one for immunofluorescence (15). Assessment of the villous morphology, normal or partial villous atrophy, was made as previously described (29).…”

Section: Methodsmentioning

confidence: 99%

Antibody Production to Milk Proteins in the Jejunal Mucosa of Children with Cow's Milk Protein Intolerance

Pearson¹,

Kingston²,

Shiner³

1983

Pediatr Res

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Summary A direct immunofluorescent technique with fluorescein-labeledantigens was used to examine the jejunal mucosa for specific antibody production in 23 children aged 2-25 months referred for diagnostic biopsy. Plasma cells containing antibodies to p-lactoglobulin (PLG) or bovine serum albumin (BSA) were present in I1 of 16 biopsies from patients with cow's milk protein intolerance (CMPI) but only one of eight controls, all on a diet containing cow's milk. Antibody-containing cells (ACC) constituted approximately 0.5-5% of the total (IgA + IgM) plasma cell population. In children with CMPI there may be gastrointestinal symptoms only, or these may be combined with other allergic manifestations such as eczema or asthma. In many CMPI children diagnostic tests for allergy-skin prick tests or RAST-are negative and the serum IgE is not raised (7, 11,20). This is especially so in those children with only gastrointestinal symptoms. But challenge with cow's milk often produces profound changes in the small intestinal mucosa, including villous atrophy of varying degree (9,10,12,34) and increased numbers of eosinophils (41) intra-epithelial lymphocytes (40) and plasma cells (10,21,33,34). It has not been established whether the increase in plasma cells is just part of a generalized, non-specific response of the immune system to antigenic stimulation (23, 37) or whether it represents a specific response to milk-protein antigens at the point of entry.In order to study the mucosal immune response to bovine milk proteins we have developed a simple direct immunofluorescent technique for the presence of plasma cells containing specific antibody to two bovine milk proteins, PLG and BSA. Brief, preliminary reports of this work have been published (16,27). MATERIALS AND METHODSPatients. Twenty-three children, aged 2-25 months, had been routinely referred to us for diagnostic jejunal biopsy. Informed consent to carry out this procedure was obtained from the parents.In 15 children a diagnosis of CMPI was made, based on a history of vomiting, diarrhoea, and weight loss (or exacerbation of eczema in atopic children) when on CM and improvement when on a CM-free diet. Details of presenting symptoms, dietary history, and results of challenges are given in Table 1. Four of these fifteen patients had additional allergies: to eggs (Nos. 6, 13, and 15), chicken, fish, and antibiotics (No. 11). Five of the fifteen had atopic symptoms such as eczema (Nos. 2, 8 and 13), asthma (NO. 13), and urticaria (No. 6). Five patients (Nos. 4, 5, 9, 10 and 11) were challenged with CM at the time of investigation, and had pre-and postchallenge biopsies as previously described (34); patient No. 4 had a second challenge at age 18 months. In this group a total of 23 biopsies were performed, 16 while the patient was taking CM and 7 while the patient was on a CM-free diet.Eight children whose symptoms could not be related to consumption of CM served as the control group. (Table 2). All were receiving CM at the time of jejunal biopsy.Biopsy specimens. Upper jej...

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“…Histological analysis was performed according to the criteria proposed by others (8)(9)(10), with small modifications. The material was scored as follows: grade 0 or normal: high and thin villi are present throughout the extension of the fragment examined and correspond to 2.5 to 3 times the depth of the crypts.…”

Section: Methodsmentioning

confidence: 99%

Morphological changes of the jejunal mucosa in protracted diarrhea and their correlation with disease duration, weight loss and serum albumin levels

La¹,

Fj³

1997

Braz J Med Biol Res

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The pathogenesis of protracted diarrhea is multifactorial. In developing countries, intestinal infectious processes seem to play an important role in triggering the syndrome. Thirty-four children aged 1 to 14 months, mean 6.5 months, with protracted diarrhea were studied clinically and in terms of small intestinal mucosal morphology. Mild, moderate or severe hypotrophy of the jejunal mucosa was detected in 82% of cases, and mucosal atrophy was observed in 12%. The intensity of the morphological changes of the jejunal mucosa correlated negatively with serum albumin levels. No correlation was detected between mucosal grading and duration of diarrhea or between mucosal grading and weight reported as percentile. After nutritional support was instituted, serial jejunal biopsies were obtained from 12 patients: five patients submitted to parenteral nutrition for 7 to 38 days, mean 17 days, and 7 patients receiving a hypoallergenic oral diet (semi-elemental formula, 3; chicken formula, 3; human milk, 1). In seven cases (58%) a progressive increase in villus height and a decrease in the number of inflammatory cells were noted. Recovery of the morphologic pattern was accompanied by clinical improvement in all patients.

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Jejunal mucosal morphometry in children with and without gut symptoms and in normal adults.

Cited by 39 publications

References 29 publications

Digital morphometric and stereologic analysis of small intestinal mucosa in well-nourished and malnourished children with persistent diarrhea

Digital morphometric and stereologic analysis of small intestinal mucosa in well-nourished and malnourished children with persistent diarrhea

Antibody Production to Milk Proteins in the Jejunal Mucosa of Children with Cow's Milk Protein Intolerance

Morphological changes of the jejunal mucosa in protracted diarrhea and their correlation with disease duration, weight loss and serum albumin levels

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