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

Abstract

One hundred and twenty-five small intestinal biopsies from children with coeliac disease (CD), cow's milk protein intolerance (CMPI) and controls were compared by morphometric analysis, by counting intraepithelial lymphocytes (IEL) and by quantitative evaluation of immunoglobulin-containing cells of lamina propria. The double-stain immunofluorescent technique of Brandtzaeg and Baklien [2] was used, based on defined mucosal tissue units. A patchy enteropathy was found in 60% of CMPI, and in 14% of nonspecific changes, but never in CD. There was a significant difference in crypt depth between CD (360 +/- 80 microns) and CMPI (217 +/- 92 microns), even when lesions of equal grade were compared (P less than 0.015). IEL counts per 1000 epithelial cells showed even better discrimination between the groups (CD: 793 +/- 173, CMPI: 320 +/- 143, P less than 0.001). In CD, there was a relatively greater increase of IgM-cells (X 4.9) and of IgG-cells (X 4.2) than of IgA-cells (X 2.6). Ig-cell changes outlasted the morphological lesion in CD on a gluten-free diet. In CMPI, IgM-cells (X 2.3), IgG-cells (X 2.5), and IgA-cells (X 1.7) were proportionately increased, compared to controls. A special increase of IgE-cells in CMPI could not be substantiated. By computerized stepwise discriminant analysis based upon crypt depth, villus/crypt-ratio, IEL-count, and counts of IgM-, IgG-, IgA-containing cells of lamina propria, accurate classification of patient groups was accomplished, even when only the initial biopsy data were analysed.

Gliadin- and immunoglobulin-containing cells of small intestinal lamina propria in childhood coeliac disease

“…All but two children with CMPI had been on a gluten-containing diet. Distribution and relative proportions of immunoglobulins in these cells were roughly similar to general immunoglobulin findings in small intestinal lamina propria [27] (Fig. 4).…”

“…Fluorochrome/protein ratio was (FITC) and green (TRITC) light excitation. Appropriate controls of specificity were done [27]. In additional experiments, indirect immunofluorescence had also been accomplished using rabbit antigliadin and TRITC conjugates to rabbit immunoglobulins (Nordic Laboratories, Netherlands).…”

“…Details of diagnosis and morphology will be published separately [27]. All non-coeliac groups served for controls in this study.…”

“…Additional controls of specificity were done, using antigen-coupled pyruvic aldehyde-treated red cells, in order to exclude cross-reacting conjugates [27].…”

Detection of Celiac Disease and Lymphocytic Enteropathy by Parallel Serology and Histopathology in a Population-Based Study

“…25 , 26 Possible etiologies of LD are legion including infection, drugs and autoimmune disease. 25 , [27][28][29][30][31] The prevalence of LD, whether associated with gluten sensitivity or otherwise in the normal population is unknown.…”