The introduction of the small bowel biopsy as a diagnostic method for diseases of the small bowel is relatively recent. Nevertheless, considerable research has been done in histochemical, histopathological as well as the electron microscopic aspects of many gastroenterologic disorders which has added greatly to our understanding of diseases of the small intestine.
Histologic changes most frequently seen in nontropical sprue, such as clubbing, or flattening of villi, elongation of crypts, surface epithelial cell atypia, changes of staining characterics of epithelial cells etc., were considered to be diagnostic of the disease at one time. However, as experience has accumulated there have been increasing reports of similar histologic changes seen in other diseases as well, and now it is agreed that the changes are not pathognomonic for nontropical sprue.
Whereas many clinicians agree that in nontropical sprue the symptomatic response to a gluten free diet serves as a diagnostic criterion, some investigators disagree with this view in that similar response can be seen in other diseases also.
Therefore to provide data bearing on this question a histologic and clinical correlation was done by reviewing 359 small bowel biopsies using the light microscope and related clinical data. Particular attention was paid to 120 cases of nontropical sprue and the author drew the following conclusions:
1. Diagnosis of nontropical sprue should meet the
following criteria:
a) physical, clinical or laboratory evidence ofmalabsorption
b) characteristic histologic changes in small bowel mucosa
c). dramatic response to treatment with gluten free diet.
2. The best and only reliable screening test for nontropical sprue is a jejunal biopsy.
3. Unless the diagnosis is in doubt repeated biopsy for the purpose of follow up evaluation in nontropical spree is not necessary.
4. Unless there is a definii e history of treatment wtih gluten free diet in tl -e past, the combination of normal surface epithelium and moderate to severe mucosal changes strongly point to possibility of other diseases than nontropical sprue.
5. As a rule there is some improvement in histology and laboratory findings in nontropical sprue after treatment, but in moderate to severe cases, the degree of recovery is very seldom complete, both histologically and functionally despite satisfactory clinical improvement.
6. Beyond a certain stage of structural damage, there seems to be only incomplete recovery histologically. To have complete morphologic recovery of surface epithelium, there needs to be at least a certain height of the villus.
7. The change in individual surface epithelial cell morphology and function seems to play a major role in nontropical sprue.
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