The morphological and histochemical changes of the intestinal mucosa in primary malabsorption syndrome as tropical or nontropical sprue have ben repeatedly reporte.
Similar observations on the common digestive diseases, however, have been rarely made with varied results as to the reporters and few of them have mentioned a mild degree of mucosal changes of the intestine.
Authors intended to elucidate whether such mucosal changes as atrophy of mucosa or decreased alkaline phosphatase activity would occur definitely in digestive diseases including postgastrectomy donditions, and also to confirm whether even the typical mucosal pattern of primary sprue could be proved in such diseases.
A total of 42 jejunal biopsies was performed at operation in 5 cases of control group(non-digestive diseases) and 31 cases of disease group (9 cases of gastric cancer, 4 of peptic ulcer, 4 intestinal obstruction, 2 intestinal firstula, 2 colon cancer, 2 intestinal tuberculosis, 4 benign biliary disease, 2 benign pancreatic disease, 2 liver disease and 6 postgastrectomy).
Hematoxylin-eosin double stain and periodic acid-Schiff (PAS) stain were applied for morphological study and classified by Rubin´s method, and Gomeri´s stain for alkaline phosphatase activity. For the comparison with concomitant intestinal function, Ⅰ^131-Triolein absorption test was employed.
The results abtained are as follows:
1) Among 31 cases of disease group, all but a case of silent gall-bladder stone(30 cases, 96%) showed various degrees of villous atrophy of the jejunal mucosa. Of these 30 cases, 10(32%) were with marked to extremely marked atrophy as encountered in primary sprue, of which 2(6.4%) were typical(Table 2 & Fig. 1,3-6).
2) Increased number of goblet cells in the villi and increased round cell infiltration in the lamina propria were proved in 25 cases (80%) respectively, and distention of Lieberkuehn´s gland or crypt in 24 cases (77%) ; all these changes were also of variable degree (Tabel 3-5). Decreased alkaline phosphatase activity in varying degree was seen in 29 cases (93%), of which 9(29%) were of marked decrease(Table 6 & Fig. 2, 6, 7).
3) These mucosal changes, though the atrophy of villi was most distinct, showed a tendency to run parallel with each other in their degree and frequency, but a poor correlation in individual case; furthermore, the variety of each change did not appear to be much effected by the difference of the affected organ or the disease and even the duration of the disease; so was in postgast rectomy group.
4) The mucosal changes of the jejunum in digestive diseases do not always correlate with the amount of fecal Ⅰ^131-Trionlein (Table 8).
5) On the basis of the data presented, it may be said that the morphological and histochemical changes of the intestimal mucosa in digestive diseases are considered as presprue condition or latent sprue (steat orrhea).
6) The mechanism on the development of intestinal mucosal changes in malasorption syndrome and the mucosal effect on the malabsorption are discussed.
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