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KMID : 0816119980010010045
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Korean Journal of Pediatric Gastroenterolology and Nutrition
1998 Volume.1 No. 1 p.45 ~ p.55
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Quantitative Analysis of Small Intestinal Mucosa Using Morphometry in Cow’s Milk-Sensitive Enteropathy
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Hwang Jin-Bok
Kim Yong-Jin
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Abstract
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Purpose: To make objective standards of small intestinal mucosal changes in cow’s
milk-sensitive enteropathy(CMSE) we analyzed histological changes of endoscopic
duodenal mucosa biopsy specimens from normal children and patients of CMSE.
Methods: We review the medical records of patients who had been admitted and
diagnosed as CMSE by means of gastrofiberscopic duodenal mucosal biopsy following
cow’s milk challenge and withdrawal. Thirteen babies with CMSE, ranging from 14
days to 56 days of age, were studied. Five non-CMSE patients were used as control,
ranging from 22 days to 72 days of age. The morphometric parameters under study
were villous height, crypt zone depth, ratio of villous height to crypt zone depth, total
mucosal thickness and length of surface epithelium by using H & E stained specimens
under the drawing apparatus attached microscope. In addition, the numbers of
lymphocytes in the epithelium and eosinophil cells in the lamina propria and epithelium
were measured.
Results: In the duodenal mucosal biopsy specimens in CMSE we found partial and
subtotal villous atrophy with an increased number of interepithelial lymphocytes. The
mean villous height(135±59 μm), ratio of villous height to crypt zone depth (0.46±
0.28), total mucosal thickness (499±56 μm), length of surface epithelium of small
intestinal mucosa (889±231 μm) in CMSE was significantly decreased compared with
the control (p<0.05). The mean crypt zone depth (311±65 μm) was significantly greater
than the control (188±24 μm)(p<0.05). Infiltration of interepithelial lymphocytes (34.1±
10.5) were significantly greater than the control (13.6±3.6)(p<0.05). The number of
eosinophil cells in both lamina propria and epithelium was no significant differences
between groups (p>0.05). The small intestinal mucosa in treated CMSE showed much
improved enteropathy of villous height, crypt zone depth, interepithelial lymphocytes
compared with the control as well as untreated CMSE.
Conclusion: Quantitation of mucosal dimensions confirmed the presence of CMSE. It
seems to be a limitation in the capacity of crypt cells to compensate for the loss of
villous epithelium in CMSE. Specimens obtained by gastrofiberscopic duodenal mucosal
biopsy were suitable for morphometric diagnosis of CMSE. Improvement of CMSE also
can be confirmed histologically after the therapy of protein hydrolysate.
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KEYWORD
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Small intestinal mucosal biopsy, Morphometry, Cow’s milk-sensitive enteropathy, Gastrofiberscopic,
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