Long-term morphological and immunohistochemical observations on biopsy specimens of small intestine from children with gluten-sensitive enteropathy.

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Abstract
Jejunal biopsy specimens from 9 Spanish children with gluten-sensitive enteropathy were studied with morphometric and immunohistochemical techniques in 3 disease stages: the 1st biopsy was taken for diagnosis, when the child had a gluten-containing diet, the 2nd after gluten withdrawal, and the 3rd biopsy after gluten-provocation. The findings were compared with those in 10 healthy adults. The villous:crypt ratio and the surface epithelium length per stretched millimeter muscularis mucosae were decreased, whereas the interepithelial lymphocyte number per millimeter surface epithelium was increased when the child had a gluten-containing diet. Although these parameters improved after gluten withdrawal for at least 7 mo., they never reached the healthy control group values. The indirect immunoperoxidase technique showed that the numbers of IgA-, IgG- and IgM-containing cells, expressed per mucosal tissue unit of 4 .mu.m thick and 1 mm wide, were significantly increased during the disease active phases. This increase was most striking for the IgM-containing cells. The most sensitive parameters for the histological diagnosis of gluten-sensitive enteropathy are the villous:crypt ratio or the surface epithelium length per millimeter muscularis mucosae, the interepithelial lymphocyte number per millimeter surface epithelium, and the number of IgM-containing cells per millimeter muscularis mucosae.