Jejunal biopsy in the diagnosis of malabsorption syndromes

Summary This paper concerns the use of peroral jejunal biopsy in the diagnosis of malabsorption syndromes. Such biopsy reveals characteristic findings in the following diseases which may cause steatorrhea: sprue, amyloidosis, Whipple’s disease, lymphoma, a-beta-lipoproteinemia, and scleroderma. In nontropical sprue (and to a lesser degree in tropical sprue), microscopic examination of the jejunum reveals blunting or absence of the villi, substitution of cuboidal for columnar surface cells, infiltration of the lamina propria with lymphocytes and plasma cells, and increased mitotic activity in the crypts of the unusually deep intestinal glands. In amyloidosis, which affects the intestinal tract in 50% of cases, there is deposition of amyloid in the lamina propria and around blood vessels. In Whipple’s disease, villi of the intestinal mucosa are thickened and have bulbous tips, and the laminae propria contain foamy histiocytes and lipid deposits; also the macrophages contain a carbohydrate-protein complex which is readily demonstrated by the periodic-acid, Schiff staining technic. In lymphoma, mucosal lesions may be identical to those seen in sprue; on the other hand, diagnostic nodules of lymphocytes or unusual cellular infiltrations may be seen in the lamina propria. In a-beta-lipoproteinemia, numerous vacuoles of fat are found in the epithelial cells. In scleroderma, which may involve the intestine, collagen deposition has been demonstrated around Brunner’s glands in the duodenum. Other diseases associated with malabsorption may show nonspecific villous changes and infiltration of the lamina propria with inflammatory cells. In giardiasis,Giardia may be observed between the villi and in the surface mucus. Read at the meeting of the American Proctologic Society, Minneapolis, Minnesota, June 14 to 17, 1965.