Biomedical subjects
Publications and source records attributed to D N Challacombe.
A semi-automatic method has been used to study the morphology of sections of the jejunal mucosa from adults with coeliac disease and from normal controls. Mucosal morphology was quantified in each patient by using the Mucosal Index (surface mucosal length/muscularis mucosal length), which numerically expressed the degree of villous flattening present in patients with coeliac disease.
Tissue concentrations of histamine have been estimated in peroral duodenal biopsy specimens from five children with coeliac disease while on a gluten-free diet and after a three-month gluten challenge. Histamine concentrations in the patients on a diet did not differ significantly from a group of control children. However after gluten challenge, histological relapse of the duodenal mucosa in each patient was associated with increased tissue concentrations of histamine. The findings suggest that histamine may be involved in the pathogenesis of the small intestinal mucosal changes in children with coeliac disease.
Two children with protracted gastrointestinal symptoms were found to be chronically excreting enteropathogenic bacteria in their faeces. Withdrawal of cows' milk protein from their diets resulted in clinical recovery and stool cultures became negative, suggesting that allergy to cows' milk may have contributed to their bacterial carrier state.
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Urinary excretion of 5-hydroxyindoleacetic acid and creatinine has been measured in 8-hour collections from adult patients with coeliac disease, and results have been compared with a group of healthy adult controls. Results were expressed as 5-HIAA/creatinine and significantly higher values of this ratio were found in patients with coeliac disease. Measurement of this ratio is a non-invasive technique which is useful in selecting patients with suspected coeliac disease for further investigation.
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Bile acids were estimated in the duodenum of infants with protracted diarrhoea and compared with those in a control group. Significantly lower levels of total bile acids were found in infants with protracted diarrhoea, a finding which may be due to ileal dysfunction. Low concentrations of total bile acids may contribute to the poor nutritional state of these patients by impairing the normal digestion and absorption of dietary fat and fat-soluble vitamins. The absence of deconjugated bile acids in the duodenal juice of most infants with protracted diarrhoea suggests that they do not contribute significantly to the pathophysiology of this disorder.
Tissue concentrations of 5-HT have been measured in the duodenal mucosa of adults and children with coeliac disease and were found to be significantly higher than those from a control group. This finding may be associated with hyperactivity or hyperplasia of enterochromaffin (EC) cells in the duodenum of patients with coeliac disease and could also be directly related to described abnormalities of 5-HT metabolism in this disease.
A cell counting technique was used to count enterochromaffin (EC) cells in the duodenal mucosa of 10 children with coeliac disease and 10 controls, and significantly greater numbers of EC cells were found in children with coeliac disease. In four children with a clinical history suggestive of coeliac disease, but with minor histopathological changes in the duodenum, gluten challenge resulted in increased numbers of EC cells. Abnormalities of 5-hydroxytryptamine metabolism in coeliac disease may result from hyperplasia of EC cells in the small intestine.
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8-hour urine excretions of 5-hydroxyindoleacetic acid (5-HIAA) were measured in 18 children with coeliac disease before treatment and the results expressed as microgram 5-HIAA/mg creatinine. Similar measurements were made on urine collections from an age-matched control group of 24 children. Significantly higher values of 5-HIAA excretion were found in children with untreated coeliac disease. Measurement of the 5-HIAA: creatinine ratio in 8-hour urine collections is therefore proposed as an aid in the diagnosis of coeliac disease.
Duodenal bile acids have been estimated in three age groups in infancy from birth to 7 months, and age-related changes have been shown. The lowest concentrations of duodenal bile acids occurred in the youngest infants, and increasing concentrations were found with increasing age. Taurine conjugated bile acids predominated in early infancy, while in older infants bile acids were mainly conjugated with glycine. The probable presence of taurolithocholic acid in the duodenal bil of 2 newborns before the establishment of a gastrointestinal microflora remains to be confirmed, but could result either from transplacental passage of secondary bile acids or from endogenous synthesis by the fetal liver.
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