Asymptomatic environmental enteropathy among slum-dwelling infants.
OBJECTIVE: We documented asymptomatic environmental enteropathy, which may occur in low socioeconomic populations, and which is manifested by bacterial proliferation in the upper portions of the small bowel and by alterations in the digestive-absorptive capacity. DESIGN: Forty asymptomatic infants (< 1 year) of the Cidade Leonor slum in São Paulo, Brazil, were investigated for digestive-absorptive function, bacterial proliferation in the small bowel lumen, and jejunal morphology. They were compared with a control group of 8 well-nourished children from economically sound families. RESULTS: Mean value of the D-xylose absorption test in the slum infants 21.0 +/- 10.0 mg%) was significantly lower than in controls (46.0 +/- 13.8 mg%) (p < 0.001). Colonic bacterial proliferation in the small bowel was identified in 25 (62.5%) of slum-dwelling infants. Grade II villous atrophy with inflammatory infiltration in the lamina propria was the most frequent alteration found. CONCLUSION: These data show that alterations in the microecology, function and morphology of the small intestine can occur even in the absence of diarrhea. Therefore, the absence of symptoms does not necessarily imply a healthy well-being among children living in a slum.