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Background: Enteroendocrine cells (EEC) have been suggested to have a role in the pathogenesis of irritable bowel syndrome (IBS). Although many studies have analysed possible numeric changes of EEC in IBS, the results differ between different studies. One reason might be due to difficulties in standardising the morphometric method.Aim: The aim of this study was to compare two different methods for counting EEC in jejunum biopsies from patients with IBS and healthy controls.Method: Fifty-one patients with IBS and 35 healthy controls were included in the study. Jejunum mucosa was procured using a Watson capsule. Slides were immunostained for serotonin and chromogranin A and then scanned digitally. The morphometry was done by counting cells per high power field (hpf) and per mm2 after defining area of the mucosa. The two methods were compared using Bland Altman analysis.Results: There was no difference in the number of EEC in patients with IBS compared to healthy controls. The number of cells detected by per mm2 area of mucosa were higher than number of cells per hpf. Counting EEC per high power field systematically underestimated the number of cells in the mucosal area.Conclusions: Counting cells per mm2 mucosal area gives a better representation of the number of EEC in small bowel mucosa. The finding of no difference in EEC numbers does not imply an equal function and further studies are needed to evaluate the role, if any of EEC, in IBS.

The micro-flora of the proximal jejunum in healthy volunteers was compared with the micro-flora in patients with gastrointestinal symptoms suggestive of spontaneous bacterial overgrowth in the small intestine. Biopsies were taken distally to the ligament of Treitz with a Watson capsule. The samples were diluted and inoculated on selective and non-selective agar plates that were incubated aerobically and anaerobically. No major differences were found in the small jejunum micro-flora in healthy persons or in a heterogenous group of patients with gastrointestinal disorders. Oropharyngeal micro-organisms dominated the micro-flora in all subjects and colonic micro-organisms were found in low numbers in a few subjects from both groups. Streptococcus intermedius and Haemophilus parahaemolyticus were only found in the micro-flora of healthy subjects while Lactobacillus spp. was more frequently found in the samples from patients. Eight of 20 healthy subjects and five of 18 patients met the criterion of small intestinal overgrowth. Emerging evidence suggests that other factors are involved in the pathogenesis of the irritable bowel syndrome complex. There is a need for better understanding of the complicated interactions between the host and the endogenous micro-flora.

OBJECTIVE: There are no studies on the prevalence of celiac disease (CD) in either Brazil or, as far as we know, South America. The aim of this study was to determine the prevalence of CD in healthy blood donors in the city of Brasilia, Brazil. METHODS: Sera were obtained, independently of age and gender, from an unselected group of 2045 blood donors attending the Hematological Center of Brasilia. An IgG antigliadin antibody (AGA) test was used as a first-level screening step, followed by IgA-AGA test, serum IgA antiendomysium (EMA), and total serum IgA determination performed in all sera showing abnormally high IgG-AGA results. Jejunal biopsy was suggested for all subjects showing at least one of the following: IgA-EMA positivity; IgG-AGA and IgA-AGA positivity; IgG-AGA positivity and selective IgA deficiency. AGA was determined by an enzyme-linked immunosorbent assay (ELISA) technique and IgA-EMA was ascertained by indirect immunofluorescence on cryostat sections of monkey esophagus. Jejunal mucosa samples were obtained with a Watson capsule. RESULTS: Sixty-two (3.03%) blood donors had IgG-AGA above the cut-off values. Fifty-eight individuals showed isolated high values of IgG-AGA, whereas four had simultaneously increased IgG and IgA-AGA. Three patients had positive IgA-EMA test (one with both IgG- and IgA-AGA and two with only IgG-AGA) and underwent jejunal biopsies that disclosed complete villous atrophy associated with an increased number of intraepithelial lymphocytes and hypertrophic criptae. In this study group, the prevalence of biopsy-proven celiac disease was 1.47 ± 1.66 in 1000 subjects. CONCLUSIONS: We found a prevalence of undiagnosed CD of 1:681 among apparently healthy blood donors. These preliminary results support the view that CD is not a rare disease in Brazil.

The hydrogen breath test (H2BT) with d-xylose has proven valid in both early recognition and follow-up of intestinal malabsorption. To further evaluate the specificity of the H2BT with d-xylose in the diagnosis of intestinal malabsorption as compared to the conventional urinary d-xylose test, we analyzed the result in 49 patients referred to our unit with a clinical diagnosis of intestinal malabsorption. These patients had an abnormal 25-g d-xylose H2BT but a normal conventional urinary d-xylose test. Jejunal biopsy with Watson capsule was performed in all patients. H&E staining was prepared from each biopsy specimen, and histological changes were classified according to the Marsh criteria. Jejunal biopsy showed mucosal atrophy in 5 patients (10%), hyperplastic lesion in 11 (22.5%), infiltrative lesion in 14 (28.5%), and normal appearance in 19 (39%). G. lamblia infection was additionally diagnosed in two patients. Histological changes were independent of the presence of diarrhea, weight loss, abdominal pain, or anemia. H2 excretion, assessed as increase over baseline and area under the curve, was similarly independent of the histological pattern. In conclusion, performance of a d-xylose H2BT in patients with a normal urinary test reveals a significant number of patients with intestinal mucosal atrophy who might otherwise remain undiagnosed.

We have investigated the intestinal mononuclear cell subpopulations in patients with systemic lupus erythematosus (SLE) and correlated these with the disease activity.Eighteen female outpatients were studied; in 10 of them lupus activity was measured with the Lupus Activity Criteria Count and the SLE Disease Activity Index. Eight patients were in lupus remission. The control group consisted of 10 healthy volunteers. Peroral jejunal biopsy was performed in all individuals, at the angle of Treitz, using a Watson capsule, under X-ray control. Histologic studies analysed the villous to crypt ratio, lamina propria cells, and intraepithelial lymphocyte count. Immunohistochemical evaluation was carried out with the indirect immunoperoxidase technique, using monoclonal antibodies against CD3, CD4, CD8, D1, D7, D9, and M1.Lamina propria CD3+, CD8+, D7+, and M1+ cells from patients with SLE did not differ significantly from those of controls. CD4+ cells were decreased in all patients with SLE, especially in the clinically inactive patients. D1+ and D9+ cells were also decreased in all patients.The finding of quantitative abnormalities in the cell-mediated immunity of the intestinal mucosa may reflect systemic defects of the immune system in SLE.

Diagnostic ultrasound showed that the passing of the Watson capsule through the pylorus can be proved demonstrating its catheter within the pylorus. Only the biopsy itself has to be done under radiologic control which results in decreasing X-ray time from sometimes six minutes to a few seconds, usually less than one minute.

La ferropenia puede ser la única manifestación de un síndrome malabsortivo, secundario a la presencia de una atrofia intestinal. Por ello, descartadas las pérdidas gastrointestinales, debería tenerse en cuenta esta posibilidad en el estudio de la ferropenia. Objetivos: Evaluar la utilidad de la biopsia yeyunal en el diagnóstico de la malabsorción intestinal como causa de ferropenia y analizar cuales son las causas de ferropenia malabsortiva. Método: Se han incluido 70 pacientes con ferropenia (ferritina < 25 ng/ml) remitidos a la Unitat de Proves Funcionals Digestives, para la valoración de una posible malabsorción intestinal mediante la realización de una biopsia yeyunal. La biopsia yeyunal se obtuvo distal al ángulo de Treitz mediante cápsula de Watson. Se clasificaron los resultados histológicos según los criterios de Marsh. Resultados: La biopsia yeyunal se realizó en 66 pacientes. Fue normal en 25 pacientes, inespecífica en 1, en 12 se evidenciaron lesiones grado 1 (infiltrado linfocitario), en 2 lesiones grado 2 (hiperplasia de criptas) y en 25 lesiones grado 3 (atrofia). En otro paciente se objetivó una giardiasis intestinal. El diagnóstico clínico de los pacientes incluídos fue de enfermedad celíaca en 21 (32%), aclorhidria en 7 (10,5%), sobrecrecimiento bacteriano en 1 (1,5%), giardiasis intestinal en otro (1,5%), pérdidas ginecológicas en otra (1,5%) y 35 (53%) quedaron sin diagnóstico definitivo. Conclusiones: La biopsia yeyunal es una prueba útil en el diagnóstico de malabsorción como causa de ferropenia, permitiendo poner de manifiesto la existencia de patología intestinal en un alto porcentaje de casos.

Background Reported frequencies of celiac disease in selective IgA deficiency in childhood vary widely and this is probably due to the different characteristics of the patients studied and to the different criteria used for intestinal biopsy: all patients or only those with symptoms of malabsorption. Diagnosis of celiac disease is of considerable importance in IgA deficiency because of its increased frequency and also because avoidance of dietary gluten permits elimination of the symptoms and complications of celiac disease. Objectives To obtain a more reliable estimate of the incidence of celiac disease in childhood IgA deficiency, jejunal biopsies were performed in 65 consecutively diagnosed IgA-deficient children whose parents consented. Some clinical and laboratory parameters including IgA-antigliadin and IgG-antigliadin antibodies were evaluated to predict their usefulness in selecting IgA-deficient patients for intestinal biopsy. Methods All IgA-deficient patients had serum IgA levels below 5 mg/mL and salivary IgA below 0.5 mg/dL. Jejunal biopsy was performed using a peroral Watson capsule and IgA-antigliadin and IgG-antigliadin antibodies were performed by an ELISA assay. Results Biopsy findings of severe villous atrophy permitted diagnosis of celiac disease in 7.7% (5/65 children). IgG-antigliadin antibody levels, elevated in 16 patients including all five celiacs, were the best parameter for predicting celiac disease and gave no false negatives. Conclusions The 7.7% frequency of celiac disease observed in these IgA-deficient children is about 20 times higher than in the general Italian population, and the lowest among the studies biopsying all patients; this is probably attributable to the presence of a substantial proportion of healthy children (20/65) and very few (2/65) with autoimmune disorders. The elevated sensitivity and negative-predictive value of IgG-antigliadin antibodies lead us to suggest that positive IgG-antigliadin antibodies can be used to select IgA-deficient children for jejunal biopsy with a very low probability of missing celiac disease while allowing a drastic reduction in the number of biopsies performed.

We analyzed the results of 607 small bowel biopsies performed over a seven-year period: 284 biopsies were obtained using a fiberendoscope and 323 biopsies using a Watson capsule. Three to six specimens were removed during endoscopy. The biopsy fragments obtained with the fiberendoscope were deeper than those obtained with the Watson capsule (p less than 0.0001) and were more often located in the duodenum (p less than 0.0001). The failure rate of the fiberendoscope biopsies (1%) was lower than for the Watson capsule biopsies (9%) (p less than 0.0001). Multiple biopsies increased the diagnostic value of fiberendoscopy which was 95% versus 85% for Watson capsule. The mean duration of the endoscopic procedure recorded in 30 children was 6.5 min for four to six samples, i.e. 1.5 min per biopsy specimen. Fiberendoscopy appears to be an efficient and safe method for performing small bowel biopsies in infants and children.

In order to trace, in greater depth, the sequence of events involved in mucosal flattening, small groups of well-treated coeliac patients were challenged orally with FF3, in doses ranging from 0.1, 0.5, 1.0, 1.5, 3, 6 to 12G. Per-oral jejunal biopsies were performed with the Watson capsule pre-challenge, and at 12, 36, 60 and 84h post-challenge. Mucosae were processed to epon, and 1μm toluidine blue-stained sections were analyzed by computerized image analysis. Specimens were measured in terms of volumes of surface (VSE) and crypt (VCR) epithelium, and their corresponding populations (NV,SE:NV,CR) of intra-epithelial lymphocytes.

Small-intestinal mucosal biopsy specimens obtained by a Watson capsule were assessed by light (LM) and scanning electron (SEM) microscopy in 18 patients with various sites of Crohn's disease and in 6 healthy controls. By means of LM, partial villous atrophy of the upper small-intestinal mucosa was assessed in six patients. With the use of SEM a further seven patients were shown to have mucosal abnormalities of possible clinical significance. These specimens showed a convoluted villous pattern at low-power SEM and some also enterocyte irregularity, bulging, and surface ultrastructural distortion at medium- and high-power SEM. The medium- and high-power mucosal alterations were unevenly distributed. The high prevalence of abnormalities of the upper small-intestinal mucosa in patients with Crohn's disease elsewhere in the gastrointestinal tract adds further weight to the concept of a diffuse involvement along the entire gastrointestinal tract in Crohn's disease.

Forty-eight patients with dermatitis herpetiformis were investigated with duodenoscopy, endoscopic biopsy, and conventional upper jejunal biopsy. Three endoscopic biopsy specimens were obtained from the duodenal bulb, three to six specimens from the second part of the duodenum, and one suction biopsy from the upper jejunum. In 60%, 71%, and 65% of the patients subtotal or partial villous atrophy was found in biopsies from the three levels, respectively. In eight patients (17%) mucosal abnormalities were confined to the duodenal biopsies and in two patients to the jejunal biopsies. The technique of endoscopic biopsy is advocated because multiple visually selected duodenal specimens may be obtained and because this technique also enables a complete evaluation of the stomach.

Details of jejunal biopsies using the Watson small intestinal biopsy capsule done from 1966 through 1976 at three centers in Liverpool were obtained. The only complications were jejunal perforation which occurred in 2 patients over 65 years of age, 1 of whom died. This increased risk in the elderly does not appear to have been previously recognized and both cases are reported. Diagnostic yield in the age group over 65 is discussed. Stricter criteria in selection of these patients for biopsy are suggested. A period of inpatient observation after biopsy in those over the age of 65 may decrease the risks of perforation. In addition, the use of a pediatric capsule, ideally with controlled suction, may lessen the risk further. The use of duodenal biopsy via an endoscope may prove to be a useful additional technique in elderly patients.

Morphometric techniques were employed to measure (i) lamina propria volumes and (ii) the absolute numbers of neutrophils and plasma cells, of A, M and G isotype, within the lamina propria of jejunal mucosa. Mucosal specimens were obtained with a Watson capsule (a) from 5 patients with untreated coeliac disease, and again at least 3 months after starting on a gluten-free diet, and (b) from 9 control individuals. Lamina propria volume of untreated coeliac mucosa (2.5 +/- 0.17 X 10(6) micron3 ) was increased 2.3-fold (p less than 0.01) above that of control mucosae (1.35 +/- 0.08 X 10(6) micron3 ). Compared with control mucosae, there was a 20-fold increase of neutrophils in untreated coeliac mucosae (p less than 0.005). The total complement of all plasma cells in untreated coeliac mucosae (309) was twice that (149) of control mucosae. The populations of each isotype were also significantly increased over controls by factors of 1.6 (IgA; p less than 0.05), 3.0 (IgM; p less than 0.01) and 3.5 (IgG; p less than 0.01). Their percentage distributions in untreated coeliac mucosae (A:M:G--52:43:5) differed from those in control mucosae (A:M:G--69:28:3) but were restored after treatment with a gluten-free diet. However, when each isotype was expressed per unit volume of lamina propria, there was an apparent fall (X 1.4) in IgA cells, while the increase in IgM and IgG cells was less marked i.e. X 1.4 and X 1.5 respectively. These precise measurements explain why many previous investigators found a paradoxical fall in IgA cells because the (increased) volume of distribution of these cells was not taken into account. The importance of morphometric techniques in achieving valid cell 'counts' within the intestinal mucosa is thus illustrated by this study.

Description d'une technique presentant des avantages: rapidite (generalement 15 mn), pas de gene pour le sujet, pas de necessite d'anesthesie locale ni de sedation. Indication principale: suspicion de maladie cœliaque