Intractable Diarrhea: Value of the Small Intestinal Biopsy

PEDIATRICS ◽  
1981 ◽  
Vol 68 (3) ◽  
pp. 470-471
Author(s):  
William J. Byrne ◽  
Arthur R. Euler
Keyword(s):  
Small Bowel ◽  
Nutritional Support ◽  
Mucosal Injury ◽  
Intestinal Biopsy ◽  
Intractable Diarrhea ◽  
Small Bowel Biopsy ◽  
Entire Small Intestine ◽  
Small Intestinal Biopsy ◽  
Close Proximity ◽  
Small Intestinal

In summarizing their article on intractable diarrhea of infancy Rossi et al1 stated, "a small bowel biopsy is useful in assessing the degree of injury present and guiding nutritional support." We concur that the small bowel biopsy is useful in assessing mucosal injury but has certain limitations. The authors used the Crosby-Krugler capsule, which obtains two small pieces of tissue, in close proximity. This limits the sensitivity of the technique as the specimens are not necessarily representative of the mucosal state of the entire small intestine nor do they allow exclusion of a patchy villous lesion.2

Letters to the Editor

PEDIATRICS ◽  
1981 ◽  
Vol 68 (3) ◽  
pp. 471-471
Author(s):  
Thomas M. Rossi ◽  
Emanuel Lebenthal
Keyword(s):  
Clinical Response ◽  
Intestinal Biopsy ◽  
Letters To The Editor ◽  
Intractable Diarrhea ◽  
Mucosal Atrophy ◽  
Small Intestinal Biopsy ◽  
Small Intestinal

Our report1 clearly documents prolonged mucosal atrophy in infants with intractable diarrhea of infancy. We feel that this highlights the pathophysiology of the diarrhea and accounts for the malabsorptive state which leads to malnutrition in many infants. In their letter, Drs Byrne and Euler focus on a tangential isue. We are aware of the limitations of the use of the small intestinal biopsy and recognize that disaccharidase activities are not absolute in predicting the clinical response of a given infant to a certain disaccharide-containing formula.

Role of small bowel biopsy in infantile intractable diarrhea

1986 ◽  
Vol 91 (3) ◽  
pp. 791-792 ◽  
Author(s):  
Alan D. Phillips ◽  
John A. Walker-Smith
Keyword(s):  
Small Bowel ◽  
Intractable Diarrhea ◽  
Small Bowel Biopsy

Extent and Duration of Small Intestinal Mucosal Injury in Intractable Diarrhea of Infancy

PEDIATRICS ◽  
1980 ◽  
Vol 66 (5) ◽  
pp. 730-735
Author(s):  
Thomas M. Rossi ◽  
Emanuel Lebenthal ◽  
Kenneth S. Nord ◽  
Rafiqua R. Fazili
Keyword(s):  
Elemental Diet ◽  
Mucosal Injury ◽  
Height Velocity ◽  
Common Finding ◽  
Small Intestinal Mucosa ◽  
Intractable Diarrhea ◽  
Young Infants ◽  
Intestinal Mucosal Injury ◽  
Small Intestinal

Thirty infants with intractable diarrhea of infancy (IDI) underwent small bowel biopsies in order to determine the extent and duration of small intestinal mucosal injury. The onset of the persistent diarrhea occurred prior to 3 months of age and continued for an average of 48 days prior to investigation. In 18 cases, no associated entities were found. Mucosal injury was invariably found in all 30 infants: grade IV injury in 11, grade III in eight, grade II in nine, and grade I atrophy in one. Disaccharidase activities were diminished and corresponded to the degree of atrophy. Lactase activity was diminished to a greater extent than sucrase and maltase. Significant, persistent mucosal injury existed for an average of six months in 16 of the 23 (70%) repeat biopsies. All infants were given an elemental diet (ED). Twelve of the 30 infants required parenteral nutrition (PN). These infants were gradually advanced to an oral elemental diet and maintained on this diet until histologic findings and disaccharidase levels were normal. Eighteen infants were fed and maintained on an elemental diet by mouth from time of admission until normal histologic findings and disaccharidases were found. No mortality occurred during management and follow-up. Twenty-two of the 28 infants in whom follow-up growth data were available excelled in weight and height velocity. The data suggest that prolonged injury to the small intestinal mucosa is a common finding in many cases of intractable diarrhea of infancy. Elemental diets should be started early in the course of protracted diarrhea in young infants, and may need to be continued for several months since histologic and enzymatic changes of the small intestine may persist for extended periods.

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