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Histologic findings are not correlated with disaccharidase activities in infants with protracted diarrhea
R J Shulman1, C Langston, C H Lifschitz
1USDA/ARS Children's Nutrition Research Center, Department of Pediatrics, Houston, TX 77030.
Insights
Histologic assessment of small intestinal mucosal damage in infants did not correlate with disaccharidase activity. This suggests that while histology is useful, enzyme levels may not directly reflect mucosal damage severity in these cases.
Area of Science:
- Gastroenterology
- Pediatric Gastroenterology
- Histopathology
Background:
- Small intestinal mucosal damage can impact disaccharidase activity.
- Assessing this relationship is crucial for managing patients with protracted diarrhea in infants.
Purpose of the Study:
- To determine if the degree of small intestinal mucosal damage correlates with reduced disaccharidase activity (lactase, sucrase, maltase).
Main Methods:
- Compared histologic assessment (pathologist score, villus surface area, villus/crypt ratio) with disaccharidase activity in 21 infants with protracted diarrhea.
- Histology was graded blindly using subjective scores and a computer-assisted digitizing system.
Main Results:
- Good correlation was found between pathologist grading and computer-assisted histologic assessment (VSA vs. P, r=0.695; V/C vs. P, r=0.791).
- All infants showed some degree of mucosal damage.
- No significant correlation was observed between histologic damage scores and lactase, sucrase, or maltase activity.
Conclusions:
- Histologic findings of small intestinal mucosal damage in infants with protracted diarrhea do not correlate with measured disaccharidase activity.
- Disaccharidase assays may not accurately reflect the severity of mucosal damage in this patient population.
Abstract:
Histologic assessment as well as information about the disaccharidase activity of the small intestinal mucosa can be useful in the management of patients with small intestinal mucosal damage. In an effort to determine whether the degree of small intestinal mucosal damage would be reflected in a corresponding reduction in disaccharidase activity, we compared small intestinal mucosal histology with the results of disaccharidase activity measured in per oral suction small intestinal biopsies obtained from 21 infants with protracted diarrhea. The degree of small intestinal mucosal damage was graded using a subjective score (i.e., 0 to 4+ damage) by a pathologist (P) and by a computer-assisted digitizing system (to assess villus surface area, VSA, and villus/crypt ratio, V/C) in a blinded fashion. The mean (+/- SD) age of the infants was 2.5 +/- 1.5 months, and the duration of diarrhea was 25.2 +/- 11.5 days. There was good correlation between the results obtained from the digitizing system and from the pathologist: VSA versus P, r = 0.695; V/C versus P, r = 0.791; p = 0.0004. All infants demonstrated some degree of small intestinal mucosal damage. The mean (+/- SD) values for P, VSA, and V/C were 2.2 +/- 1.3, 2.9 +/- 0.9, and 0.9 +/- 0.5, respectively. The mean values for lactase, sucrase, and maltase were 17.1 +/- 17.0, 71.1 +/- 54.0, and 224.3 +/- 233 mumol/min/g protein, respectively. No correlation was observed between the histologic scoring results and lactase, sucrase, or maltase measurements. Expressing the disaccharidase activities per unit wet weight of tissue did not improve the correlations. Log transformation of the data also failed to improve the correlations.(ABSTRACT TRUNCATED AT 250 WORDS)