Small intestinal mucosal fat in childhood enteropathies

A sequential series of 100 small bowel mucosal biopsies from children was studied to assess the frequency and pattern of mucosal fat staining, and to compare patterns of fat distribution with mucosal structure and clinical diagnosis. Deep mucosal fat was commonly associated with those clinical groups showing normal mucosal structure. While fine granular surface epithelial fat was common in normal and abnormal biopsies, the presence of large fat globules in the surface epithelium was almost entirely limited to biopsies showing villous shortening. Large fat globules in the surface epithelium in coeliac disease and cow's milk sensitive enteropathy were probably related to the more severe degrees of villous abnormality encountered in these clinical groups. However, large fat globules in surface epithelium were also found in a few cases of cow's milk sensitive enteropathy with normal or minimal villous blunting. Fat staining may be a useful additional histological marker to aid in the interpretation of small intestinal mucosal biopsies.