Scanning electron microscopy of small intestinal repair following treatment for gluten sensitive enteropathy

Sequential small intestinal biopsies from patients with gluten sensitive enteropathy were studied by scanning electron microscopy before and after dietary treatment. Compared with patients without evidence of villus atrophy, there were marked architectural changes. Before treatment, villi were absent and crypts were prominent. After treatment, the intestinal repair could be divided into stages. The first stage consisted of circular ridges surrounding the crypts. Unequal cellular repletion around the crypts resulted in the formation of horseshoe shaped ridges. Elongation of the arms of the horseshoes led to the formation of cerebriform ridges. Mitten-like villi were formed in the last stage by the development of furrows and septation of the ridges. The scanning electron microscope is a useful adjunct to the light microscopic and dissecting microscopic assessment of small intestinal biopsies. It can detect changes not possible with either light microscopy or the dissecting microscope and may be a more sensitive technique for the morphological assessment of patient response to treatment for gluten sensitive enteropathy.