J Wehba

Protracted diarrhea in infancy: clinical aspects and ultrastructural analysis of the small intestine.

Summary: Protracted diarrhea is a clinical entity characterized by diarrhea lasting >2 weeks, starting before 3 months of age, with severe nutritional aggravation and negative stool culture for enteropathogens. This report deals with the ultrastructural abnormalities found in the intestinal mucosa of children with protracted diarrhea. Forty children (mean age 5.1 months) were studied. They were submitted to the following tests of intestinal function: D-xylose, triglyceride tolerance, small bowel biopsy (light and electron microscope), sigmoidoscopy, and sweat test. D-Xylose absorption and triglyceride tolerance test in these patients were both significantly tower than controls. Ultrastructural analysis of the small bowel of 12 patients showed various degrees of alterations, mainly shortening of the micovilli, increased number of multivesicular bodies, and vacuolation of mitochondria and endoplasmic reticulum. These lesions were totally reversible after clinical and nutritional recovery, as could be proven in two children. The most common cause of protracted diarrhea in these patients was secondary carbohydrate intolerance and dietary protein cows milk and soy bean intolerance, which resulted in colitis or malabsorption as a consequence of intestinal mucosa injury due to acute gastroenteritis.

Giardiasis in childhood and its effects on the small intestine.

Summary: The effects of Giardia lamblia on small bowel function were studied. Thirty‐three asymptomatic children were studied before and after treatment with metronidazole (Nimorazol®). Patients had a small intestinal biopsy, bile salt determinations, and the following absorptive tests: D‐xylose, triglyceride, and lactose and sucrose tolerance tests. Before treatment, 87% had unconjugated bile salts in duodenal fluid but afterwards only 60% did. Small bowel biopsy changes did not correlate with the pre‐ and posttreatment periods. Triglyceride absorption showed significant differences between patients at different periods of the study; D‐xylose absorption did not reveal differences between the periods of the study but was significantly impaired when compared with controls. Lactose malabsorption was detected in 56% and sucrose in 7% of the patients. G. lamblia may have some pathogenic role, although nonspecific to intestinal function. It probably acts more in a synergistic way with other pathogenic agents that inhabit the intestinal lumen of children living under unfavorable conditions producing the picture of tropical enteropathy.

Ultrastructural study of alterations in the small intestinal epithelium of children with acute diarrhoea.

: We studied the ultrastructure of the jejunal epithelium of six children suffering from acute episodes of gastroenteritis. Ultrastructural alterations of the jejunal mucosa occurred in practically all of the fragments analyzed, although the intensity of the abnormalities observed varied considerably. In most of the patients the alterations were confined to the microvilli, which appeared shortened and tufted in comparison with controls. These ultrastructural alterations are nonspecific and may represent a general response of the intestinal mucosa against different noxious agents. Severe alteration of the epithelial cells was observed in only one patient. In this case the cytoplasm contained multiple vacuoles that may correspond to dilated endoplasmic reticulum. It is hypothesized that the small intestinal lesions observed in these patients may allow penetration of food antigens, resulting in the appearance of food intolerance frequently described in children suffering from acute diarrhea.

Caroli's disease in childhood: report of two new cases

Carolis disease is a rare congenital disorder characterized by segmentary saccular dilatation of the intrahepatic bile ducts, which manifests itself clinically by cholangitis and bile stones. We report two cases of Carolis disease in schoolgirls with clinical signs of recurrent abdominal pain associated with intermittent crises of cholestatic jaundice. Diagnosis was made by retrograde cholangiography in one patient and by intravenous cholangiography in the other.