Duodenal Biopsy in Diarrhea and Steatorrhea ‡

Beginning with Gee's7 mention of atrophy of glandular crypts in 1888, many investigators of idiopathic sprue agreed that the significant changes in the small bowel at autopsy consisted of mucosal and villous atrophy, edema, and chronic mucosal inflammation and ulceration. Later, these observations were dismissed by Thaysene as due to post-mortem autolysis. According to Suarez et al.,' Koppisch subsequently described shortened, clubbed, and blunted villi in 8 of 16 autopsied cases of sprue, and Adlers-berg and Schein' found bizarre villous shapes or clubbing in 2 of 10 autop-sied cases. It remained for small bowel biopsy to settle the question of post-mortem artefact, however. Studies of the histological appearance of biopsy specimens of small intestinal mucosa have been concerned mainly with changes occurring in the jejunum in patients with sprue, both tropical and nontropical, and with celiac disease. The changes described range from blunting, mushrooming, and reduction in the size of villi to almost total flattening of the villous surface area. This report presents observations of biopsy material which indicate that some mucosal changes in the duodenum are as striking and characteristic as those described in the jejunum, and that in severe chronic diarrhea there may occur quantitatively less extreme changes which are nonspecific in nature. METHODS AND MATERIALS Biopsy specimens were obtained by means of the small bowel biopsy tube devised by Shiner.' Twenty-two duodenal biopsies and three jejunal biopsies were obtained; one