Description:
This 49 year old lady has had a one year history of worsening diarrhea of up to 8-10 bowel movements per day. Prior serologic studies suggested the possibility of sprue. This endoscopy demonstrates changes that are very suggestive of sprue also called gluten sensitive enteropathy or celiac disease. The classic endoscopic features are seen here; there are areas of atrophic mucosa distributed in a patched mosaic pattern. The edges of the folds have an irregular appearance giving rise to the saw toothed pattern recognized as being suggestive of the diagnosis. On close inspection of the mucosal surface, the tiny villous projections characteristic of normal duodenal mucosa, are not visible.
Histologically, there is total villous atrophy, crypt hyperplasia and an increase of chronic inflammatory cells in the lamina propria all giving the appearance of colonic mucosa. The high power view shows surface injury with numerous intraepithelial lymphocytes, well above the normal limit of one lymphocyte per 6-10 enterocytes. In the lamina propria, we can better appreciate the dense lymphoplasmocytic infiltrate with most of these cells being plasma cells.
In the workup of sprue, the sensitivity and specificity of the IgA anti-endomysial and IgA tissue transglutaminase antibodies range from 85-100% depending on the series. Many authorities still feel that EGD and biopsy confirmation of the diagnosis should be considered in serologically positive individuals before committing them to lifelong dietary restriction.
Contributed By:
Peter B. Kelsey, M.D., Harvard Medical School, Massachusetts General Hospital
Histologically, there is total villous atrophy, crypt hyperplasia and an increase of chronic inflammatory cells in the lamina propria all giving the appearance of colonic mucosa. The high power view shows surface injury with numerous intraepithelial lymphocytes, well above the normal limit of one lymphocyte per 6-10 enterocytes. In the lamina propria, we can better appreciate the dense lymphoplasmocytic infiltrate with most of these cells being plasma cells.
