Small Bowel Biopsy

The time which has elapsed since the description of the first case of a-/8-lipoproteinemia is too short for detailed information on the morbid anatomy of the disease. Of the three affected subjects who have died, an autopsy was performed in only one (Sobrevilla et al.). The following describes the findings in this case. 

Gross examination of the brain in this 37 year old patient showed an organ with normal weight (1340 g) which was symmetrically shaped, and appeared normal with the exception of a brown discoloration of the lumbosacral area of the anterior horns bilaterally. 

Microscopic examination confirmed the clinical diagnosis of involvement of the posterior, lateral and anterior columns, and of the pyramidal and cerebellar tracts. There was demyelination of the anterior columns, of the spino-cerebellar tracts and of the cerebellum, with loss of anterior horn cells and cerebellar nuclei. Sections of peripheral nerves, too, showed foci of demyelination. Histochemical studies were not performed in this case. 

The fatty acid composition of all plasma lipid fractions shows a marked decrease in the proportion of linoleic acid and an increase in that of oleic acid (Rey 1961 Ways et al. 1963). It resembles the pattern observed in sprue or other disorders of fat absorption (see table 3). The fasting free fatty acid level has been found to be within normal limits by Salt et al. (1960) the composition of free fatty acids has not been determined. 

The typical finding is a marked decrease or lack of /5-lipoproteins (d 1.019 — 1.063) which can be demonstrated with paper-electrophoresis (see figure 4), ultra-centrifugation and immunoelectrophoresis (see table 4). It is not known with 

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In some cases, invasive tests such as endoscopy are needed. For most gastroenterological allergies, small bowel biopsy shows a patchy enteropathy with nonspecific inflammatory infiltrate (lymphocytes, monocytes, eosinophils). If the diagnosis is positive, the mucosa improves when the offending proteins are removed from the diet. Histology of the biopsy samples often confirms the diagnosis but does not indicate which foods are responsible for the reaction (Sampson, 2004). 

Barker CC, Mitton C, Jevon G, Mock T. Can tissue transglutaminase antibody titers replace small-bowel biopsy to diagnose celiac disease in select pediatric populations Pediatrics 2005 115 1341-1346. 

A 63-year-old hjrpertensive woman, who had a carcinoma of the distal esophagus resected 19 months earlier, developed chronic diarrhea. Clostridium difficile toxin was identified in her stools and the diarrhea resolved after treatment with metronidazole. Enalapril was added to her antihypertensive treatment, and 3 months later the diarrhea recurred. Stool examination was negative and there was no Clostridium difficile toxin. Her condition worsened and she lost 5 kg in weight She had marked eosinophiha (2.4 x 10 /1), and a small bowel biopsy showed mild chronic inflammation and edema, partial villous atrophy, and large clusters of eosinophils in the lamina propria with some focal infiltration of the epithelium. She stopped taking enalapril and her diarrhea promptly abated and the eosinophil count fell to 0.5 X 10 /1 at 3 weeks and 0.1 x 10 /1 at 2 months. 

Clinically, the most relevant symptoms are oedema, diarrhoea and lymphocytopenia due to both lymphatic leakage and rupture. The small bowel biopsy finding of numerous dilated lymphatic vessels consistent with diffuse or focal lymphangiectasia definitely support the diagnosis. 

Summary of Consequences for Intestinal Microflora Failure of intestinal clearance caused by impaired motor activity or local stagnation for anatomical reasons results in Gram-negative colonization of the small bowel. Small bowel aspirate, mucosal brush, or biopsies are optional samples for culture, which is still the gold standard for detecting this type of overgrowth. 

B16. Bolt, R. J., Pollard, H. M., and McCool, S., Staining of enzymes in mucosa of the small bowel, using a peroral biopsy tube. Am. J. Clin. Pathol. 34, 43-49 (1960). 

Sullivan, B. H., Jr., Sprinz, H., and Batsaki, J. G., Peroral small bowel mucosal biopsy. New investigative technics and experimentation have altered concepts of pathological changes and provided a tool for investigation of certain physiological processes. J. Am. Med. Assoc. 174, 2200-2203 (1960). 

Carson BW, Brown JA, Cooperberg PL (1998) Ultrasonograph-ically guided percutaneous biopsy of gastric, small bowel and colonic abnormalities efficacy and safety. J Ultrasound Med 17 739-742... 

Before stent placement an accurate diagnosis is paramount for choosing between curative and palUative treatment. CT, upper GI series and endoscopy with biopsy should be performed to evaluate length, location and nature of the stenosis (Fig. 3.5a). In addition, distal obstruction in the small bowel which could compromise passage of intestinal contents should also be excluded (De Baere et al. 1997 Soetikno et al. 1998). Insertion of stents via gastrostomy... 

Fig. 7.17. Image from a 33-year-old man obtained 20 months after simultaneous pancreas-kidney transplantation with pancreatic graft dysfunction and acute rejection verified by histopathological examination. Helical CT is used for image-guided percutaneous biopsy arrows) of pancreatic graft arrow) adjacent to contrast-medium-filled small bowel arrowhead) and renal graft asterisk)...

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