American Journal of Clinical Nutrition, Vol 24, 112-116, Copyright © 1971 by The American Society for Clinical Nutrition, Inc.

Jejunal histology and clinical status in tropical sprue and other chronic diarrheal disorders

¹ From U.S. Army Tropical Research Medical Laboratory and The University of Puerto Rico School of Medicine, San Juan, Puerto Rico

Abnormalities of jejunal histology were compared with clinical and laboratory tests of small bowel absorptive function in 110 symptomatic untreated patients in Puerto Rico, who were referred for evaluation of diarrhea or weight loss and possible intestinal malabsorption (tropical sprue).

A spectrum of progressive degrees of abnormality of the jejunal mucosa paralleled, in general, the clinical status and the presence and degree of malabsorption. Sixty-eight of 71 patients (96%) whose biopsies were classified as tropical sprue had steatorrhea and d-xylose malabsorption. Among the 15 patients with borderline biopsy changes, 67% had steatorrhea, and 60% had abnormal d-xylose tests. Serum carotene levels were low in only 26%. In the 25 patients with a biopsy reading of nonspecific jejunitis, only one-fourth had malabsorption of fat or d-xylose.

The criteria used in this study for categorizing jejunal biopsy abnormalities are useful in predicting the presence of malabsorption in symptomatic, untreated patients in a tropical area endemic for tropical sprue. The degree of biopsy abnormality correlates, in general, with severity of clinical illness.