Parfenov A I, Vasil'ev Iu V, Chikunova B Z, Parfenov D A, Sivash E S
Ter Arkh. 2001;73(8):38-43.
To study diagnostic value of intestinoscopy with biopsy of the mucosa from different portions of the small intestine in patients with chronic diarrhea and malabsorption.
The examination of 116 patients with chronic diarrhea and malabsorption (endoscopic and histological study of biopsy specimens from different portions of the small intestine) detected gluten enteropathy (n = 51), Wipple's disease (n = 8), general variable hypogammaglobulinemia (n = 11), lymphangioectasy (n = 9), lymphangiomatosis (n = 1), lymphoma (n = 2), amyloidosis (n = 3), eosinophilic gastroenteritis (n = 1), duodenoejunitis without atrophy (n = 7). 23 patients had normal mucosa of the small intestine.
Pathological changes in the jejunum and duodenum were identical in glutenic enteropathy (GE), Wipple's disease (WD), variable hypogammaglobulinemia (VH) and amyloidosis.
For diagnosis of GE, WD, VH and amyloidosis it is sufficient to take biopsy from distal duodenum. Spot biopsy from sites of lymphostasis or nodular lymphoid hyperplasia is most informative for identification of lymphangioectasy, lymphangiomatosis and small intestinal lymphoma. Pathological changes in the ileum in GE, WD, VH and amyloidosis indicate severe total lesion of the small intestine.
研究小肠镜检查及对慢性腹泻和吸收不良患者小肠不同部位黏膜进行活检的诊断价值。
对116例慢性腹泻和吸收不良患者进行检查（对小肠不同部位活检标本进行内镜及组织学研究），发现麸质过敏性肠病（n = 51）、惠普尔病（n = 8）、一般性可变低丙种球蛋白血症（n = 11）、淋巴管扩张（n = 9）、淋巴管瘤病（n = 1）、淋巴瘤（n = 2）、淀粉样变性（n = 3）、嗜酸性胃肠炎（n = 1）、无萎缩性十二指肠空肠炎（n = 7）。23例患者小肠黏膜正常。
麸质过敏性肠病（GE）、惠普尔病（WD）、可变低丙种球蛋白血症（VH）和淀粉样变性患者空肠和十二指肠的病理变化相同。
对于GE、WD、VH和淀粉样变性的诊断，取十二指肠远端活检即可。对淋巴淤积部位或结节状淋巴样增生部位进行定点活检，对识别淋巴管扩张、淋巴管瘤病和小肠淋巴瘤最具诊断价值。GE、WD、VH和淀粉样变性患者回肠的病理变化表明小肠存在严重的全层病变。
