Grefte J M, Bouman J G, Grond J, Jansen W, Kleibeuker J H
Department of Gastroenterology, University Hospital, Groningen, The Netherlands.
J Clin Pathol. 1988 Aug;41(8):886-91. doi: 10.1136/jcp.41.8.886.
To assess the course of recovery of gluten sensitive enteropathy in adults, histological and functional recovery was studied in 22 patients, aged 20-79 years. Biopsy specimens taken at the time of diagnosis were studied in 20; after adhering to a gluten free diet for nine to 19 (mean 14) months in 14; and after adhering to the same diet for 24-48 (mean 34) months in 10 patients. Histological recovery was assessed morphometrically in the proximal jejunum. Mucosal linings significantly improved over time, but did not completely return to normal with a gluten free diet: at diagnosis the surface: volume ratio was 22% of normal, increasing to 48% and 66% after nine to 19 and 24-48 months, respectively, of a gluten free diet. Disaccharidase activities progressively increased. After 24-48 months maltase, sucrase, and isomaltase had returned to normal in the proximal jejunum; they were still significantly decreased in the distal duodenum. Duodenal and jejunal lactase activities were both below normal after 24 to 48 months. It is concluded that recovery of the intestinal mucosa of adults with gluten sensitive enteropathy during a gluten free diet continues beyond nine to 19 months and is still incomplete after two to four years. The recovery of disaccharidase activities extends from the distal to the proximal part of the small intestine, and is aligned to histological recovery.
为评估成人麸质敏感性肠病的恢复过程，对22例年龄在20至79岁之间的患者进行了组织学和功能恢复情况的研究。20例患者在诊断时采集了活检标本；14例患者在遵循无麸质饮食9至19个月（平均14个月）后采集；10例患者在遵循相同饮食24至48个月（平均34个月）后采集。通过对空肠近端进行形态计量学评估来判断组织学恢复情况。随着时间推移，黏膜内衬有显著改善，但无麸质饮食后并未完全恢复正常：诊断时表面与体积比为正常的22%，在无麸质饮食9至19个月和24至48个月后分别增至48%和66%。双糖酶活性逐渐增加。在24至48个月后，空肠近端的麦芽糖酶、蔗糖酶和异麦芽糖酶已恢复正常；十二指肠远端仍显著降低。在24至48个月后，十二指肠和空肠的乳糖酶活性均低于正常水平。得出的结论是，患有麸质敏感性肠病的成人在无麸质饮食期间，肠道黏膜的恢复持续超过9至19个月，且在两到四年后仍不完全。双糖酶活性的恢复从小肠远端延伸至近端，并与组织学恢复一致。
