Bryant D A, Mintz E D, Puhr N D, Griffin P M, Petras R E
Department of Anatomic Pathology, Cleveland Clinic Foundation, OH 44195, USA.
Am J Surg Pathol. 1996 Sep;20(9):1102-9. doi: 10.1097/00000478-199609000-00008.
The term Brainerd diarrhea has been applied to outbreaks of chronic watery diarrhea of unknown etiology characterized by acute onset and prolonged duration. Our aim was to describe the histologic changes in gastrointestinal biopsy specimens from patients with Brainerd diarrhea. We examined 52 colonic and 12 small bowel biopsy specimens from 22 patients who were involved in an outbreak of Brainerd diarrhea that was linked to the water supply of a cruise ship visiting the Galapagos Islands. Small bowel biopsy specimens from seven patients were histologically normal. One patient had a duodenal biopsy specimen that resembled celiac sprue. Colonic biopsy specimens from 20 patients revealed surface epithelial lymphocytosis without distortion of mucosal architecture, surface degenerative changes, or thickened subepithelial collagen plates. The degree of surface epithelial lymphocytosis was greater than that seen in control groups of persons with normal colons, acute colitis, and ulcerative colitis (p < 0.001), similar to that seen with collagenous colitis, and less than that seen with lymphocytic colitis (p < 0.001). Three patients showed focal active colitis similar to that described in acute infectious-type colitis in addition to the epithelial lymphocytosis. Two patients had colonic biopsy specimens that were histologically normal. In summary, histologic abnormalities in the small bowel are generally absent in Brainerd diarrhea. Colonic biopsy specimens in Brainerd diarrhea frequently show epithelial lymphocytosis similar to that seen in collagenous and lymphocytic colitis. Although currently Brainerd diarrhea can be diagnosed only with epidemiologic data indicating an epidemic and a point source, the lack of surface degenerative changes and the relatively lower lymphocyte counts seen in our cases of Brainerd diarrhea may serve to distinguish it from lymphocytic colitis, and the lack of a thickened subepithelial collagen plate distinguishes it from collagenous colitis.
“布雷纳德腹泻”一词用于描述病因不明的慢性水样腹泻暴发，其特点为起病急且病程长。我们的目的是描述布雷纳德腹泻患者胃肠道活检标本的组织学变化。我们检查了22例参与与一艘访问加拉帕戈斯群岛游轮供水相关的布雷纳德腹泻暴发的患者的52份结肠活检标本和12份小肠活检标本。7例患者的小肠活检标本组织学正常。1例患者的十二指肠活检标本类似乳糜泻。20例患者的结肠活检标本显示表面上皮淋巴细胞增多，黏膜结构无扭曲、表面无退行性改变或上皮下胶原板未增厚。表面上皮淋巴细胞增多的程度大于正常结肠、急性结肠炎和溃疡性结肠炎对照组所见（p<0.001），与胶原性结肠炎所见相似，小于淋巴细胞性结肠炎所见（p<0.001）。3例患者除上皮淋巴细胞增多外，还表现出类似于急性感染型结肠炎中所描述的局灶性活动性结肠炎。2例患者的结肠活检标本组织学正常。总之，布雷纳德腹泻患者小肠通常无组织学异常。布雷纳德腹泻患者的结肠活检标本常显示上皮淋巴细胞增多，类似于胶原性和淋巴细胞性结肠炎所见。尽管目前布雷纳德腹泻只能根据表明暴发和点源的流行病学数据进行诊断，但我们的布雷纳德腹泻病例中缺乏表面退行性改变以及淋巴细胞计数相对较低，这可能有助于将其与淋巴细胞性结肠炎区分开来，而缺乏增厚的上皮下胶原板则将其与胶原性结肠炎区分开来。
