Application of fluorescence in situ hybridization (FISH) as a tool to aid cytogenetics in 1,409 fetal samples.

AIM: To evaluate the technical application of fluorescence in situ hybridization (FISH) as a support to classical cytogenetic in numerical chromosomal aneuploidies studies in samples of amniotic fluid, chorionic villus, and fetal loss. MATERIALS AND METHODS: The authois performed cytogenetic analyses in 1,409 patients (678 amniocentesis, 512 chorionic villus samples, and 219 spontaneous abortions) during one year. FISH molecular study aided traditional cytogenetic in 90 cases. These cases were indicated based on the diagnostic hypothesis of each patient or when no cellular growth was obtained. The authors standardized the FISH in discoloured slides. RESULTS: They had 85% positive FISH in amniotic fluid, 70% in chorionic villus, and 90% in abortion material using 13, 18, 21 X and Y centromeric probes. It showed 12% of altered FISH in amniotic fluid (100% trisomies), 10% in chorionic'villus (50% trisomy and 50% X - monosomy), and 22% in abortion material (50% trisomy, 25% X-monosomy, and 25% triploidy). FISH and cytogenetic analysis confirmed the results. CONCLUSION: This technique revolutionized clinical and research applications of cytogenetics. In this particular paper, FISH was a valuable and reliable technique to promptly identify rapid detection of aneuploidies in interphase cells, metaphase spread and paraffin-embedded samples. It is hoped that, in the future, the economic viability of array CGH and FISH, with the decreasing cost of testing and their genomics advantages can be incorporated as routine and customized in the approach of prenatal diagnosis.

Nitric oxide levels in the intestines of mice submitted to ischemia and reperfusion: L-arginine effects.

OBJECTIVE: Usually an experimental necrotizing enterocolitis experimental model, we Investigated nitric oxide levels in intestinal tissues of newborn mice with or without l-arginine therapy during sessions of ischemia and reoxygenation. METHODS: Twenty-six newborn mice from the Wistar EPM-1 lineage, weighing from 4.5 to 6.2 g, were randomly assigned to three groups: G-I/R, hypoxia and reoxygenation; G-Arg, l-arginine treatment I/R; and G-CTL, controls. G-I/R and G-Arg mice underwent twice a day during their first 3 days of life exposure to gas chambers with 100% CO(2) for 5 minutes at 22 degrees C before reoxygenation with 100% O(2) for another 5 minutes. After 12 hours, all animals were sedated, laparotomized, and had samples of ileum and colon taken and- either formalin fixed histopathologic examinations or frozen to -80 degrees C for estimation of tissue nitric oxide levels. Intestinal injuries were classified according to the criteria of Chiu et al. RESULTS: The G-I/R and G-Arg groups showed injuries characteristic of necrotizing enterocolitis (NEC) with an improved structural preservation rate in G-Arg. The concentration of nitric oxide in the Ileum was much higher with G-Arg (16.5 +/- 4.9; P = 0.0019) G-I/R (7.3 +/- 2.0). This effect was not observed in the colon: G-I/R = 10.7 +/- 4.6 versus G-Arg = 15.5 +/- 8.7 (P = .2480). CONCLUSION: Supply of L-arginine increased tissue levels of nitricoxide and reduced morphologic intestinal injury among mice undergoing I/R.

The regular arrangement of collecting venules pattern evaluated by standard endoscope and the absence of antrum nodularity are highly indicative of Helicobacter pylori uninfected gastric mucosa.

AIM: To evaluate the accuracy of antrum nodularity and the regular arrangement of collecting venules for diagnosing Helicobacter pylori gastritis. METHODS: Ninety-nine consecutive children and adolescents (1.07 years-17.69 years, mean+/-S.D.=9.71+/-3.80 F:M 54:45) undergoing upper digestive endoscopy were assessed for the presence of antrum nodularity and regular arrangement of collecting venules pattern to determine the status of H. pylori infection. Antrum nodularity was observed by a tangential view of the greater curvature of the gastric antrum. Regular arrangement of collecting venules was visualized as being the regular pattern of red points evaluated with a standard endoscope. Two biopsies from the antrum were collected for histology and rapid urease test. The accuracy of diagnosis based on antrum nodularity and regular arrangement of collecting venules was evaluated considering the sensitivity, specificity and likelihood ratio. RESULTS: H. pylori was detected in 32/99 patients (32.3%). Antrum nodularity provided 59.4% sensitivity (95% confidence interval 50.7-68.1), 98.5% specificity (95% confidence interval: 97-100), likelihood ratio+ 39.78, and likelihood ratio- 0.41. A regular arrangement of collecting venules pattern provided 96.9% sensitivity (95% confidence interval: 93.8-100), 88.1% specificity (95% confidence interval: 84.1-92), likelihood ratio+ 8.11, and likelihood ratio- 0.04. CONCLUSION: Antrum nodularity is a specific finding, although its sensitivity is low. A regular arrangement of collecting venules pattern and the absence of antrum nodularity are highly indicative of normal gastric mucosa that is negative for Helicobacter pylori.

Carditis is related to Helicobacter pylori infection in dyspeptic children and adolescents.

BACKGROUND: Etiology of gastric cardia inflammation is still controversial. AIMS: To evaluate the association between carditis and Helicobacter pylori infection and the correlation among inflammatory changes observed in biopsies taken from cardia, corpus, and antrum in a well-defined group of patients. PATIENTS: The mean age of 45 dyspeptic patients was 10.4 years (range 5.1-17.0 years); gender F/M rate: 1.6/1. METHODS: A total of 450 specimens from esophagus (2), cardia (2), corpus (3), and antrum (4) were collected for biopsy. The presence of H. pylori was assessed by histology and a rapid urease test. The types of glandular epithelium of cardia found in specimens were identified and both inflammatory changes and H. pylori density were graded. RESULTS: Carditis was present in specimens of 30/45 (66.7%) of the patients. Presence of H. pylori in specimens was detected in the antrum (26/45; 57.8%), in the corpus (19/45; 42.2%), and in the cardia (14/45; 31.1%). There was a strong association between carditis and presence of H. pylori infection (OR=27.08) by multivariate analysis. The scores for inflammation and activity in the cardia, corpus and antrum have shown a relationship except for both cardia and antrum H. pylori density and corpus and cardia activity. The intensity of gastritis and degree of colonization with H. pylori were significantly higher in the antrum than in both the corpus and the cardia. Pangastritis was highly associated to H. pylori infection in 22/25 (88%) of the patients. CONCLUSIONS: 1. Carditis is associated to H. pylori infection in children with symptoms of dyspepsia; 2. The degrees of gastritis found at the cardia were correlated to those at the antrum and body except for both cardia and antrum H. pylori density and corpus and cardia activity.

Repercussions of extensive small bowel resections in growing rats.

OBJECTIVE: To study the effects of extensive intestinal resection on growing rats, with regard to animal weight and histomorphometry of the remaining small intestine. METHODS: Forty growing rats were allocated according to the extent of small intestine resection: 60%, 70%, 80%, or 90%. The animals were weighed every week and observed for 30 days. Following sacrifice the remaining small intestine was resected, fixed in 10% formol for 24 hours, embedded in paraffin, and stained using hematoxylin and eosin. The histological changes in the remaining small intestine were assessed for the length and thickness of villi, the thickness of the muscle layer, and the number of intestinal glands. RESULTS: All growing rats showed a fall in body weight, although it was more significant with the largest intestinal resection (80% and 90%). Villus length and muscle thickness increased after 30 postoperative days in all rats, but the number of intestinal glands remained unaltered. CONCLUSION: Growing rats with greatest resection of small intestine (80% and 90%) had better intestinal adaptation and slower recovery of body weight.

Evaluation of invasive and non-invasive methods for the diagnosis of Helicobacter pylori infection in symptomatic children and adolescents.

CONTEXT: Multiple diagnostic methods are available for the detection of Helicobacter pylori infection, but at present no single one can be used as the gold standard. OBJECTIVE: The aim of this study was to evaluate the diagnostic accuracy of 3 invasive and 2 non-invasive methods for detection of Helicobacter pylori infection in symptomatic children and adolescents. DESIGN: Prospective cohort study SETTING: Peptic Disease outpatients service, Discipline of Pediatric Gastroenterology, Universidade Federal de São Paulo / Escola Paulista de Medicina. PATIENTS: Forty-seven patients who underwent endoscopy because of dyspeptic symptoms. DIAGNOSTIC METHODS: Endoscopy with gastric biopsies for 3 invasive (rapid urease test, histology and culture) and 2 non-invasive methods (a commercial ELISA serology and 13carbon urea breath test - isotope ratio mass spectrometry) for detection of Helicobacter pylori infection. MAIN MEASUREMENTS: Sensitivity, specificity, positive and negative predictive values of each method and agreement and disagreement rates between the methods. RESULTS: Forty-seven patients [mean age, 11y9mo (SD 2y10mo), 27 female and 20 male]; 62% of them were Helicobacter pylori-positive. All methods agreed in 61%, and were negative in 21% and positive in 40%. The greatest concordance between 2 methods occurred between the invasive methods: histology and rapid urease test (89.6%) and histology and culture (87.5%). The greatest sensitivity, considering Helicobacter pylori-positive cases, for any combination of 3 or more tests, was achieved by the rapid urease test (S=100%), followed by histology, serology and 13carbon-urea breath test (S=93.1%) and lastly by culture (S=79.3%). The highest specificity was obtained by histology (100%) and culture (100%), followed by the rapid urease test (84.2%), serology (78.9%) and 13carbon-urea breath test (78.9%). CONCLUSIONS: Our results suggest that among invasive methods, an association between the rapid urease test and histology constituted the best choice for the detection of Helicobacter pylori infection. If results of histology and the rapid urease test are different, serology may be recommended.

Triple therapy with clarithromycin, amoxicillin and omeprazole for Helicobacter pylori eradication in children and adolescents.

BACKGROUND: Helicobacter pylori infection presents high prevalence in developing countries, but there are few pediatric assays evaluating antimicrobial treatment. OBJECTIVE: The aim of this study was to investigate Helicobacter pylori eradication rate using a short regimen (7 and 10 days) of triple therapy with clarithromycin, amoxicillin and omeprazole. PATIENTS AND METHODS: Twenty-five Hp positive patients who presented severe epigastralgia, were submitted to antimicrobial treatment with amoxicillin (50 mg/kg/day--maximum dose 1 g bid), clarithromycin (30 mg/kg/day--maximum dose 500 mg bid) and omeprazole (0.6 mg/kg/day--maximum dose 20 mg bid) during 7 or 10 days. After 2 months, clinical symptoms were evaluated and gastric biopsies were taken to test Hp eradication. RESULTS: Overall eradication rate was achieved in 16/25 patients (64%--IC(95% = 45-83%), in 11/15 (73%--IC(95%) = 51-95%) patients who used 10 days therapy course and in 5/10 (50%--IC(95%) = 19-81%) who used 7 days therapy course. Eradication drugs were well accepted and adverse effects were reported in two patients (8%). CONCLUSIONS: This triple therapy regimen had moderate efficacy (64%). The data suggests that 10 days therapy course achieves better eradication rate (73%) than 7 days course (50%) to treat Hp infection in our population.

Cow's milk protein intolerance and chronic constipation in children.

Cow's milk protein (CMP) allergy was investigated in 25 children (age-range 3 months to 11 years) with chronic constipation. A diagnosis of constipation was made on the basis of a history of painful elimination of hard stools for at least 1 month, whether or not associated with a reduced frequency of stools or soiling. The children were evaluated using clinical parameters and the following laboratory tests: total serum immunoglobulin E (IgE); specific IgE (radioallergosorbent test [RAST]) for whole cow's milk, alpha-lactoalbumin, beta-lactoglobulin, and a food group; and skin-prick tests with whole milk, alpha-lactoalbumin, beta-lactoglobulin, and casein. Following the evaluation, the children were submitted to a CMP-free diet for a period of 4 weeks. In seven patients (28%), constipation disappeared during the CMP-free diet and reappeared within 48-72 h following challenge with cow's milk. In two infants a rectal biopsy revealed allergic colitis and they therefore did not undergo the challenge. High serum levels of total IgE were observed in five of the children who showed a clinical improvement (71%), a positive skin-test in two (29%), and detectable specific IgE in two (29%). These results suggest that CMP allergy or intolerance should be considered as a cause of chronic refractory constipation in children, although the underlying mechanism still require further investigation.

Blomstrand chondrodysplasia: a lethal sclerosing skeletal dysplasia. Case report and review.

We report a female stillborn with typical clinical, radiological, and anatomopathological features of Blomstrand chondrodysplasia. The main findings in this lethal osteochondrodysplasia are osteosclerosis and advanced skeletal maturation. Autosomal recessive inheritance has been proposed because of parental consanguinity of affected siblings in all reported cases, including this one. Histopathological study of the bones confirmed the advanced skeletal maturation radiological features. We also review this rare lethal osteochondrodysplasia.

Imaging Trypanosoma cruzi within tissues from chagasic patients using confocal microscopy with monoclonal antibodies.

Confocal fluorescence microscopy combined with differential interference contrast imaging of tissues from chagasic patients enabled the unequivocal identification of the parasite Trypanosoma cruzi. Using different monoclonal antibodies that indicate the parasite form and replication stage in conjunction with DNA labelling, specimens derived from distinct clinical forms of the disease were examined. Intracellular amastigote forms of the parasite were clearly detected in heart, brain, skin, lung, and kidney. Dividing amastigotes as well as trypomastigote forms were recognized in samples obtained from patients undergoing either acute-phase or some form of reactivation caused by immunosuppression.

[Effect of malnutrition and chronic use of nicotine during pregnancy on lung phospholipid concentration in neonate rats] / Efeito da desnutrição e do uso crônico de nicotina durante a gestação sobre a concentração de fosfolipídios pulmonares em ratos recém-nascidos.

OBJECTIVE: The aim of the present study was to determine whether lung phospholipid concentration is affected in neonate rats "Wistar EPM-1" following a continuous 21-day gestational exposure to nicotine. METHODS: Eighty rats "Wistar EPM-1" were randomly divided in four control (diet free and water "ad libitum") groups (10 rats each): 1 - Control, 2 - Physiologic Solution (infused with 0.15ml of NaCl 0.9%), 3 - Nicotine 1 (infused with 900 micro g/kg/day of nicotine bitartrate 95%), and 4 - Nicotine 2 (infused with 2.700 micro g/kg/day of nicotine bitartrate 95%), and four undernourished (diet 13g/day and water ad libitum) groups (10 rats each), that received the same kind of treatment as the control groups. The infusion of nicotine was subcutaneous. The offspring were divided in eight groups according to their origin. RESULTS: A significant high lung phospholipid concentration was observed in the non-undernourished nicotized group which was injected with a high dose of nicotine. In the other groups, there was no alteration in that concentration. CONCLUSION: We conclude that gestational exposure to nicotine increases lung phospholipid concentration in neonate rats, and that the nutritional state also influences this lung phospholipid concentration.

[Dosage of the antibody antigliadin in first degree relatives of celiac patients]. / Dosagem do anticorpo antigliadina em parentes de primeiro grau de pacientes celíacos.

Celiac disease is a permanent gluten intolerance followed by a variety of symptoms and damage to the enterocite. Forty families of celiac patients were investigated in the period of March 1992 through March 1993. The aim of the study was to utilize a dosage of serum antigliadin antibody (IgA and IgG) as screening method to stablish the frequency of celiac disease in siblings of carriers of the disease and diagnose it in first degree relatives of those patients. The 121 relatives who agreed to take part on the study were submitted to an inquire, evaluation of nutritional status and collecting 3 ml of venous blood for dosage of antigliadin antibody class IgA and IgG. Positive sorology was obtained in seven subjects and a biopsy could be obtained in five. One mother presented a pathologic anatomical picture of celiac disease representing sibling frequency of 0.8% in the group of relatives studied.

Morphometric study of the small bowel mucosa in infants with diarrhea due to enteropathogenic Escherichia coli strains.

BACKGROUND/AIMS: Enteropathogenic Escherichia coli (EPEC) strains are the most important cause of gastroenteritis in infants under 1 year of age and may induce several patterns of villous atrophy in the intestinal mucosa. However, the interpretation of these abnormalities has usually been based on semiquantitative criteria, giving rise to considerably subjective results. We utilized the linear morphometry to analyze the morphological lesions of the small bowel mucosa induced by EPEC strains in infants with persistent diarrhea in comparison with those seen in infants with asymptomatic environmental enteropathy (AEE) and controls. METHODOLOGY: Fifty nine specimens of small bowel mucosa were comparatively studied and divided in the following groups: 1. Group I: Thirty infants with persistent diarrhea due to EPEC strains, mean age 6.4 months; 2. Group II: Sixteen infants with AEE, mean age 6.5 months with no enteropathogenic bacteria in stools; 3. Group III: Thirteen children with short stature and no gastrointestinal complaints, mean age 15 months. Morphometric analysis of the small bowel mucosa was performed by using a x10 objective to a Zeiss light microscope, to which a measuring Zeiss ocular, t8x was adapted. The following measurements were carried out: Total mucosal thickness (TMT); Villous height (VH); Crypt length (CL); Intraepithelial lymphocyte (IEL) count. RESULTS: Except for the IEL, there was a significant difference in all the parameters analyzed among the evaluated groups. Group I revealed the lowest values for total mucosal thickness, villous height, and the ratio villous height/crypt length in comparison with the two other groups. On the other hand, the crypt length measurements for Group II were larger than those for Groups I and III. The measurements of villous height and the ratio villous height/crypt length for Group III turned out to be greater than those for Group II. CONCLUSIONS: The utilization of an accurate technique in the morphological study of the small bowel mucosa allowed us to detect severe abnormalities not only in infants with EPEC infection, but also in those counterparts who live in contaminated environments, and can therefore potentially acquire this type of intestinal infection.

[Evaluation of small intestine mucosal biopsies obtained simultaneously by suction capsule and endoscopic forceps in children with suspected enteropathy]. / Avaliação de biopsias de mucosa de intestino delgado obtidas simultaneamente através de cápsula de sucção e pinça endoscópica em crianças com suspeita de enteropatia.

The aim of the study was to compare biopsy specimens obtained by suction with those obtained by endoscopy morphometrically and histologically in order to evaluate their adequacy for histological interpretation. For this, 23 children with suspected enteropathy underwent upper gastrointestinal endoscopy. For histological evaluation, biopsies were assessed for orientation, depth, length, presence of Brunner's glands and/or lymphoid follicles and presence of artifact. The mucosa total height and villi height were evaluated for morphometric assessment. The results of all the analysed parameters were not statistically significant, except for the presence of Brunner's glands that were most evident in endoscopic biopsies. Although, the suction capsule biopsies and the endoscopic ones were appropriate for histological interpretation in 91.3% respectively, the difference was not statistically significant. Based on the morphometric analysis, the mucosa total height and the villi height values in both biopsy techniques were not statistically significant different. The small intestine mucosal biopsies obtained by endoscopy compared with those obtained by suction capsule were adequate for histological interpretation.

Morfometria do intestino delgado em crianças com diarréia por Escherichia coli enteropatogênica clássica e enteropatia ambiental assintomática / Morphometrics of the small bowel in children with diarrhea due to classical enteropathogenic Escherichia coli and to environmental asymptomatic enteropathy

Infecçäo entérica por Escherichia coli enteropatogênica clássica (EPEC) pode causar diferentes graus de alteraçöes das vilosidades do intestino delgado.OBJETIVOS. Este estudo teve por objetivo: 1) avaliar as alteraçöes morfológicas da mucosa intestinal na diarréia aguda por EPEC, por meio da morfometria linear, e compará-la a um grupo controle; 2) comparar o número de LIE encontrado na diarréia aguda e/ou persistente por EPEC com aqueles encontrados no grupo controle; 3) pesquisar a presença de E. coli aderida à mucosa do intestinodelgado naquelas crianças que apresentaram diarréia com coprocultura positiva para EPEC. PACIENTES E MÉTODOS. Foram analisados 30 biópsias da mucosa do intestino delgado de crianças com diarréia aguda e/ou persistente, com coprocultura positiva para EPEC e 16 biópsias obtidas da mucosa do intestino delgado de crianças portadoras de enteropatia ambiental assintomática, que constituíram nosso grupo controle. Foram realizadas as seguintes análises morfométricas: RESULTADOS: Espessura total mucosa µ EPEC=279,6 EAA=445,1 p<0,001; Altura vilosidade µ EPEC 134,3 EAA 248,0 p<0,001; Extensäo da zona críptica µ EPEC 145,2 EAA 197,1 p<0,02; linfócitos intra-epiteliais EPEC 11,6 EAA 15,5 p<0,005. CONCLUSÄO. Presença de bactéria gram-negativa, portanto, provavelmente, EPEC, foi constatada em três dos 30 pacientes com diarréia, apresentando coprocultura positiva para EPEC. As alteraçöes morfométricas ocorrem, principalmente, às custas da diminuiçäo das visolidades intestinais.

[Tissue weight and histologic alterations in pregnant rats submitted to malnutrition and chronic nicotine distress, and in their neonates]. / Alterações de peso tecidual e histológicas em ratas gestantes submetidas à desnutrição e ao estresse crônico de nicotina, e em seus recém-nascidos.

The effects of a gestational exposure of 80 rats Wistar EPM-1 to nicotine and undernutrition was examined. The weight and histological alterations on the liver and lungs was evaluated on the rats and their offspring. A significantly lower weight gain, including liver and lung weight, was observed in nicotine exposed groups. There was no alteration of the placental weight. Decidual necrosis and hepatic congestion was frequent in the rats. Lung emphysema was found in the neonates.

[Morphometrics of the small intestine in children with diarrhea due to classical enteropathogenic Escherichia coli and to environmental asymptomatic enteropathy]. / Morfometria do intestino delgado em crianças com diarréia por Escherichia coli enteropatogênica clássica e enteropatia ambiental assintomática.

The enteric EPEC infection may cause different degrees of abnormalities in the small bowel villi. Morphological changes in the small intestine have been described in asymptomatic children who live in unfavourable environmental conditions. Enteric EPEC infections frequently occur in children living in such conditions and may worsen the already existing lesions. OBJECTIVES--1) To evaluate the morphological changes of the morphometry and compare them to the intestinal mucosa of children bearing Asymptomatic Environmental Enteropathy (AEE). 2) To compare the number of intra-epithelial lymphocytes (IEL) found in acute and/or persistent diarrhea by EPEC to those ones found in the other two groups. MATERIAL AND METHODS--Thirty (30) specimens of small intestinal mucosa obtained from children having acute and/or persistent diarrhea by EPEC were analysed and then compared to the specimens of the small intestinal biopsy of sixteen (16) patients bearing AEE. The following measurements were performed: RESULTS-- [table: see text] CONCLUSIONS--The villous changes were more remarkable in EPEC infection but the crypt hypertrophy was significantly higher in patients with AEE. This fact is probably due to repeated damages caused by the environmental problems. The use of linear morphometry has been a relevant technique which allows to evaluate the possible small intestinal morphological changes more accurately than the subjective criteria. In this way, the application of this technique enables the comparative approach of determined values under statistical bases.

[Small bowel morphometry in acute and persistent diarrhea due to classic enteropathogenic Escherichia coli]. / Morfometria do intestino delgado na diarréia aguda ou persistente por Escherichia coli enteropatogênica clássica.

Enteropathogenic E.coli infection may cause different ranges of abnormalities in the small bowel villi, but there are no morphometric studies about it. Thirty specimens of small intestinal mucosa obtained from children having acute or persistent diarrhea by enteropathogenic E.coli were analysed and then compared to the specimens of the small intestinal biopsy of thirteen patients of the control group. We had the following target in this paper: evaluate the morphological changes of intestinal mucosa using linear morphometry and to verify the number of intra-epithelial lymphocytes/100 enterocytes; search the presence of Gram negative bacteria adhered to the small intestinal mucosa. Gram negative bacteria were present in three patients with acute diarrhea. The morphometric changes were more remarkable in the villosites which were shorter, in the enteropathogenic E.coli group. The total mucosa thickness as well as the villous height and the relation villous/crypt were significantly shorter in the enteropathogenic E.coli group when compared to the control Group. There were no differences between the two groups for the crypt length and for de number of intraepithelial lymphocytes/100 enterocytes.

[Serum antigliadin antibodies in the diagnosis and follow-up of celiac disease]. / Anticorpo sérico antigliadina no diagnóstico e seguimento da doença celíaca.

Between July 1985 and June 1990, we prospectively investigated 236 children suspected of having malabsorption syndrome. Each patient had a xylose absorption test and small intestinal biopsy. Blood samples were collected to AGA assay. The aim of the study was to evaluate the use of antigliadin antibodies test, IgG and IgA, in screening celiac disease for intestinal biopsy and in the monitoring of gluten-free diet and challenge in celiac patients. Twenty patients were diagnosed with celiac disease confirmed by three small intestinal biopsies; 12 patients were suspected of having celiac disease, with two biopsies, before and one year after a gluten-free diet; 106 patients had environmental enteropathy; 45 patients had protracted diarrhea and 56 children had failure to thrive with no gastrointestinal symptoms. The AGA test was considered a reliable test in screening for biopsy and in the differential diagnosis between celiac disease and other causes of malabsorption syndrome. The IgG AGA test had high sensitivity (90.4%) and the IgA AGA test had high specificity (92.1%) in screening for celiac disease. In the follow-up of the celiac patients the antibody levels were significantly higher during gluten containing diet than after gluten avoidance being thus a reliable test to evaluate dietary compliance.

Asymptomatic environmental enteropathy among slum-dwelling infants.

OBJECTIVE: We documented asymptomatic environmental enteropathy, which may occur in low socioeconomic populations, and which is manifested by bacterial proliferation in the upper portions of the small bowel and by alterations in the digestive-absorptive capacity. DESIGN: Forty asymptomatic infants (< 1 year) of the Cidade Leonor slum in São Paulo, Brazil, were investigated for digestive-absorptive function, bacterial proliferation in the small bowel lumen, and jejunal morphology. They were compared with a control group of 8 well-nourished children from economically sound families. RESULTS: Mean value of the D-xylose absorption test in the slum infants 21.0 +/- 10.0 mg%) was significantly lower than in controls (46.0 +/- 13.8 mg%) (p < 0.001). Colonic bacterial proliferation in the small bowel was identified in 25 (62.5%) of slum-dwelling infants. Grade II villous atrophy with inflammatory infiltration in the lamina propria was the most frequent alteration found. CONCLUSION: These data show that alterations in the microecology, function and morphology of the small intestine can occur even in the absence of diarrhea. Therefore, the absence of symptoms does not necessarily imply a healthy well-being among children living in a slum.