Summary
In seven patients with dermatitis herpetiformis, the intestinal structure was studied by means of the electron microscope. In 5 patients the absorptive epithelial cells showed variable modifications consisting of a dilatation of the rough endoplasmic reticulum and an overdevelopment of the smooth endoplasmic reticulum. The striated border microvilli were abnormal and presented edema and fusion with occasional disappearance, leaving clear areas on the intestinal surface. In two patients the ultrastructural study showed no modifications of the epithelial cells.
In all the cases examined the only constant finding consisted of a marked lymphocytic infiltration of the epithelium. The lymphocytes traversed through the basement membrane and were located in the intercellular space. The latter was frequently widened. The widening of the intercellular space was interpreted as secondary to the passage of the leukocytes through the epithelium.
On the basis of this study it was suggested that the lymphocytic infiltration could impair the absorptive ability of the intestinal epithelium, and that the electron microscopic study supports the opinion that some relationship exists between the intestinal changes in dermatitis herpetiformis and those present in non tropical sprue.
Similar content being viewed by others
References
Ashworth, C. T., Chears, W. C., Jr., Sanders, E., Pearce, M. B.: Nontropical sprue fine structure of the intestinal epithelial lesion. Arch. Path. 71, 13–19 (1961).
Biempica, L., Toccalino, H., O'Donnell, J. C.: Cytochemical and ultrastructural studies of the intestinal mucosa of children with celiac disease. Amer. J. Path. 4, 795–804 (1968).
Dobbins, W. O. III.: Electron microscope study of the intestinal mucosa in intestinal lymphangiectasia. Gastroenterology 51, 1004–1017 (1966).
Fry, L., Keir, P., McMinn, R. M. H., Cowan, J. D., Hoffbrand, A. V.: Small intestine structure and function and hematological changes in Dermatitis herpetiformis. Lancet 1967 II, 729–731.
—— McMinn, R. M. H., Cowan, J. D., Hoffbrand, A. V.: Effect of gluten-free diet on dermatological, intestinal and hematological manifestatons of Dermatitis herpetiformis. Lancet 1968 I, 557–561.
Hartman, R. S., Butterworth, C. E., Hartman, R. E., Crosby, W. H., Shirai, A.: An electron microscopic investigation of the jejunal epithelium in sprue. Gastroenterology 38, 506–516 (1960).
Kamer, J. H. van de, Huinink, H. ten. B., Weyers, H. A.: Rapid method for the determination of fat in feces. J. biol. Chem. 177, 347–355 (1949).
Marks, J., Shuster, S., Watson, A. J.: Small bowel changes in Dermatitis herpetiformis. Lancet 1966 II, 1280–1282.
Marks, R., White, M. W., Beard, R. J., Robertson, W. B., Gold, S. C.: Small bowel abnormalities in Dermatitis herpetiformis. Brit. med. J. 1968, 552–555.
Padykula, H. A., Straus, E. W., Ladman, A. J., Gardner, F. H.: A morphological and histochemical analysis of the human jejunal epithelium in nontropical sprue. Gastroenterology 40, 735–765 (1961).
Rubin, P., Brandborg, L. L., Flick, A. L., MacDonald, W. C., Parkins, R. A., Parmentier, C. M., Phelps, P., Sribhibhadh, S., Trier, J. S.: Biopsy studies on the Pathogenesis of celiac sprue. In: Intestinal biopsy. Ciba Foundation Study Group 14, p. 67–83. Boston: Little 1962.
Rubin, W., Ross, L. L., Sleisenger, M. H., Weser, E.: An electron microscopic study of adult celiac disease. Lab. Invest. 15, 1720–1747 (1966).
Shearman, D. J. C., Girdwood, R. H., Williams, A. W., Delamore, I. W.: A study with the electron microscope of the jejunal epithelium in primary malabsorptive disease. Gut 3, 16–25 (1962).
Shields, J. W., Touchon, R. C., Dickson, D. R.: Quantitative studies on small lymphocyte disposition in epithelial cells. Amer. J. Path. 54, 129–145 (1969).
Shiner, M., Birbeck, M. S. C.: The microvilli of the small intestinal surface epithelium in celiac disease and idiopathic steatorrhea. Gut 2, 277–284 (1961).
Shuster, S., Marks, J.: Dermatogenic enteropathy. A new cause of steatorrhea. Lancet 1965 I, 1367–1368.
Toner, P. G.: Cytology of intestinal epithelial cells. Int. Rev. Cytol. 24, 233–244 (1968).
Tongeren, J. H. M. van, Staak, W. J. B. M. van der, Schillings, P. H. M.: Small bowel changes in Dermatitis herpetiformis. Lancet 1967 I, 218–219.
Zetterqvist, H., Hendrix, T. R.: A preliminary note on an ultrastructural abnormality of the intestinal epithelium in adult celiac disease (nontrophical sprue) which is reversed by a gluten-free diet. Bull. Johns Hopk. Hosp. 106, 240–249 (1960).
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Laguens, R., Schaposnik, F., Echeverría, R. et al. Fine structure of the small bowel in dermatitis herpetiformis. Virchows Arch. Abt. A Path. Anat. 352, 34–42 (1971). https://doi.org/10.1007/BF00549761
Received:
Issue Date:
DOI: https://doi.org/10.1007/BF00549761