Small Intestine: Patterns of Non-infective Mucosal Damage

Abstract

All patterns of mucosal damage, whether infective or not, tend to produce flattening with decrease of absorptive surface. This leads to defective absorption which can present in a number of ways, particularly as weight loss, diarrhoea and foul-smelling stools which often have an increased content of unabsorbed fat. Just as ‘all that waddles is not dystrophy’ so ‘all that flattens is not sprue’¹. Capsule biopsies sample blindly and cannot be directed at focal lesions, and since in generalized conditions there is commonly variability in severity of damage, the degree of flattening present in a single biopsy may not be representative. Among the more common disorders which can cause generalized flattening, are gluten-induced enteropathy (g.i.e.), idiopathic steatorrhoea, tropical sprue, acute and chronic infective enteritis, bacterial overgrowth in stagnant loop syndromes, abnormal sensitivity to soy and cows’ milk protein, immunodeficiency syndromes with or without giardiasis or neoplasia, malnutrition including kwashiorkor, irradiation and the use of certain drugs; the list is not exhaustive.