WHIPPLES-DISEASE - A HISTOLOGICAL, IMMUNOCYTOCHEMICAL, AND ELECTRON-MICROSCOPIC STUDY OF THE SMALL-INTESTINAL EPITHELIUM

At endoscopy, the duodenum in Whipple's disease frequently appears abn ormal and some clinical features such as gastrointestinal blood loss a nd anaemia suggest epithelial damage. However, the intestinal epitheli al cells themselves appear to be normal on light and electron microsco py. The aims of this study were to analyse in detail the cytological c hanges in epithelial cells over time and in response to therapy in bio psies obtained from 20 patients, to investigate the functional repercu ssion on digestive enzymes such as lactase, and to assess the expressi on by the epithelial cells of MHC antigens. Cytological changes were m inimal at both the light- and the electron-microscopic level and MHC c lass I expression was preserved. However, changes indicative of functi onal deficits were demonstrated. Lactase and MHC class II expression w ere reduced or even absent. Antibiotic therapy resulted in normalizati on within 3-6 months. These findings are consistent with the clinical evolution and are of interest with regard to the importance of the imm une response in aetiopathogenesis.