B. Kristiansson et al., INTESTINAL, PANCREATIC AND HEPATIC INVOLVEMENT IN CARBOHYDRATE-DEFICIENT GLYCOPROTEIN SYNDROME TYPE-I, Journal of pediatric gastroenterology and nutrition, 27(1), 1998, pp. 23-29
Background: Children with carbohydrate-deficient glycoprotein syndrome
type I during infancy have gastrointestinal symptoms and growth impai
rment, the cause of which is largely unknown. Methods: Seven children
were investigated with small intestinal biopsy, liver biopsy, duodenal
intubation with determination of lipolytic and proteolytic activity,
and test meal. Weight, length-height, and head circumference were reco
rded regularly. Results: Growth was affected from early infancy, with
an initial low rate of weight gain followed by impaired linear growth.
Vomiting and diarrhea were dominant symptoms. Four of seven children
had abnormal findings in light microscopic examination of small intest
inal biopsy specimens, with short villi and increased inflammatory cel
ls in the stroma, that did not respond to elimination of such food pro
teins as cow's milk or gluten. Electron microscopic study showed dilat
ation of smooth endoplasmic reticulum and abnormal inclusions containi
ng lipids. The liver was abnormal in all. Besides steatosis and fibros
is or cirrhosis, there was a remarkable increase of inflammatory cells
in portal zones. Activity of lipolytic enzymes in duodenal juice was
low, except in one child, who no longer had growth problems or symptom
s. Two of six had abnormal proteinolytic activity in duodenal juice. D
igestion of triglycerides and absorption were within normal limits, as
was the absorption of glucose and xylose. Conclusions: Inflammation o
f small intestine and liver may be the cause of gastrointestinal sympt
oms. In all Likelihood, the growth failure was because of low caloric
intake and increased losses related to vomiting. Growth and gastrointe
stinal symptoms improved spontaneously as time elapsed. (C) 1998 Lippi
ncott-Raven Publishers.