SMALL-INTESTINE IN LYMPHOCYTIC AND COLLAGENOUS COLITIS - MUCOSAL MORPHOLOGY, PERMEABILITY, AND SECRETORY IMMUNITY TO GLIADIN

There is a recognised association between the ''microscopic'' forms of colitis and coeliac disease, There are a variety of subtle small inte stinal changes in patients with ((latent)) gluten sensitivity, namely high intraepithelial lymphocyte (IEL) counts, abnormal mucosal permeab ility, and high levels of secretory IgA and IgM antibody to gliadin, T hese changes have hitherto not been investigated in microscopic coliti s. Nine patients (four collagenous, five lymphocytic colitis) with nor mal villous architecture were studied. Small intestinal biopsies were obtained by Crosby capsule; small intestinal fluid was aspirated via t he capsule. IEL counts were expressed per 100 epithelial cells, and in testinal IgA and IgM antigliadin antibody levels were measured by ELIS A. Small intestinal permeability was measured by the lactulose:mannito l differential sugar permeability test. IEL counts were normal in all cases, median 17, range 7-30. Intestinal antigliadin antibodies were m easured in six erases and were significantly elevated in two patients (both IgA and IgM). Intestinal permeability was measured in eight case s and was abnormal in two and borderline in one. These abnormalities d id not overlap: four of nine patients had evidence of abnormal small i ntestinal function. Subclinical small intestinal disease is common in the two main forms of microscopic colitis.