PATCHY ENTEROPATHY IN CHILDHOOD

Two hundred and seventy-eight duodenal biopsy specimens taken consecutively from children using either a single portal pediatric Crosby capsule or a double port modification were examined both histologically and by dissecting microscopy, in order to determine the incidence of patchy mucosal lesions. One hundred and six specimens were abnormal and 49 of these were patchy. Patchy lesions occurred most commonly in cow's milk sensitive enteropathy where 66% of 33 specimens were patchy; in comparison all children with undiagnosed celiac disease taking a normal diet showed a uniformly flat mucosa. Twenty-two percent of specimens taken using the double port and 10% using the single port capsule were patchy, a statistically significant difference (P = 0.01) using standard errors. Where lesions were uniform, grading by dissecting microscopy correlated well with histological grading; 18 (37%) of specimens were, however, recognized as patchy only on gross appearance. The high incidence of patchy lesions of the proximal small intestine reflected the prevalence of cow's milk protein intolerance and the postenteritis syndrome in these children. The use of the double port capsule and of dissecting microscopy also contributed to the high incidence found.