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RESPONSES OF SMALL INTESTINAL ARCHITECTURE AND FUNCTION OVER TIME TO ENVIRONMENTAL FACTORS IN A TROPICAL POPULATION

To determine the response of the small intestinal mucosa to environmental conditions, we studied changes in mucosal architecture and function in a longitudinal cohort study in African adults. Over three consecutive years, 238 adults submitted monthly stool samples for parasitologic and bacteriologic analysis and underwent an annual endoscopic jejunal biopsy for mucosal morphometry. Absorption and permeability assays were performed on the same day as the enteroscopy. Variation in mucosal architecture and function was correlated with environmental factors and stool microbiology. The whole cohort had structural and functional evidence of tropical enteropathy, but structure and function were only weakly correlated. There were marked changes over time, and seasonal variation was observed in villous height (16%), xylose recovery (16%), and permeability (28%). Asymptomatic intestinal infections were common. Enteropathy was more severe in participants with Citrobacter rodentium or hookworm ova in the stool sample taken one month before the investigations were performed.

Received October 2, 2003. Accepted for publication December 8, 2003.

Acknowledgments: We gratefully acknowledge the dedicated work of Emmanuel Kunda, Rosemary Banda, Vera Yambayamba, Coillard Kaunga, John Samson Mbewe, Stayner Mwanamakondo, Rose Soko, and Miriam Banda in the clinical team and the endoscopy unit. We are also very grateful to our study participants.

Financial support: This study was supported by The Wellcome Trust (grant 056481).

Authors’ addresses: Paul Kelly, Department of Medicine, University of Zambia School of Medicine, University Teaching Hospital, Lusaka, Zambia and Department of Adult and Paediatric Gastroenterology, Bart’s and The London School of Medicine, Turner Street, London E1 2AD, United Kingdom. Ian Menzies and Roger Crane, Department of Biochemistry, King’s College Hospital, London SE5 9RS, United Kingdom. Isaac Zulu, James Mwansa, Victor Mudenda, and Max Katubulushi, Department of Medicine, University of Zambia School of Medicine, University Teaching Hospital, Lusaka, Zambia. Carole Nickols, Roger Feakins, and Steve Greenwald, Department of Histopathology and Morbid Anatomy, Bart’s and The London National Health Service Hospital Trust, London E1 1BB, United Kingdom. Michael Farthing, St. George’s Hospital Medical School, London SW17 0RE, United Kingdom.

Reprint requests: Paul Kelly, Department of Adult and Paediatric Gastroenterology, Bart’s and The London School of Medicine, Turner Street, London E1 2AD, United Kingdom. Telephone: 44-20-7882-7191, Fax: 44-20-7882-7192, E-mail: m.p.kelly{at}qmul.ac.uk.

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