Volume 70, Issue 4
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645


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 or hookworm ova in the stool sample taken one month before the investigations were performed.


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  1. Wiginton DA, 2000. Gene regulation: the key to intestinal development. Sanderson I, Walker A, eds. Development of the Gastrointestinal Tract. Hamilton, Ontario, Canada: BC Decker, 13–36.
  2. Wright N, Alison M, 1984. The Biology of Epithelial Cell Populations. Oxford, United Kingdom: Clarendon Press, 553–558.
  3. Walker-Smith J, 1972. Variation of small intestinal morphology with age. Arch Dis Child 47 : 80–83.
  4. Howie D, MacDonald TT, 2000. Ontogeny of T lymphocytes within the human intestine. Sanderson I, Walker A, eds. Development of the Gastrointestinal Tract. Hamilton, Ontario, Canada: BC Decker, 165–174.
  5. Baker SJ, Mathan VI, 1972. Tropical enteropathy and tropical sprue. Am J Clin Nutr 25 : 1047–1055.
  6. Cook GC, 1980. Tropical Gastroenterology. London: Oxford University Press.
  7. Lindenbaum J, Harmon JW, Gerson CD, 1972. Subclinical malabsorption in developing countries. Am J Clin Nutr 25 : 1056–1061.
  8. Wood GM, Gearty JC, Cooper BT, 1991. Small bowel morphology in British and Afro-Caribbean subjects: evidence of tropical enteropathy. Gut 32 : 256–259.
  9. Schneider RE, Viteri FE, 1972. Morphological aspects of the duodenojejunal mucosa in protein-calorie malnourished children and during recovery. Am J Clin Nutr 25 : 1092–1102.
  10. Sullivan PB, Marsh MN, 1992. Small intestinal mucosal histology in the syndrome of persistent diarrhoea and malnutrition: a review. Acta Paediatr Suppl 381 : 72–77.
  11. Mayoral LG, Tripathy K, Bolanos O, Lotero H, Duque E, Garcia FT, Ghitis J, 1972. Intestinal, functional, and morphological abnormalities in severely protein-malnourished adults. Am J Clin Nutr 25 : 1084–1091.
  12. Cummins AG, Thompson FM, Butler RN, Cassidy JC, Gillis D, Lorenzetti M, Southcott EK, Wilson PC, 2001. Improvement in intestinal permeability precedes morphometric recovery of the small intestine in coeliac disease. Clin Sci 100 : 379–386.
  13. Fylkesnes K, Ndhlovu Z, Kasumba K, Musonda RM, Sichone M, 1998. Studying dynamics of the HIV epidemic: population-based data compared with sentinel surveillance in Zambia. AIDS 12 : 1227–1234.
  14. Kelly P, Zulu I, Amadi B, Munkanta M, Banda J, Rodrigues LC, Feldman R, Mabey DCW, Farthing MJG, 2002. Morbidity and nutritional impairment in relation to CD4 count in a Zambian population with high HIV prevalence. Acta Trop 83 : 151–158.
  15. Marsh MN, 1980. Studies of intestinal lymphoid tissue III: quantitative analyses of epithelial lymphocytes in the small intestine of control subjects and of patients with celiac sprue. Gastroenterology 79 : 481–492.
  16. Menzies IS, Zuckerman MJ, Nukajam WS, Somasundaram SG, Murphy B, Jenkins AP, Crane RS, Gregory GG, 1999. Geography of intestinal permeability and absorption. Gut 44 : 483–489.
  17. Barrow GI, Feltham RKA, 1993. Cowan & Steel’s Manual for the Identification of Medical Bacteria. Third edition. Cambridge, United Kingdom: Cambridge University Press.
  18. Sheehy TW, Meroney WH, Cox RS, Soler JE, 1962. Hookworm disease and malabsorption. Gastroenterology 42 : 148–156.
  19. Deng W, Li Y, Vallance BA, Finlay BB, 2001. Locus of enterocyte effacement from Citrobacter rodentium: sequence analysis and evidence for horizontal transfer among attaching and effacing pathogens. Infect Immun 69 : 6323–6335.
  20. Higgins LM, Frankel G, Connerton I, Goncalves N, Dougan G, MacDonald TT, 1999. Role of bacterial intimin in colonic hyperplasia and inflammation. Science 285 : 588–591.
  21. Goncalves NS, Ghaem-Maghami M, Monteleone G, Frankel G, Dougan D, Lewis DJ, Simmons CP, MacDonald TT, 2001. Critical role for tumour necrosis factor alpha in controlling the number of luminal pathogenic bacteria and immunopathology in infectious colitis. Infect Immun 69 : 6651–6659.
  22. Keating J, Bjarnason I, Somasundaram S, Macpherson A, Francis N, Price AB, Sharpstone D, Smithson J, Menzies IS, Gazzard BG, 1995. Intestinal absorptive capacity, intestinal permeability and jejunal histology in HIV and their relation to diarrhoea. Gut 37 : 623–639.
  23. Juby LD, Dixon MF, Axon AT, 1987. Abnormal intestinal permeability and jejunal morphometry. J Clin Pathol 40 : 714–718.
  24. Fasano A, 2001. Intestinal zonulin: open sesame! Gut 49 : 159–162.
  25. Lionetti P, Breese E, Braegger CP, Murch SH, Taylor J, Mac-Donald TT, 1993. T-cell activation can induce either mucosal destruction or adaptation in cultured human fetal small intestine. Gastroenterology 105 : 373–381.
  26. Veitch A, Kelly P, Zulu I, Segal I, Farthing MJG, 2001. Tropical enteropathy: a T cell-mediated, crypt hyperplastic enteropathy. Eur J Gastroenterol Hepatol 13 : 1175–1181.
  27. Young A, Levin RJ, 1990. Diarrhoea of famine and malnutrition: investigations using a rat model. Gut 31 : 43–53, 162–169.
  28. Elia M, Goren A, Behrens R, Barber RW, Neale G, 1987. Effect of total starvation and very low calorie diets on intestinal permeability in man. Clin Sci 73 : 205–210.
  29. Maxton DG, Menzies IS, Slavin B, Thompson RP, 1989. Small intestinal function during enteral starvation and feeding in man. Clin Sci 77 : 401–406.
  30. Brewster DR, Greenwood BM, 1993. Seasonal variation of paediatric diseases in The Gambia, west Africa. Ann Trop Paediatr 13 : 133–146.
  31. Kelly P, Davies SE, Mandanda B, Veitch A, McPhail G, Zulu I, Drobniewski F, Fuchs D, Summerbell C, Luo NP, Pobee JOM, Farthing MJG, 1997. Enteropathy in Zambians with HIV related diarrhoea: regression modelling of potential determinants of mucosal damage. Gut 41 : 811–816.
  32. Greenson JK, Belitsos PC, Yardley JH, Bartlett JG, 1991. AIDS enteropathy: occult enteric infections and duodenal mucosal alterations in chronic diarrhea. Ann Intern Med 114 : 366–372.
  33. Batman PA, Miller ARO, Forster SM, Harris JRW, Pinching AJ, Griffin GE, 1989. Jejunal enteropathy associated with HIV infection: quantitative histology. J Clin Pathol 42 : 275–281.
  34. Bjarnason I, Sharpstone DR, Francis F, Marker A, Taylor C, Barrett M, Macpherson A, Baldwin C, Menzies IS, Crane RC, Smith T, Pozniak A, Gazzard BG, 1996. Intestinal inflammation, ileal structure and function in HIV. AIDS 10 : 1385–1391.
  35. Lim SG, Condez A, Lee CA, Johnson MA, Elia C, Poulter LW, 1993. Loss of mucosal CD4 lymphocytes is an early feature of HIV infection. Clin Exp Immunol 92 : 448–454.
  36. Kotler DP, 1999. Characterization of intestinal disease associated with HIV infection and response to antiretroviral therapy. J Infect Dis 179 (suppl 3): S454–S456.

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  • Received : 02 Oct 2003
  • Accepted : 08 Dec 2003

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