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. 1991 Apr;32(4):377–382. doi: 10.1136/gut.32.4.377

Small intestinal function and dietary status in dermatitis herpetiformis.

D J Gawkrodger 1, C McDonald 1, S O'Mahony 1, A Ferguson 1
PMCID: PMC1379074  PMID: 2026337

Abstract

Small intestinal morphology and function were assessed in 82 patients with dermatitis herpetiformis, 51 of whom were taking a normal diet and 31 a gluten free diet. Methods used were histopathological evaluation of jejunal mucosal biopsy specimens, quantitation of intraepithelial lymphocytes, cellobiose/mannitol permeability test, tissue disaccharidase values, serum antigliadin antibodies, and formal assessment of dietary gluten content by a dietician. There was no correlation between dietary gluten intake and the degree of enteropathy in the 51 patients taking a normal diet, whereas biopsy specimens were normal in 24 of the 31 patients on a gluten free diet, all previously having been abnormal. Eighteen patients on gluten containing diets had normal jejunal histology and in seven of these all tests of small intestinal morphology and function were entirely normal. Intestinal permeability was abnormal and serum antigliadin antibodies were present in most patients with enteropathy. Studies of acid secretion in seven patients showed that hypochlorhydria or achlorhydria did not lead to abnormal permeability in the absence of enteropathy. This study shows that a combination of objective tests of small intestinal architecture and function will detect abnormalities in most dermatitis herpetiformis patients, including some with histologically normal jejunal biopsy specimens. Nevertheless there is a small group in whom all conventional intestinal investigations are entirely normal.

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Selected References

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  1. Andersson H., Björkman A. C., Gillberg R., Kastrup W., Mobacken H., Stockbrügger R. Influence of the amount of dietary gluten on gastrointestinal morphology and function in dermatitis herpetiformis. Hum Nutr Clin Nutr. 1984 Jul;38(4):279–285. [PubMed] [Google Scholar]
  2. Andersson H., Dotevall G., Mobacken H. Gastric secretion of acid and intrinsic factor in dermatitis herpetiformis. Scand J Gastroenterol. 1971;6(5):411–416. doi: 10.3109/00365527109180718. [DOI] [PubMed] [Google Scholar]
  3. Brow J. R., Parker F., Weinstein W. M., Rubin C. E. The small intestinal mucosa in dermatitis herpetiformis. I. Severity and distribution of the small intestinal lesion and associated malabsorption. Gastroenterology. 1971 Mar;60(3):355–361. [PubMed] [Google Scholar]
  4. Chorzelski T. P., Rosinska D., Beutner E. H., Sulej J., Kumar V. Aggressive gluten challenge of dermatitis herpetiformis cases converts them from seronegative to seropositive for IgA-class endomysial antibodies. J Am Acad Dermatol. 1988 Apr;18(4 Pt 1):672–678. doi: 10.1016/s0190-9622(88)70089-4. [DOI] [PubMed] [Google Scholar]
  5. DAHLQVIST A. METHOD FOR ASSAY OF INTESTINAL DISACCHARIDASES. Anal Biochem. 1964 Jan;7:18–25. doi: 10.1016/0003-2697(64)90115-0. [DOI] [PubMed] [Google Scholar]
  6. Ferguson A., Blackwell J. N., Barnetson R. S. Effects of additional dietary gluten on the small-intestinal mucosa of volunteers and of patients with dermatitis herpetiformis. Scand J Gastroenterol. 1987 Jun;22(5):543–549. doi: 10.3109/00365528708991895. [DOI] [PubMed] [Google Scholar]
  7. Ferguson A., Murray D. Quantitation of intraepithelial lymphocytes in human jejunum. Gut. 1971 Dec;12(12):988–994. doi: 10.1136/gut.12.12.988. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Fry L., Leonard J. N., Swain F., Tucker W. F., Haffenden G., Ring N., McMinn R. M. Long term follow-up of dermatitis herpetiformis with and without dietary gluten withdrawal. Br J Dermatol. 1982 Dec;107(6):631–640. doi: 10.1111/j.1365-2133.1982.tb00520.x. [DOI] [PubMed] [Google Scholar]
  9. Fry L., Seah P. P., McMinn R. M., Hoffbrand A. V. Lymphocytic infiltration of epithelium in diagnosis of gluten-sensitive enteropathy. Br Med J. 1972 Aug 12;3(5823):371–374. doi: 10.1136/bmj.3.5823.371. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Gawkrodger D. J., Blackwell J. N., Gilmour H. M., Rifkind E. A., Heading R. C., Barnetson R. S. Dermatitis herpetiformis: diagnosis, diet and demography. Gut. 1984 Feb;25(2):151–157. doi: 10.1136/gut.25.2.151. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Gawkrodger D. J., Ferguson A., Barnetson R. S. Nutritional status in patients with dermatitis herpetiformis. Am J Clin Nutr. 1988 Aug;48(2):355–360. doi: 10.1093/ajcn/48.2.355. [DOI] [PubMed] [Google Scholar]
  12. Griffiths C. E., Menzies I. S., Barrison I. G., Leonard J. N., Fry L. Intestinal permeability in dermatitis herpetiformis. J Invest Dermatol. 1988 Aug;91(2):147–149. doi: 10.1111/1523-1747.ep12464390. [DOI] [PubMed] [Google Scholar]
  13. Hall R. P., Waldbauer G. V. Characterization of the mucosal immune response to dietary antigens in patients with dermatitis herpetiformis. J Invest Dermatol. 1988 May;90(5):658–663. doi: 10.1111/1523-1747.ep12560821. [DOI] [PubMed] [Google Scholar]
  14. Hamilton I., Fairris G. M., Rothwell J., Cunliffe W. J., Dixon M. F., Axon A. T. Small intestinal permeability in dermatological disease. Q J Med. 1985 Sep;56(221):559–567. [PubMed] [Google Scholar]
  15. Juby L. D., Rothwell J., Axon A. T. Cellobiose/mannitol sugar test--a sensitive tubeless test for coeliac disease: results on 1010 unselected patients. Gut. 1989 Apr;30(4):476–480. doi: 10.1136/gut.30.4.476. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Kilander A. F., Gillberg R. E., Kastrup W., Mobacken H., Nilsson L. A. Serum antibodies to gliadin and small-intestinal morphology in dermatitis herpetiformis. A controlled clinical study of the effect of treatment with a gluten-free diet. Scand J Gastroenterol. 1985 Oct;20(8):951–958. doi: 10.3109/00365528509088854. [DOI] [PubMed] [Google Scholar]
  17. Marks J., Shuster S., Watson A. J. Small-bowel changes in dermatitis herpetiformis. Lancet. 1966 Dec 10;2(7476):1280–1282. doi: 10.1016/s0140-6736(66)91692-8. [DOI] [PubMed] [Google Scholar]
  18. Marsh M. N. Studies of intestinal lymphoid tissue. XI--The immunopathology of cell-mediated reactions in gluten sensitivity and other enteropathies. Scanning Microsc. 1988 Sep;2(3):1663–1684. [PubMed] [Google Scholar]
  19. Marsh M. N. Studies of intestinal lymphoid tissue. XV. Histopathologic features suggestive of cell-mediated reactivity in jejunal mucosae of patients with dermatitis herpetiformis. Virchows Arch A Pathol Anat Histopathol. 1989;416(2):125–132. doi: 10.1007/BF01606317. [DOI] [PubMed] [Google Scholar]
  20. Myren J., Berild D., Orstavik I., Serck Hanssen A. Virus antibodies in the serum of patients with liver disease. Scand J Gastroenterol. 1982 Jan;17(1):5–9. doi: 10.3109/00365528209181035. [DOI] [PubMed] [Google Scholar]
  21. O'Donoghue D. P., Lancaster-Smith M., Johnson G. D., Kumar P. J. Gastric lesion in dermatitis herpetiformis. Gut. 1976 Mar;17(3):185–188. doi: 10.1136/gut.17.3.185. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. O'Mahony S., Arranz E., Barton J. R., Ferguson A. Dissociation between systemic and mucosal humoral immune responses in coeliac disease. Gut. 1991 Jan;32(1):29–35. doi: 10.1136/gut.32.1.29. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Scott B. B., Young S., Rajah S. M., Marks J., Losowsky M. S. Coeliac disease and dermatitis herpetiformis: further studies of their relationship. Gut. 1976 Oct;17(10):759–762. doi: 10.1136/gut.17.10.759. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Strobel S., Brydon W. G., Ferguson A. Cellobiose/mannitol sugar permeability test complements biopsy histopathology in clinical investigation of the jejunum. Gut. 1984 Nov;25(11):1241–1246. doi: 10.1136/gut.25.11.1241. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Troncone R., Merrett T. G., Ferguson A. Prevalence of atopy is unrelated to presence of inflammatory bowel disease. Clin Allergy. 1988 Mar;18(2):111–117. doi: 10.1111/j.1365-2222.1988.tb02850.x. [DOI] [PubMed] [Google Scholar]
  26. Weinstein W. M. Latent celiac sprue. Gastroenterology. 1974 Apr;66(4):489–493. [PubMed] [Google Scholar]

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