Small intestinal biopsy in childhood coeliac disease.

Small intestinal biopsies from children with treated and untreated coeliac disease have been analysed morphometrically and compared with controls. Two methods have been used; one, described by Dunnill and Whitehead (1972) provides indices of surface-tovolume ratio and of mucosal volume. The other, described by Meinhard, Wadbrook and Risdon (1965), involves tracing the microscopic image of the biopsy on to computer data cards to produce measured encoded data for direct analysis with a computer. Biopsies from untreated coeliacs were clearly distinguished from control specimens by both techniques. Comparison of these two groups by computer card morphometry shows the mucosal lesion in coeliac disease to be associated with a spatial redistribution of the tissue components rather than a change in their absolute amounts. No difference in the total mucosal volume was found so that a true mucosal atrophy does not occur in this condition. Surface-to-volume (c: lh) ratios were measured in twenty-eight children treated empirically with a gluten-free diet for suspected coeliac disease, in biopsies taken before and after a gluten challenge. By this means the diagnosis of coeliac disease was confirmed in eighteen of these patients. In morphologically normal biopsies correlation of c: lh ratios with age showed significantly smaller values in younger children. Slight changes in biopsies from young children should, therefore, be interpreted cautiously and should not necessarily be regarded as pathological on the evidence of the villous pattern alone.