Ultrastructural Study on the Jejunal Mucosa in Patients with Crohn's Disease Tsutomu Yamamoto 1 , Koichi Fujita 1 , Tsuneyoshi Yao 1 1The First Department of Internal Medicine, School of Medicine, Fukuoka University pp.781-788
Published Date 1985/7/25
DOI https://doi.org/10.11477/mf.1403109909
  • Abstract
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 An electron microscopic study was performed to investigate the ultrastructural abnormality in the apparently normal mucosa and minute scar area in eight patients with Crohn's disease. Biopsy specimens were taken under direct vision during small intestinal endoscopy (normal mucosa: eight cases, scar area: two cases). The discernible alterations were described as follows.

 1) Apparently normal mucosa: Supranuclear portion of the epithelial cells showed an increase in heterogenous lysosomes in five cases. Autophagic vacuoles and residual bodies were frequently seen in the perinuclear and the lateral portions of the epithelial cells in four cases. Myelin-like structures, presumably residual bodies, were also seen in the cytoplasm and the intercellular spaces.

 2) Minute scar area: In addition to the findings concerning the increased number of lysosomes and frequent occurrence of autophagic vacuoles similar to those found in the normal mucosa, various sized vacuoles containing degenerated cell organella were observed in the apical portion. Therefore, some of them were considered to be residual bodies not yet discharged into the extracellular space. These vacuoles were relatively rare in the epithelial cell of the normal mucosa. Neither viral particles nor degraded bacteria were detected in the normal mucosa and the minute scar area.

 The autophagic vacuoles in the small intestinal epithelium have been reported in various pathological conditions such as starvation, x-ray irradiation and marasmus. The present cases have no such clear cause for cell injury. Therefore, our findings of autophagic vacuoles and residual bodies even in the normal mucosa may possibly be explained as a consequence of the intestinal lesion of Crohn's disease. And the epithelial cell necrosis, so called“patchy necrosis”, would be caused when these structures are ruptured by noxious agents from the lumen.

 These findings, above mentioned, are compatible with the concept of Crohn's disease as a diffuse lesion of the gastrointestinal tract.

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