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Intestinal Mucosal Hypoplasia: Types, Risk Factors and Treatment Options (pp. 91-112) $100.00
Authors:  (I. Sukhotnik, Technion-Israel Institute of Technology, the Ruth & Bruce Rappaport Faculty of Medicine, Dept of Pediatric Surgery and Pathology, Bnai Zion Medical Center, Haifa, Israel)
Abstract:
Intestinal mucosal hypoplasia (IMH) defines abnormalities of the small intestinal mucosa, visible with the light microscope, of various etiologies, that can be separated into acute versus chronic conditions. IMH include a large spectrum of intestinal disorders (microvillous inclusion disease, microvillous atrophy, chemotherapy induced mucositis, portal hypertensive enteropathy, etc.) and characterized by the early or late onset of abundant diarrhea, nutrient and micronutrient malabsorption persisting despite total bowel rest. The gold standard in the diagnosis of diseases associated to IMH is represented by mucosal biopsy and histology though some patterns are similar and create difficulties in the differential diagnosis. Standard histology reveals a variable degree of villous atrophy without marked crypt hyperplasia, in addition to abnormal positive secretory granules accumulating in the apical cytoplasm of mature enterocytes and an altered (atrophic) enterocyte brush border membrane. This review focuses on these areas in which recent progress has been made. The most common malabsorption syndrome from mucosal abnormalities is celiac disease for which, with small bowel enteroclysis a specific radiographic pattern has been identified. Severe infections increase mucosal permeability and induce local expression of co-stimulatory molecules allowing antigen penetration in the mucosa, T cell activation and possible disruption of oral tolerance. Biotherapeutics are of importance in the prevention and treatment of (chronic) enteropathy of infectious origin. The dietary approach to allergy has evolved to include
active stimulation of the immature immune system in order to support the establishment of tolerance. Supplementation with probiotics may provide maturational signals for the lymphoid tissue and improve the balance of pro- and anti-inflammatory cytokines. Enteral polymeric feeding is effective in Crohn's disease. Dietary nucleotides may improve growth and immunity, optimize maturation, recovery and function of rapidly dividing tissue. Adequate dietary lipids are important not just for caloric value but also for immune-modulatory effects. 


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Intestinal Mucosal Hypoplasia: Types, Risk Factors and Treatment Options (pp. 91-112)