[Adaptive changes in intestinal mucosa of the small intestine as a result of intraluminal stress]

Abstract

Under physiological conditions, the intestinal mucosa is the site of a delicate balance between cell proliferation in the crypt region and cell desquamation at the villus tips. This balance can be deranged by a number of endogenous or exogenous factors, oneof which is the intraluminal contents. This review discusses the effects of different modifications of the luminal milieu on the structure and function of the mucosa. Following intestinal resection or loop transposition, the contents reaching the remnant or the transposed loop differ markedly from those with which they come into contact under normal conditions. Hyperplasia without zonal transformation then develops in the experimental loop. The villi do not become wider, and changes in the strucutre of the epithelium are not observed. There are conflicting resutls in the literature concerning the enzyme activities in the individual enterocytes resulting from this hyperplasia. However, the epithelium its functionally immature, since transport capacities measured in vitro are reduced. On the other hand, the hyperplasia of the mucosa is such that absorptive capacities in vivo, when expressed in terms of intestinal length, are larger than normal. When the intestine is subjected to prolonged infusion of lactic acid, the enterocytes are damaged and increased exfoliation results. A similar result is obtained in the blind-loop syndrome, where the accumulation of bile acids and bacteria provides the stress responsible for the destruction of the enterocytes, and in non-tropical spure, where the epithelium is attacked by noxious peptides in the diet. The first consequence of the accelerated desquamation is epithelial hyperplasia without zonal transformation, though the enterocytes are damaged - in contrast to those of the resected intestine - and apparently possess reduced enzyme activities. If the application of the stress is continued, a stage is reached in which the cell proliferation does not suffice to counteract the cell loss at the villus tips. Then a zonal transformation occurs whereby, despite the lengthened crypts, the villi become shorter and wider until, in extreme cases, the mucosa is completely devoid of villi. The transport capacity in vitro and in vivo - even when expressed in terms of unit-length is reduced, and good correlations exist between the reduction in function and the diminution in surface area of the intestine. In a self-emptying blind loop, the intestine is devoid of all contact with nutritional material. Under these circumstances, hypoplasia of the mucosa develops in which the enterocytes appear unchanged, though in extreme cases they may possess reduced enzyme levels, and the absorption capacity in vivo is consequently reduced.