title: Responses of small intestinal architecture and function over time to environmental factors in a tropical population.
abstract: To determine the response of the small intestinal mucosa to environmental conditions, we studied changes in mucosal architecture and function in a longitudinal cohort study in African adults. Over three consecutive years, 238 adults submitted monthly stool samples for parasitologic and bacteriologic analysis and underwent an annual endoscopic jejunal biopsy for mucosal morphometry. Absorption and permeability assays were performed on the same day as the enteroscopy. Variation in mucosal architecture and function was correlated with environmental factors and stool microbiology. The whole cohort had structural and functional evidence of tropical enteropathy, but structure and function were only weakly correlated. There were marked changes over time, and seasonal variation was observed in villous height (16%), xylose recovery (16%), and permeability (28%). Asymptomatic intestinal infections were common. Enteropathy was more severe in participants with Citrobacter rodentium or hookworm ova in the stool sample taken one month before the investigations were performed.
authors.affiliation: Department of Medicine, University of Zambia School of Medicine, University Teaching Hospital, Lusaka, Zambia. m.p.kelley@qmul.ac.uk
authors.forename: Paul
authors.initials: P
authors.lastname: Kelly
authors.forename: Ian
authors.initials: I
authors.lastname: Menzies
authors.forename: Roger
authors.initials: R
authors.lastname: Crane
authors.forename: Isaac
authors.initials: I
authors.lastname: Zulu
authors.forename: Carole
authors.initials: C
authors.lastname: Nickols
authors.forename: Roger
authors.initials: R
authors.lastname: Feakins
authors.forename: James
authors.initials: J
authors.lastname: Mwansa
authors.forename: Victor
authors.initials: V
authors.lastname: Mudenda
authors.forename: Max
authors.initials: M
authors.lastname: Katubulushi
authors.forename: Steve
authors.initials: S
authors.lastname: Greenwald
authors.forename: Michael
authors.initials: M
authors.lastname: Farthing
mesh_terms: D000328:Adult; D001706:Biopsy; D015331:Cohort Studies; D016099:Endoscopy, Gastrointestinal; D005243:Feces / Q000382:microbiology / Q000469:parasitology; D005260:Female; D015658:HIV Infections / Q000473:pathology; D015497:HIV-1 / Q000254:growth & development; D006651:Histocytochemistry; D006801:Humans; D007408:Intestinal Absorption / Q000502:physiology; D007413:Intestinal Mucosa / Q000382:microbiology / Q000469:parasitology / Q000502:physiology* / Q000648:ultrastructure; D007421:Intestine, Small / Q000382:microbiology / Q000469:parasitology / Q000502:physiology* / Q000648:ultrastructure; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D012621:Seasons; D013997:Time Factors; D014329:Tropical Climate; D014994:Xylose / Q000378:metabolism; D015024:Zambia
chemical_list: D014994:Xylose