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414 LIGHT MICROSCOPIC ABNORMALITIES OF PROXIMAL SMALL IN TESTINAL BIOPSIES OF PATIENTS WITH CYSTIC FIBROSIS (CF)

In pancreatic insufficiency, a reduction of HCO3 secretion results in increased proximal small intestinal acidity. Injury to the mucosa by increased acidity may contribute to malabsorption. Multiple small intestinal biopsies (bx) from the region of the duodeno-jejunal junction were examined in patients with CF and controls (C) to determine if there was significant mucosal injury. The bx were read in a double blind fashion by 2 independent observers. 40 small intestinal bx from 10 patients with CF and 12 bx from 3 normal C were evaluated. Bx were evaluated for villus-crypt ratio, mitotic index, cell content of lamina propria and other morphologic abnormalities. Bx were categorized as normal, mildly, moderately or severely abnormal on the basis of specific morphologic criteria. The CF patients (mean age 15.2 years) had steatorrhea in spite of taking high doses of pancreatic enzymes. Mean fasting duodenal pH in 7 was 4.96. The bx from 8 CF patients were distinguished from the C by both observers. Bx from 2 were categorized as moderately, 2 as mildly-moderately and 4 as mildly abnormal. The bx from 2 CF patients could not be distinguished from the C by both observers. There was complete concordance between the observers. Proximal small intestinal bx of 8 of 10 CF patients demonstrated significant mucosal injury. This may have resulted from increased proximal small intestinal acidity due to pancreatic insufficiency or increased acid production and may contribute to malabsorption.