The Mucosal Lesion of the Proximal Small Intestine in Acute Infectious Nonbacterial Gastroenteritis

Abstract

The pathogenesis of acute infectious nonbacterial gastroenteritis, a common illness, is uncertain. Indeed, the morphology of the mucosa of the small intestine in this disease has not been described. Fifteen volunteers with normal base-line intestinal biopsies ingested orally stool filtrate containing Norwalk agent. Twelve acquired clinical gastroenteritis and abnormal intestinal histology with mucosal inflammation, absorptive cell abnormalities, villous shortening, crypt hypertrophy and increased epithelial-cell mitoses. Abnormal mucosal histologic findings persisted for at least four days after clinical symptoms cleared. Biopsies six to eight weeks after illness were normal. In one of three asymptomatic volunteers a typical mucosal lesion developed; biopsies in the other two remained normal. These findings indicate that a characteristic intestinal lesion accompanies acute infectious nonbacterial gastroenteritis, is demonstrable a few hours before clinical illness, can occur in asymptomatic infected persons, persists for at least four days after disappearance of clinical symptoms and eventually reverts to normal. (N Engl J Med 288:1318–1323, 1973)