Mucosa of the Small Intestine in Folate-Deficient Alcoholics

Abstract

Peroral mucosal biopsy specimens from the duodenojejunal junction were obtained from alcoholics with marrow megaloblastosis caused by folate deficiency. Three patients with severe megaloblastosis had striking histological lesions of the intestinal mucosa that included decreased mitoses in the crypts, enlarged crypt and villous epithelial cells, increased cellularity of the lamina propria, and, in two of three patients, marked shortening of villi. Quantitation of mitoses, epithelial surface length, and epithelial-cell nuclear size confirmed the histologic observation. Five of eight patients with mild megaloblastosis had similar but less severe intestinal mucosal lesions. Six patients with intestinal lesions, who were rebiopsied after folate replacement therapy, showed reversion of the intestinal lesion to normal. Administration of large quantities of alcohol to two alcoholic volunteers induced histologic changes in the intestinal mucosa only when folate deficiency developed.