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Jejunal Crypt Cell and Marrow Morphology in Tropical Sprue

MUNSEY S. WHEBY, M.D., F.A.C.P.; VIRGINIA SWANSON, M.D.; and THEODORE M. BAYLESS, M.D., F.A.C.P.
Ann Intern Med. 1968;69(3):427-434. doi:10.7326/0003-4819-69-3-427
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SUMMARY:

Jejunal crypt cell and marrow morphology were compared, and their relationship to folic acid deficiency was studied in an effort to clarify the pathogenesis of tropical sprue. Folic acid deficiency was found in almost every patient with tropical sprue, even those with symptoms of only 1 month's duration. In addition to patients with untreated tropical sprue, other conditions associated with folic acid or vitamin B12 deficiency were studied. Excellent correlation was found in untreated tropical sprue, although marrow changes were milder than crypt cell changes. With nutritional folate deficiency and pernicious anemia, crypt cell changes were minimal while marrow changes were striking. In tropical sprue, crypt cell morphology improved with folic acid or vitamin B12 treatment but did not return to normal even when plasma folic acid clearance rate was normal.

In early tropical sprue, marrow changes are secondary to folic acid deficiency, and crypt cell morphological alterations suggest a basic defect of inhibition of cellular maturation.

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