Microvillous inclusion disease

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Microvillus inclusion disease
Classification and external resources
OMIM 251850
DiseasesDB 32409
eMedicine ped/461

Microvillus inclusion disease, also known as Davidson's disease, congenital microvillus atrophy and, less specifically, microvillus atrophy (note: microvillus is often misspelled as microvillous), is a rare genetic disorder of the small intestine that is inherited in an autosomal recessive pattern.[1][2]

Presentation[edit]

It is characterized by chronic, intractable diarrhea in new-born infants, starting in the first few days of life.[3] This results in metabolic acidosis and severe dehydration. Pregnancy and birth are usually normal.

Prognosis[edit]

It is nearly always fatal unless, like short bowel syndrome patients, treated with parenteral nutrition or an intestinal transplant.[3] The patient is often classified as being in "intestinal failure" and treated with the cohort of patients known as "short bowel syndrome" patients.

Pathophysiology[edit]

It is caused by a congenital lack of apical microvilli in the epithelial cells of the small intestine.[4]

Diagnosis[edit]

Prenatal screening in utero is currently offered by several medical centers since the gene(s) involved in the disease were recently discovered to be MYO5B;[5][6] Diagnosis is typically made by biopsy of the small intestine.[1]

Biopsy[edit]

The appearance of microvillous inclusion disease on light microscopy is similar to celiac sprue; however, it usually lacks the intraepithelial lymphocytic infiltration characteristic of celiac sprue and stains positive for carcinoembryonic antigen (CEA).[2] The definitive diagnosis is dependent on electron microscopy.[7]

Differential diagnosis[edit]

The differential diagnosis of chronic and intractable diarrhea is:[8]

  • Intestinal epithelial dysplasia
  • Syndromatic diarrhea
  • Immunoinflammatory enteropathy

Genetic prevalence[edit]

Microvillous inclusion disease has an autosomal recessive pattern of inheritance.

Microvillus inclusion disease is thought to be extremely rare; only approximately 200 cases have been identified in children in Europe.[9]

One patient, a teenage female living in Arizona, suddenly began to grow microvilli after thirteen years of TPN (Total Parenteral Nutrition) and Lipid dependency. She now enjoys a typical teenage diet and is seen regularly by her Gastroenterologist.

One patient from the UK was documented to achieve nutritional independence at age 3.[10]

On 26 June 2009 a six year old girl diagnosed with microvillus inclusion disease became the third person in the UK to die of swine flu.[11]

History[edit]

Microvillus inclusion disease was first described in 1978 by Davidson et al.[12] It was originally described as familial enteropathy.

References[edit]

  1. ^ a b Chehade, Mirna; Sicherer, Scott H (2005). "Infantile food protein-induced enterocolitis syndrome". In David, Timothy J. Recent Advances in Paediatrics 22. London: Royal Society of Medicine Press. p. 140. ISBN 1-85315-572-1. 
  2. ^ a b Mills SE, Carter D, Greenson JK, Oberman HA, Reuter V, Stoler MH. Sternberg's Diagnostic Surgical Pathology. 4th Ed. Lippincott Williams & Wilkins. Copyright 2004. ISBN 978-0-7817-4051-7.
  3. ^ a b Salvatore, S.; Hauser, B.; Vandenplas, Y. (2007). "Chronic enteropathy and feeding". In Cooke, Richard J.; Vandenplas, Yvan; Wahn, Ulrich. Nutrition Support for Infants and Children at Risk. Basel, Switzerland; New York: Karger. p. 123. ISBN 3-8055-8194-7. 
  4. ^ Arpin, M.; Crepaldi, T.; Louvard, D. (1999). "Cross-talk between Apical and Basolateral Domains of Epithelial Cells Regulates Microvillus Assembly". In Birchmeier, Walter; Birchmeier, Carmen. Epithelial Morphogenesis in Development and Disease. Amsterdam: Harwood Academic. p. 104. ISBN 90-5702-419-5. 
  5. ^ Mueller T; Hess, MW; Schiefermeier, N; Pfaller, K; Ebner, HL; Heinz-Erian, P; Ponstingl, H; Partsch, J et al. (2008). "MYO5B mutations cause microvillus inclusion disease and disrupt epithelial cell polarity". Nat Genet 40 (10): 1163–5. doi:10.1038/ng.225. PMID 18724368. 
  6. ^ Szperl A, Golachowska M, Rings E, IJzendoorn S, et al (2011). "Functional characterization of mutations in the myosin Vb gene associated with microvillus inclusion disease.". J Ped Gastroenterol Nutr 52 (3): 307–13. doi:10.1097/MPG.0b013e3181eea177. PMC 3058815. PMID 21206382. 
  7. ^ Kennea N, Norbury R, Anderson G, Tekay A (2001). "Congenital microvillous inclusion disease presenting as antenatal bowel obstruction". Ultrasound Obstet Gynecol 17 (2): 172–4. doi:10.1046/j.1469-0705.2001.00211.x. PMID 11251929. 
  8. ^ Ruemmele FM (2007). "Chronic enteropathy: molecular basis". Nestle Nutr Workshop Ser Pediatr Program. Series Set, 2007 59: 73–85; discussion 85–8. doi:10.1159/000098514. ISBN 3-8055-8194-7. PMID 17245092. 
  9. ^ Online 'Mendelian Inheritance in Man' (OMIM) Microvillus atrophy -251850
  10. ^ Croft NM; Howatson, AG; Ling, SC; Nairn, L; Evans, TJ; Weaver, LT (2000). "Microvillous inclusion disease: An evolving Condition". J Pediatr Gastroenterol Nutr 32 (2): 185–189. PMID 10941974. 
  11. ^ "Swine flu girl 'had tough life'". BBC News. 30 June 2009. Retrieved 12 May 2010. 
  12. ^ Davidson GP, Cutz E, Hamilton JR, Gall DG (1978). "Familial enteropathy: a syndrome of protracted diarrhea from birth, failure to thrive, and hypoplastic villus atrophy". Gastroenterology 75 (5): 783–90. PMID 100367. 

External links[edit]