The Nature of the Gastrointestinal Lesion in Asiatic Cholera and Its Relation to Pathogenesis: A Biopsy Study

Abstract

Summary 1. A serial intestinal biopsy study of patients with classical epidemic and endemic Asiatic cholera demonstrates that the intestinal epithelium in this disease is intact, contrary to the classical textbook concept that a mucolytic enzyme causes desquamation of the epithelium during life. 2. The histological abnormalities of the small bowel in cholera revealed an acute enteritis manifested by a mononuclear cell inflammatory exudate, vascular congestion, marked goblet cell hyperplasia with eventual exhaustion atrophy, and increased “turn-over” of epithelial cells. Except in degree, the lesion in cholera could not be differentiated from that in cases of nonspecific diarrhea observed during this epidemic. 3. The additional finding of a separate, underlying, chronic, atrophic enteritis suggested that a dietary or nutritional factor may be important in predisposing an individual to cholera. 4. Mucus rather than desquamated cells gives the “rice-water” stool its characteristic appearance.