Forty-five duodenal biopsies from 33 children and 3 adult patients were maintained in organ culture for 24 h and exposed to various cow's milk
proteins and
gluten. In 10 of 11 celiac patients with a flat duodenal mucosa, and in 2 of 4 patients with partial villous
atrophy, a significant reduction in the mean enterocyte height was found after in vitro
gluten exposure, compared to culture in basic culture medium. Three patients had coexisting
celiac disease and cow's milk
protein intolerance.
alpha-Lactalbumin and
beta-lactoglobulin exhibited toxic effects on flat biopsies from two of these patients, and
casein was toxic in one. In 10 patients with cow's milk
protein intolerance, a significant reduction in enterocyte height was noted in one case with
gluten, and in three patients with
casein and
lactoglobulin, whereas
lactalbumin did not affect the tissues. In seven control patients having a normal duodenal mucosa, no in vitro influences were noted, whereas in four patients with partial villous
atrophy, a toxic reaction to
gluten was seen in one and a reduced enterocyte height was seen after
lactoglobulin exposure in another. In vitro toxicity induced by
gluten corresponded well with the diagnosis of
celiac disease, whereas toxic reactions to cow's milk
proteins during organ culture were inconsistent in cow's milk intolerance, except for cases in which a marked enteropathy was documented.