Intestinal Goblet Cell Autoantibody-Associated Enteropathy
There is a second form of autoimmune enteropathy that is characterized by the presence of circulating antibodies to goblet cells. These can be demonstrated using the patient’s serum applied to sections of normal human intestine that stain the goblet cell mucus. The clinical presentation of these patients is similar to autoimmune enteropathy but the histology is distinctive. Patients with intestinal goblet cell autoantibody-associated enteropathy have a normal intestinal architecture, but the mucosa lacks goblet cells, Paneth cells, and perhaps endocrine cells. The base of the crypts may contain apoptotic figures and mitoses. The lamina propria often appears hypercellular, infiltrated by mononuclear cells and eosinophils (Fig. 6.202). Similar findings occur in both the small bowel and the colon. There may be an increase in crypt (but not surface) IELs and apoptotic bodies (563).