Forty years ago on November 2, 1957, The Lancet published a historic case report that described for the first time abnormalities of the small intestinal mucosa obtained on biopsy via the oral route in a child with coeliac disease in London (1). This first report described severe abnormalities in an eight-year-old boy as “villous atrophy,” as the villi were “virtually absent.” In addition, “the lamina propria was increased in thickness.” These findings were similar to those found in 13 cases of adult idiopathic steatorrhoea.
Dr. Margot Shiner performed this first biopsy in a child with coeliac disease using the adult biopsy tube she had first described in 1956 (2). Her application of this technique to children proved to be of cardinal diagnostic importance for children with coeliac disease, and later for other disorders. It offered a whole new era of understanding of disorders of the small intestine in childhood. Indeed, there are those who believe that the development of the technique to perform oral small intestinal biopsy in childhood was the real beginning of paediatric gastroenterology (3). As Visakorpi (4) has said prior to this observation, “coeliac disease was an essential part of general paediatrics but the new technique demonstrated well that special skills are needed and that was the origin of the specialty.”
Margot Shiner is still active in research in Jerusalem and presented an abstract at the 7th International Coeliac Symposium in Tampere in 1996.
The Journal of Pediatric Gastroenterology and Nutrition salutes Dr. Shiner on this 40th anniversary of her pioneering observation, which transformed the ability of paediatricians to diagnose small intestinal disease.
John A. Walker-Smith
This new section has been initiated to give the readership of the Journal of Pediatric Gastroenterology and Nutrition a historic perspective of the field of pediatric gastroenterology, hepatology, and nutrition.
1. Sakula J, Shiner M. Coeliac disease with atrophy of the small intestinal mucosa. Lancet
2. Shiner M. Duodenal biopsy. Lancet
3. Walker-Smith JA. The role of small intestinal biopsy in the development of paediatric gastroenterology in Britain. In: Bynum WF, Ed. Britain historical essays. The Wellcome Institute for the History of Medicine, 1997:124-134.
4. Visakorpi, J. cited by Walker-Smith, 1997.