To test the suggestion that an inherited defect in colonic mucus rendering it susceptible to degradation by bacterial enzymes may be an important factor in the aetiology of ulcerative colitis, 650 colonoscopic and rectal biopsy specimens from 166 patients with colitis were stained by mild periodic acid Schiff (mPAS), which shows sialic acid that is deficient in O-acetyl substituents. There was an excess of mPAS positive sialic acid in patients with chronic ulcerative colitis, but the increased expression was patchy and coincided with a morphological change in the form of epithelial hyperplasia (metaplasia). Hyperplasia was more common in the rectum and in women and was associated with, and presumably secondary to, active inflammation. It is concluded that variation in the structure of sialic acid is acquired and is therefore unlikely to be implicated in the aetiology of ulcerative colitis.
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