Evaluation of small intestinal biopsies in malabsorption syndromes
Keywords:
Malabsorption, Celiac Disease, Chronic diarrhea, Non specific duodenitis, Villous atrophy
Abstract
Backgound: The gold standard test for evaluation of intestinal malabsorption is biopsy. The various yet similar, abnormal mucosal architecture patterns in intestinal malabsorption makes it difficult for the pathologist to report its etiological causeMethods-We analyzed the clinical presentation, endoscopic and histological features of 328 consecutive patients with complaints suggestive of malabsorption syndrome. The spectrum of disease in these patients were studied and divided into four groups on the basis of histologic features and correlated with clinical/endoscopic findingsResults: Group1 were entities usually associated with a diffuse severe villous abnormality and crypt hyperplasia ,all 57 cases were of celiac disease (17.3%), Group 2 were entities usually associated with a variable villous abnormality and crypt hypoplasia, included 7 cases-malnourished 5(1.5%) and post chemotherapy 2(0.6%), Group 3 were entities usually associated with a nonspecific variable villous abnormality, usually not flat included 252 biopsies- Tropical sprue 16(4.8%), nonspecific duodenitis/jejunitis/ileitis 212 (64.6%), peptic duodenitis 16(4.8%), intestinal tuberculosis 8 (2.43%), and in Group 4 were entities associated with variable villous abnormalities illustrating specific diagnostic changes included 12 cases-giardiasis 2 (0.6%), Crohn’s disease 8 (2.4%), intestinal lymphangiectasia 1 (0.3%), lymphoma 1(0.34%).References
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2. Ramakrishna BS. Malabsorption syndrome in India. Indian J Gastroenterol 1996;15:135–41.
3. Yadav P, Das P, Mirdha BR, Gupta SD, Bhatnagar S, Pandey RM. Current spectrum of malabsorption syndrome in adults in India. Indian J Gastroenterol 2011; 30(1) : 22-28
4. Petras Robert, Gramlich Terry. Non neoplastic intestinal diseases.In : Stacey E Mills, Darryl Carter , Joel K Greenson, Victor E Reuter , Mark H Stoler et al. Sternberg’s Diagnostic Surgical Pathology. Fifth edition. Philadelphia, US :Lippincott Williams and Wilkin’s; 2009:1313-1368
5. Thakur B, Mishra P, Desai N, Thakur S, Alexander J, Sawant P. Profile of chronic small-bowel diarrhea in adults in Western India: a hospital-based study. Trop Gastroenterol 2006;27(2):84-6
6. Dutta AK, Balekuduru A, Chacko A. Spectrum of Malabsorption in India – Tropical Sprue is Still the Leader. J Assoc Physicians India 2011; 59 : 420-2
7. Ramakrishna BS. Malabsorption syndrome in India. Indian J Gastroenterol 1996 ;15:135-41.
8. Desai HG, Gupte PA. Increasing incidence of Crohn’s disease in India: is it related to improved sanitation? Indian J Gastroenterol 2005;24: 23-4.
9. Ghoshal UC, Mehrotra M, Kumar S. Spectrum of malabsorption syndrome among adults & factors differentiating celiac disease & tropical malabsorption,. Indian J Med Res 2012:136(4):687
Published
2016-11-06
Section
Original Article
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