Indian Journal of Gastroenterology

, Volume 30, Issue 1, pp 22–28 | Cite as

Current spectrum of malabsorption syndrome in adults in India

  • Pooja Yadav
  • Prasenjit Das
  • Bijay R. Mirdha
  • Siddhartha Datta Gupta
  • Shinjini Bhatnagar
  • Ravinder M. Pandey
  • Govind K. MakhariaEmail author
Original Article



Tropical sprue was considered to be the most important cause of malabsorption in adults in India. However, several reports indicate that celiac disease is now recognized more frequently.


We analyzed the clinical presentation, endoscopic and histological features of 94 consecutive patients (age >12 years) with chronic diarrhea and malabsorption syndrome. The spectrum of disease in these patients and features differentiating celiac disease and tropical sprue are reported here.


Celiac disease (n = 61, 65%) was the most common cause of malabsorption followed by tropical sprue (21, 22%). Other conditions including cyclosporiasis (3), Crohn’s disease (2), common variable immunodeficiency (2), lymphangiectasia (1), William’s syndrome (1), and idiopathic malabsorption (3) accounted for the remainder. A greater number (21, 34%) of patients with celiac disease than those with tropical sprue (4, 19%) presented with atypical manifestations. Patients with celiac disease were younger (p = 0.001), more often had anemia, (p = 0.001), scalloping of folds (p = 0.001), moderate (p = 0.02) or severe (p = 0.001) villous atrophy, higher grade of intraepithelial lymphocytic infiltration (p = 0.001), crypt hyperplasia (p = 0.001), cuboidal (p = 0.001) and pseudostratified (p = 0.009) surface epithelial cells, and diffuse (p = 0.001) epithelial damage. In comparison, patients with tropical sprue were older and more often had normal duodenal folds, normal villi, tall columnar epithelial cells and focal epithelial damage.


Celiac disease was the most frequent cause of malabsorption syndrome in this series of patients. There are significant clinical and histological differences between celiac disease and tropical sprue.


Celiac disease Chronic diarrhea Tropical sprue Villous atrophy 


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Copyright information

© Indian Society of Gastroenterology 2011

Authors and Affiliations

  • Pooja Yadav
    • 2
  • Prasenjit Das
    • 3
  • Bijay R. Mirdha
    • 2
  • Siddhartha Datta Gupta
    • 3
  • Shinjini Bhatnagar
    • 4
  • Ravinder M. Pandey
    • 5
  • Govind K. Makharia
    • 1
    Email author
  1. 1.Department of Gastroenterology and Human NutritionAll India Institute of Medical SciencesNew DelhiIndia
  2. 2.Department of MicrobiologyAll India Institute of Medical SciencesNew DelhiIndia
  3. 3.Department of PathologyAll India Institute of Medical SciencesNew DelhiIndia
  4. 4.Centre for Diarrheal Diseases & Nutritional ResearchAll India Institute of Medical SciencesNew DelhiIndia
  5. 5.Department of BiostatisticsAll India Institute of Medical SciencesNew DelhiIndia

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