Current spectrum of malabsorption syndrome in adults in India

Indian Journal of Gastroenterology volume 30, pages22–28(2011)Cite this article

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Abstract

Aim

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.

Methods

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.

Results

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.

Conclusions

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.

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Author information

Affiliations

  1. Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, 110 029, India

    Govind K. Makharia

  2. Department of Microbiology, All India Institute of Medical Sciences, New Delhi, 110 029, India

    Pooja Yadav & Bijay R. Mirdha

  3. Department of Pathology, All India Institute of Medical Sciences, New Delhi, 110 029, India

    Prasenjit Das & Siddhartha Datta Gupta

  4. Centre for Diarrheal Diseases & Nutritional Research, All India Institute of Medical Sciences, New Delhi, 110 029, India

    Shinjini Bhatnagar

  5. Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, 110 029, India

    Ravinder M. Pandey

Authors
  1. Pooja Yadav
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  2. Prasenjit Das
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  3. Bijay R. Mirdha
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  4. Siddhartha Datta Gupta
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  5. Shinjini Bhatnagar
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  6. Ravinder M. Pandey
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  7. Govind K. Makharia
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Correspondence to Govind K. Makharia.

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Yadav, P., Das, P., Mirdha, B.R. et al. Current spectrum of malabsorption syndrome in adults in India. Indian J Gastroenterol 30, 22–28 (2011). https://doi.org/10.1007/s12664-011-0081-0

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Keywords

  • Celiac disease
  • Chronic diarrhea
  • Tropical sprue
  • Villous atrophy