Current spectrum of malabsorption syndrome in adults in India

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.

This is a preview of subscription content, log in to check access.

Fig. 1
Fig. 2

References

  1. 1.

    Makharia G. Where are Indian adult celiacs? Trop Gastroenterol. 2006;27:1–3.

    PubMed  Google Scholar 

  2. 2.

    Ramakrishna BS. Malabsorption syndrome in India. Indian J Gastroenterol. 1996;15:135–41.

    PubMed  CAS  Google Scholar 

  3. 3.

    Ranjan P, Ghoshal UC, Aggarwal R, et al. Etiological spectrum of sporadic malabsorption syndrome in northern Indian adults at a tertiary hospital. Indian J Gastroenterol. 2004;23:94–8.

    PubMed  Google Scholar 

  4. 4.

    Yachha SK, Misra S, Malik AK, Nagi B, Mehta S. Spectrum of malabsorption syndrome in north Indian children. Indian J Gastroenterol. 1993;12:120–5.

    PubMed  CAS  Google Scholar 

  5. 5.

    Ramakrishna BS, Venkataraman S, Mukhopadhya A. Tropical malabsorption. Postgrad Med J. 2006;82:779–87.

    PubMed  Article  CAS  Google Scholar 

  6. 6.

    Poddar U, Thapa BR, Nain CK, Prasad A, Singh K. Celiac disease in India: are they true cases of celiac disease? J Pediatr Gastroenterol Nutr. 2002;35:508–12.

    PubMed  Article  CAS  Google Scholar 

  7. 7.

    Bhatnagar S, Gupta SD, Mathur M, et al. Celiac disease with mild to moderate histologic changes is a common cause of chronic diarrhea in Indian children. J Pediatr Gastroenterol Nutr. 2005;41:204–9.

    PubMed  Article  Google Scholar 

  8. 8.

    Khoshoo V, Bhan MK, Jain R, et al. Celiac disease as cause of protracted diarrhoea in Indian children. Lancet. 1988;1:126–7.

    PubMed  Article  CAS  Google Scholar 

  9. 9.

    Varma S, Malhotra P, Kochhar R, Varma S, Kumari S, Jain S. Celiac disease presenting as iron-deficiency anaemia in northern India. Indian J Gastroenterol. 2001;20:234–6.

    PubMed  CAS  Google Scholar 

  10. 10.

    Sachdev A, Srinivasan V, Maheswary S, Mohan H, Ashish B, Singh LS. Adult onset celiac disease in north India. Trop Gastroenterol. 2002;23:117–9.

    PubMed  CAS  Google Scholar 

  11. 11.

    Sood A, Midha V, Sood N, Malhotra V. Adult celiac disease in northern India. Indian J Gastroenterol. 2003;22:124–6.

    PubMed  Google Scholar 

  12. 12.

    Fasano A, Catassi C. Current approaches to diagnosis and treatment of celiac disease: An evolving spectrum. Gastroenterology. 2001;120:636–51.

    PubMed  Article  CAS  Google Scholar 

  13. 13.

    Rewers M. Epidemiology of celiac disease: what are the prevalence, incidence, and progression of celiac disease? Gastroenterology. 2005;128 Suppl 1:S47–S51.

  14. 14.

    Ehrenpreis ED, Salvino M, Craig RM. Improving the serum D-xylose test for the identification of patients with small intestinal malabsorption. J Clin Gastroenterol. 2001;33:36–40.

    PubMed  Article  CAS  Google Scholar 

  15. 15.

    Van de Kamer JH, Huinink HTB, Weyers HA. Rapid method for the determination of fat in feces. J Biol Chem. 1949;177:347–55.

    Google Scholar 

  16. 16.

    Allen AV, Ridley DS. Further observations on the formol-ether concentration technique for faecal parasites. J Clin Pathol. 1970;23:545–6.

    PubMed  Article  CAS  Google Scholar 

  17. 17.

    Garcia LS, Bruckner DA, Brewer TC, Shimizu RY. Techniques for the recovery and identification of cryptosporidium oocysts from stool specimens. J Clin Microbiol. 1983;18:185–90.

    PubMed  CAS  Google Scholar 

  18. 18.

    Volta U, Molinaro N, Fusconi M, Cassani F, Bianchi FB. IgA antiendomysial antibody test: a step forward in celiac disease screening. Dig Dis Sci. 1991;36:752–6.

    PubMed  Article  CAS  Google Scholar 

  19. 19.

    Marsh MN, Crowe PT. Morphology of the mucosal lesion in gluten sensitivity. Baillières Clin Gastroenterol. 1995;9:273–93.

    PubMed  Article  CAS  Google Scholar 

  20. 20.

    Day DW, Jass JR, Price AB, et al. Inflammatory disorders of the small intestine. In: Day DW, Jass JR, Price AB, et al., eds. Morson and Dawson’s Gastrointestinal Pathology. UK: Blackwell Science; 2001; p. 272–309.

    Google Scholar 

  21. 21.

    Report of Working Group of European Society of Paediatric Gastroenterology, Nutrition. Revised criteria for diagnosis of celiac disease. Arch Dis Child. 1990;65:909–1.

    Article  Google Scholar 

  22. 22.

    Travis SPL, Stange EF, Lémann M, et al. European evidence based consensus on the diagnosis and management of Crohn’s disease: Current management. Gut. 2006;55:16–35.

    Google Scholar 

  23. 23.

    Westergaard H. Tropical sprue. Curr Treat Options Gastroenterol. 2004;7:7–11.

    PubMed  Article  Google Scholar 

  24. 24.

    Farthing MJG. Tropical malabsorption and tropical diarrhea. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Forrtran’s Gastrointestinal and Liver Disease (Pathophysiology/Diagnosis and Management). Philadelphia: Saunders. 2006; p. 2307–18.

  25. 25.

    Behera B, Mirdha BR, Makharia GK, Bhatnagar S, Dattagupta S, Samantaray JC. Parasites in patients with malabsorption syndrome: a clinical study in children and adults. Dig Dis Sci. 2008;53:672–9.

    PubMed  Article  Google Scholar 

  26. 26.

    Sood A, Midha V, Sood N, Kaushal V, Puri H. Increasing incidence of celiac disease in India. Am J Gastroenterol. 2001;96:2804–5.

    PubMed  Article  CAS  Google Scholar 

  27. 27.

    Dube C, Rostom A, Sy R, et al. The prevalence of celiac disease in average-risk and at-risk Western European populations: a systematic review. Gastroenterology. 2005;128 Suppl 1:S57–S67.

    PubMed  Article  Google Scholar 

  28. 28.

    Cataldo F, Montalto G. Celiac disease in the developing countries: a new and challenging public health problem. World J Gastroenterol. 2007;13:2153–9.

    PubMed  Google Scholar 

  29. 29.

    Marsh MN. The natural history of gluten sensitivity: refining and re-defining. Q J Med. 1995;85:9–13.

    Google Scholar 

  30. 30.

    Ross IM, Mathan VI. Immunological changes in tropical sprue. Q J Med. 1981;50:435.

    CAS  Google Scholar 

  31. 31.

    Bach JF. The effect of infections on susceptibility to autoimmune and allergic diseases. N Engl J Med. 2002;347:911–20.

    PubMed  Article  Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to Govind K. Makharia.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

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

Download citation

Keywords

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