Morphologic Spectrum of Duodenal Biopsies in Malabsorption: A Study from Southern India

Balasubramanian, Pradeep; Badhe, Bhawana Ashok; Ganesh, Rajesh Nachiappa; Panicker, Lakshmi C; Mohan, Pazhanivel

doi:10.7860/jcdr/2017/23871.10231

Cited by 9 publications

(32 citation statements)

References 26 publications

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“…Worrall et al and Rustgi et al in their studies observed that the genetic haplotypes of CD can be seen in SLE patients also [16] [17]. Celiac disease has occurred in 14 case reports simultaneously with lupus and a possible link has been established between the common haplotypes HLA DR3 and HLA B8 seen in both diseases [18] [19]. In our study, 2 SLE patients, who satisfied the ACR criteria were subsequently diagnosed to have celiac disease.…”

Section: Discussionsupporting

confidence: 48%

“…Patients with other autoimmune diseases may be under immunosuppressive management and this may result in subclinical manifestation of CD by clinical, serological and histopathological findings. In view of overlap of clinical and serological findings in CD and other autoimmune diseases, close observation of endoscopic findings for scalloped margins and biopsy findings of villous blunting and increased IELs is crucial in the differential diagnosis[19].In this context in our study, mild villous blunting was seen in one case of autoimmune duodenitis, however the IEL counts were normal while all the patients of CD had moderate to severe villous blunting. IELs were raised (>25/100 enterocytes) in 6 patients of autoimmune duodenitis.…”

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confidence: 49%

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Duodenitis in Systemic Autoimmune Diseases: Pathologist Perspective

Balasubramanian¹,

Badhe²,

Ganesh³

et al. 2018

OJRA

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Aims: To study the histomorphology of duodenitis associated with systemic autoimmune diseases with clinicopathologic correlation. Patients and Methods: This is a descriptive prospective study. Fifteen patients of autoimmune diseases with duodenitis were included. Informed consent was taken. Histomorphological parameters studied were villous architecture, crypt architecture, intraepithelial lymphocyte (IEL) count per 100 enterocytes, villous tip IEL count per 20 enterocytes were counted, inflammatory cells in lamina propria-lymphocytes, neutrophils, eosinophils, epithelioid cells. Statistical analysis was done using IBM-SPSS software version 21. Results: Fifteen cases of duodenitis associated with autoimmune diseases included 6 patients of systemic lupus erythematosus (SLE), 5 of rheumatoid arthritis, one each of ankylosing spondylitis, systemic sclerosis, dermatomyositis and seronegative reactive arthritis. All these cases were serologically proven. Only 3 (20%) patients had mild villous blunting. Six patients (46.7%) had increased IEL counts. The range of IELs was 8-30, mean ± SD was 14 ± 7.6. Range of villous tip IELs was 0-8 with mean ± SD of 3.45 ± 2.56. Six patients (46.7%) had increased IEL counts but only 3 patients (20%) had increased villous tip IELs. All patients had moderate increase in lymphoplasmacytic infiltrate in lamina propria. Eosinophils in lamina propria were increased in 46.7% cases. Conclusion: One of the causes for malabsorptive conditions in adult population in South India is found to be duodenitis associated with autoimmune conditions. We conclude that a combination of clinical, serological, endoscopic and histopathologic features is crucial in arriving at a correct diagnosis.

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Section: Discussionsupporting

confidence: 48%

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confidence: 49%

Duodenitis in Systemic Autoimmune Diseases: Pathologist Perspective

Balasubramanian¹,

Badhe²,

Ganesh³

et al. 2018

OJRA

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“…In present study, villi architecture was normal in 71 (71.7%) cases. Earlier studies by Balasubramanian P et al (14) reported normal villi architecture in 40.6% cases. Endoscopic duodenal nodularity was found in 16.6% cases in our study which are quite similar to study conducted by Castro F et al [16].…”

Section: Discussionmentioning

confidence: 86%

“…However, A study from south India with 101 patients of malabsorption, reported prevalence of celiac disease was 15.8%. (14) Major histopathological features of untreated celiac disease in duodenal biopsies are intraepithelial lymphocytosis, increased number of inflammatory cells at lamina propria and villous atrophy [15]. Howeverdiagnostic yield of routine duodenal biopsy for celiac disease was low as reported by Castro F et al, Stoven SA et al [8,16].…”

Section: Discussionmentioning

confidence: 98%

Histomorphological study of duodenum with special reference to RUT (Rapid Urease Test) negative dyspepsia in a rural care setting

Chattopadhyay

Nayak

Basak

2019

Trop J Pathol Microbiol

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Introduction:In our institute duodenal biopsies are taken in patients having either, unexplained anemia, weight loss, recurrent loose stool, abdominal pain, dyspepsia or suspected malabsorption. In the present study we have evaluated histomorphological features of duodenal biopsies in patients presented with specifically Rapid Urease Test (RUT) negative dyspepsia. Materials and Methods: A retrospective observational study was conducted and data of duodenal biopsies were collected from January 2017 to December 2018. Histopathology slides of duodenal biopsies were reevaluated. We have correlated clinical and endoscopic findings with various histomorphological parameters. Results:We have included total 99 cases. Demographic profile of our study population shows wide age range (9 years to 74 years) with mean age 39.8 years and Male: Female ratio 1.1:1. Dyspepsia was the common presenting symptoms (64.6% cases) and malabsorption was suspected in 29 cases. 28.3% cases show villous architectural abnormalities which correlate significantly with endoscopic findings of duodenal nodularity. Moderate to severe lamina propria lymphoplasmacytic infiltration seen in 58.56% cases and correlates significantly with dyspeptic symptoms. Duodenal biopsy was diagnostic in 3% cases. Conclusion: Diagnostic yield of duodenal biopsy is low but informative with proper clinical background.

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“…4-5µm thick sections taken and were stained with hematoxylin and eosin stain. 6 Immunohistochemistry (IHC) CD3 was done for all cases. The antibodies and chemicals were procured from Dako, Denmark (Rabbit Anti-CD3 Monoclonal Antibody (Clone EP41).…”

Section: Methodsmentioning

confidence: 99%

Celiac disease in duodenal biopsies; 2 year experience at a tertiary care hospital

Gupta¹,

Raman²,

Mallik³

et al. 2021

JDPO

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Background: Duodenal endoscopic biopsy is a common useful test advised for patients presenting with various malabsorption syndromes. Aim:To study the histopathological changes observed in suspected malabsoption cases including Celiac disease (CD) with emphasis upon the Intraepithelial Lymphocytes (IELs) and to have a clinico-pathologic correlation. Settings & Design: This was a 2 year prospective study of cases presenting to gastrology OPD with suspected malabsorption selected for duodenal biopsy. Materials and Methods : Haematoxylin and Eosin (H&E) stain was used for study of histological parameters. IEL counts were correlated in CD3 immunohistochemical (IHC) stain. Clinical and laboratory parameters were correlated wherever available. Statistical Analysis: The variables were expressed as mean ± SD. Chi-square test or independent T test was used for comparison of variables. p value was < 0.05. Results: Out of 164 duodenal biopsies,105 cases had raised IEL.11 patients had CD (10.47%), rest were non celiac disease (NCD) of differen t aetiologies.Liver function tests, Endoscopy, Architecture of mucosa, crypt architecture, blunting, villous crypt ratio showed statistically significant correlation between CD and nonceliac disease groups with p values (P~0.034),(P~0.000),P~0.002),(P~0.000), (P~0,000) and (P~0.000) respectively. The specificity and positive predictive value (PPV) of villous tip IEL in both H&E & CD3 IHC were 100% in CD cases in our study. Conclusion: A complete clinical, endoscopic, serological and histopathological evaluation is essential for diagnosis of CD cases. Raised IEL in duodenal biopsies can be a very useful initial indicator for detecting many latent or subclinical CD cases.

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Morphologic Spectrum of Duodenal Biopsies in Malabsorption: A Study from Southern India

Abstract: A constellation of clinical, serological, endoscopic and histopathologic features is essential in diagnosing CD and autoimmune duodenitis. Biopsy is also a useful tool in diagnosing infectious duodenitis that are missed in other investigations.

Cited by 9 publications

References 26 publications

Duodenitis in Systemic Autoimmune Diseases: Pathologist Perspective

Duodenitis in Systemic Autoimmune Diseases: Pathologist Perspective

Histomorphological study of duodenum with special reference to RUT (Rapid Urease Test) negative dyspepsia in a rural care setting

Celiac disease in duodenal biopsies; 2 year experience at a tertiary care hospital

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