Screening for coeliac disease in children and adults living in a slum of Dhaka, Bangladesh

Gazi, Md. Amran; Das, Subhasish; Mahfuz, Mustafa; Hasan, Md. Mehedi; Hossain, Md. Shabab; Fahim, Shah Mohammad; Alam, Md. Ashraful; Noor, Zannatun; Gilchrist, Carol A.; Petri, William A.; Rahman, Mijanur; Mazumder, Ramendra Nath; Haque, Rashidul; Sarker, Shafiqul Alam; Ahmed, Tahmeed

doi:10.1136/bmjgast-2019-000294

Cited by 3 publications

(3 citation statements)

References 42 publications

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“…The commonest etiology responsible for duodenitis in studies conducted in Western countries was found to be celiac disease (CD), which accounted for 32% of the total cases 28 . No children in the present study were found positive for celiac disease on serology 29 and the IEL count was also insignificant, which is an important histopathologic marker of CD 30 . As the unique feature for all the children was only being stunted or at risk of stunting and they also did not have any pathology diagnosed by endoscopy, the high prevalence of duodenitis among these children was possibly related to EED and not due to celiac disease or any other GI disease 16 .…”

Section: Discussioncontrasting

confidence: 56%

Environmental enteric dysfunction and small intestinal histomorphology of stunted children in Bangladesh

Hossain

Begum²,

Rahman³

et al. 2022

Preprint

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There is lack of information on the histological characteristics of the intestinal mucosa in Bangladeshi children, which is considered to be the traditional gold standard for diagnosis of environmental enteric dysfunction (EED). The purpose of the study was to evaluate the intestinal histological characteristics of stunted children aged between 12-18 months with possible EED. 110 children with chronic malnutrition (52 stunted with length-for-age Z score, LAZ<-2 and 58 at risk of stunting with LAZ <-1 to -2) from the Bangladesh Environmental Enteric Dysfunction (BEED) study protocol who underwent upper gastrointestinal (GI) endoscopy were selected for this study. To explore the association of EED with childhood stunting, upper GI endoscopy was done and the biopsy specimens were studied for histopathology. Villous height and crypt depth were measured and the presence and intensity of inflammatory infiltrates in the lamina propria was investigated. Bivariate analysis was performed to examine the relationship between stunting and histologic morphology. More than 90% children irrespective of nutritional status were diagnosed to have chronic non-specific duodenitis on histopathology. Half of the children from both groups had villous atrophy as well as crypt hyperplasia and lymphocytic infiltration was present in more than 90% children, irrespective of groups. However, no statistically significant difference was observed when compared between the groups. The prevalence of chronic non-specific duodenitis in Bangladeshi children, irrespective of nutritional status, was high. A significant number of these children had abnormal findings in intestinal histomorphology.Author SummaryEED or environmental enteropathy, results in poor gut health and suboptimal child growth, and is considered to play a major role on childhood stunting in the tropics. Growth faltering due to decreased nutrient absorption as a result of alteration of small intestinal histological structure manifested as blunting or atrophy of intestinal villi, hyperplasia or elongation of crypts and infiltration of inflammatory cells in the lamina propria, has been demonstrated as the basic characteristics of EED. The traditional gold standard for the diagnosis of EED is intestinal biopsy and assessment of the histomorphological alterations. There is lack of information on the histological characteristics of the intestinal mucosa in Bangladeshi children. The purpose of the study was to evaluate the intestinal histological characteristics of stunted children aged between 12-18 months with possible EED. 110 children with chronic malnutrition who underwent upper gastrointestinal (GI) endoscopy were selected for this study and the biopsy specimens were studied for histopathology. Villous height and crypt depth were measured and the presence and intensity of inflammatory infiltrates in the lamina propria was investigated. More than 90% children irrespective of nutritional status were diagnosed to have chronic non-specific duodenitis. Half of the children from both groups had villous atrophy as well as crypt hyperplasia and lymphocytic infiltration was present in more than 90% children, irrespective of groups. However, no statistically significant difference was observed when compared between the groups.

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Section: Discussioncontrasting

confidence: 56%

Environmental enteric dysfunction and small intestinal histomorphology of stunted children in Bangladesh

Hossain

Begum²,

Rahman³

et al. 2022

Preprint

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“…Celiac disease is the best-known cause of villous atrophy. However, celiac was found to be uncommon among the people in the same region in our earlier analysis 38 . Participants in the current study were slum dwellers and lived in a poor socioeconomic environment where EED and bacterial overgrowth in intestine is common [39][40][41] .…”

Section: Comparison Of Histologic Findings Between Lewis Posiɵve and ...mentioning

confidence: 58%

Maternal and child FUT2 and FUT3 status demonstrate relationship with gut health, body composition and growth of children in Bangladesh

Gazi

Fahim

Hasan

et al. 2022

Sci Rep

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Fucosyltransferase 2 (FUT2) and 3 (FUT3) may influence host biological functions. We aim to assess the relationship between maternal and child FUT2 (Secretor) and FUT3 (Lewis) status with growth, body composition, gut health and histologic features in Bangladeshi children. We conducted a case–control study where secretor and Lewis status were ascertained from saliva samples of 408 mother–child dyads. Upper-arm fat area estimate (UFE) and total upper arm area (TUA) were found higher among children of Lewis negative mothers (p = 0.01 and p = 0.07, respectively). Changes in UFE after nutrition intervention were significantly greater among Lewis positive children than those of negative for Lewis (p = 0.05). Significant differences were observed for child UFE based on secretor and Lewis status of the mothers (p = 0.04). Lewis positive children had greater changes in WAZ (p = 0.07) and WLZ (p = 0.02) than Lewis negative children at the end of nutrition intervention. Fecal Reg1B was elevated in secretor positive children compared to their counterparts (p = 0.03). Lewis negative children had higher concentrations of MPO compared to Lewis positive children (p = 0.08). We also observed a higher frequency of subtotal villous atrophy among secretor negative and Lewis positive children (p = 0.09 and p = 0.01, respectively) than those of their counterparts. The findings provide insights for further studies to elucidate causal influences.

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“…The commonest etiology responsible for duodenitis in studies conducted in Western countries was found to be celiac disease (CD), which accounted for 32% of the total cases [ 27 ]. No children in the present study were found positive for celiac disease on serology [ 28 ] and the IEL count was also insignificant, which is an important histopathologic marker of CD [ 29 ]. As the unique feature for all the children was only being stunted or at risk of stunting and they also did not have any pathology diagnosed by endoscopy, the high prevalence of duodenitis among these children was possibly related to EED and not due to celiac disease or any other GI disease [ 16 ].…”

Section: Discussionmentioning

confidence: 99%

Environmental enteric dysfunction and small intestinal histomorphology of stunted children in Bangladesh

Hossain

Begum²,

Rahman³

et al. 2023

PLoS Negl Trop Dis

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There is lack of information on the histological characteristics of the intestinal mucosa in Bangladeshi children. Collection of intestinal biopsy samples and assessment of the histomorphological features is considered to be the traditional gold standard for diagnosis of environmental enteric dysfunction (EED). The purpose of the study was to evaluate the intestinal histological characteristics of stunted children aged between 12–18 months with possible EED. 110 children with chronic malnutrition (52 stunted with length-for-age Z score, LAZ<-2 and 58 at risk of stunting with LAZ <-1 to -2) from the Bangladesh Environmental Enteric Dysfunction (BEED) study protocol who underwent upper gastrointestinal (GI) endoscopy were selected for this study. To explore the association of EED with childhood stunting, upper GI endoscopy was done and the biopsy specimens were studied for histopathology. Villous height and crypt depth were measured and the presence and intensity of inflammatory infiltrates in the lamina propria was investigated. Bivariate analysis was performed to examine the relationship between stunting and histologic morphology. More than 90% children irrespective of nutritional status were diagnosed to have chronic non-specific duodenitis on histopathology. Half of the children from both groups had villous atrophy as well as crypt hyperplasia and lymphocytic infiltration was present in more than 90% children, irrespective of groups. However, no statistically significant difference was observed when compared between the groups. The prevalence of chronic non-specific duodenitis in Bangladeshi children, irrespective of nutritional status, was high. A significant number of these children had abnormal findings in intestinal histomorphology. Trial registration number: ClinicalTrials.gov ID: NCT02812615 Date of first registration: 24/06/2016. https://clinicaltrials.gov/ct2/results?cond=NCT02812615&term=&cntry=&state=&city=&dist.

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Screening for coeliac disease in children and adults living in a slum of Dhaka, Bangladesh

Cited by 3 publications

References 42 publications

Environmental enteric dysfunction and small intestinal histomorphology of stunted children in Bangladesh

Environmental enteric dysfunction and small intestinal histomorphology of stunted children in Bangladesh

Maternal and child FUT2 and FUT3 status demonstrate relationship with gut health, body composition and growth of children in Bangladesh

Environmental enteric dysfunction and small intestinal histomorphology of stunted children in Bangladesh

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