Clinicopathological and Microbiological Profile of Patients with Chronic Diarrhoea and Malabsorption with Special Emphasis on Duodenal Biopsies: A Study from Tertiarycare Hospital in South India

Abstract

Background: Chronic diarrhoea and malabsorption continue to be a major health problem worldwide. Due to conflicting reports regarding the clinicohistological spectrum of malabsorption, this study was conducted to study the spectrum of malabsorption. Objective: To study the morphologic spectrum of duodenal biopsies and stool microbiological profile in patients with chronic diarrhoea and malabsorption. Materials and Methods: The study included 106 patients aged above 18 years, presenting with chronic diarrhoea or malabsorption. Duodenal mucosal biopsy obtained was evaluated for villous atrophy, crypt architecture and Intraepithelial lymphocyte count (IEL) by H&E and immunohistochemistry for CD3. Stool samples collected were subjected to wet mount and culture examination. Serological testing for antibodies to coeliac sprue were also performed. Results: This descriptive study included 57 males and 49 females. Duodenal biopsy spectrum consisted of chronic duodenitis (48), duodenitis associated with autoimmune conditions (20), histomorphology of coeliac sprue (5), duodenitis with villous atrophy (14), only increased IEL (11) and miscellaneous (8). CD3 stained sections (n=90) offer a slightly better advantage over H & E-stained sections in detecting IEL. Stool microscopy and culture were positive in 6 cases. Coeliac sprue antibodies were positive in 1 case with Marsh type 1 lesion. Conclusion: Duodenal biopsy is a useful parameter in the study of malabsorption which must be adjuncted by microbiological and serological tests. Coeliac sprue is a rare entity in our population as per this study. Key words: Chronic diarrhoea, Malabsorption, Duodenal biopsy, Serological testing