Clinical, endoscopic, and histological differentiation between celiac disease and tropical sprue: A systematic review

Sharma, Pragya; Baloda, Vandana; Gahlot, Gaurav Pratap Singh; Singh, Alka; Mehta, Ritu; Vishnubathla, Sreenivas; Kapoor, Kulwant Singh; Ahuja, Vineet; Gupta, Siddhartha Datta; Makharia, Govind; Das, Prasenjit

doi:10.1111/jgh.14403

Cited by 25 publications

(7 citation statements)

References 41 publications

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“…5 In our series we found 59 (63.4%) out of 93 patients to be vitamin B 12 deficient. 18 Considering the hematological parameters, mean hemoglobin and mean corpuscular volume (MCV) of the patients were 6.68 g/dL and 103.9 fL, respectively. MCV was less than 90 fL in five patients (5%).…”

Section: Resultsmentioning

confidence: 92%

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2021

J Lab Physicians

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Introduction Megaloblastic anemia is one of the common causes of anemia in India. Duodenal biopsies are routinely performed in the investigation of megaloblastic anemia. The present study was undertaken to analyze the value of duodenal biopsy in megaloblastic anemia and to correlate endoscopic findings with biopsy. As a secondary aim, the study has also analyzed the hematological profile and vitamin B 12 and folate status of these patients. Materials and Methods All the cases of megaloblastic anemia with bone marrow studies diagnosed at PSG Institute of Medical Sciences and Research during the two year period from January 2016 to December 2017 were retrieved. Clinical and laboratory findings (serum vitamin B 12 and folate levels) and endoscopic findings were retrieved from hospital records of the patients. Duodenal biopsies of these patients reported in the histopathology department were retrieved and reviewed. Statistical analysis was done using SPSS software 20.0. Results There were 93 cases of megaloblastic anemia diagnosed on bone marrow biopsies. Tropical sprue was diagnosed in 49.5% of cases, followed by intraepithelial lymphocytosis (17.2%), peptic duodenitis (17.2%), and no significant pathology in 16% of cases. Pancytopenia was present in 54.8% of cases. Isolated vitamin B 12 deficiency including low levels was present in 48.38% and folate deficiency was seen in 4.3% cases; 34.48% cases had both vitamin B 12 and folate deficiency. ConclusionThe incidence of tropical sprue in megaloblastic anemia is 49.5% in the study. Duodenal biopsy is valuable in the work up of megaloblastic anemia, irrespective of the endoscopic changes in identifying the etiology.

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Section: Resultsmentioning

confidence: 92%

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2021

J Lab Physicians

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“…This could be because subtle endoscopic changes were not documented since duodenal biopsies were routinely done in all the patients with megaloblastic anemia. However, Sharma et al 18 in their systematic review had found normal duodenal folds to be more common in TS.…”

Section: Discussionmentioning

confidence: 95%

The Value of Duodenal Biopsies in the Evaluation of Megaloblastic Anemia

2021

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Introduction Megaloblastic anemia is one of the common causes of anemia in India. Duodenal biopsies are routinely performed in the investigation of megaloblastic anemia. The present study was undertaken to analyze the value of duodenal biopsy in megaloblastic anemia and to correlate endoscopic findings with biopsy. As a secondary aim, the study has also analyzed the hematological profile and vitamin B12 and folate status of these patients. Materials and methods All the cases of megaloblastic anemia with bone marrow studies diagnosed at PSG Institute of Medical Sciences and Research during the two year period from January 2016 to December 2017 were retrieved. Clinical and laboratory findings (serum vitamin B12 and folate levels) and endoscopic findings were retrieved from hospital records of the patients. Duodenal biopsies of these patients reported in the histopathology department were retrieved and reviewed. Statistical analysis was done using SPSS software 20.0. Results There were 93 cases of megaloblastic anemia diagnosed on bone marrow biopsies. Tropical sprue was diagnosed in 49.5% of cases, followed by intraepithelial lymphocytosis (17.2%), peptic duodenitis (17.2%), and no significant pathology in 16% of cases. Pancytopenia was present in 54.8% of cases. Isolated vitamin B12 deficiency including low levels was present in 48.38% and folate deficiency was seen in 4.3% cases; 34.48% cases had both vitamin B12 and folate deficiency. Conclusion The incidence of tropical sprue in megaloblastic anemia is 49.5% in the study. Duodenal biopsy is valuable in the work up of megaloblastic anemia, irrespective of the endoscopic changes in identifying the etiology.

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“…Autoimmune and immune-mediated diseases Autoimmune enteropathy [16] Crohn's disease [17] Collagenous sprue [18] Common variable immune deficiency (CVID) [19] Infectious or probably infectious diseases Giardia lamblia infection [20] Helicobacter pylori infection [17] Post-viral enteropathy [21] Tuberculosis [22] Small intestinal bacterial overgrowth [23] HIV-enteropathy [24] Whipple disease [25] Tropical sprue [26] Iatrogenic causes Medication (angiotensin II receptor blockers [27], mefenamic acid [28], azathioprine [29], methotrexate [30], mycophenolate mofetil [31]) Chemotherapy [32] Radiotherapy [33] Graft versus host disease [34] Inflammatory disease Peptic duodenitis [35] Eosinophilic gastroenteritis [36] Neoplastic Small intestinal lymphoma [37] Other Amyloidosis [38] Malnutrition [39] Food allergy (cow's milk, soy) [20] According to the few studies available on the subject, the frequency of occurrence of SNVA varies considerably, particularly between adult and child populations. CD is diagnosed in 28-45% of adults with SNVA [5,13,40]; among the remainder, the most common causes of non-CD SNVA are believed to be inter alia medication-related enteropathy and infectious causes, including giardiasis and small intestinal bacterial overgrowth, peptic duodenitis, and collagenous sprue [5,13,40,41].…”

Section: Aetiology Of Non-coeliac Seronegative Villous Atrophymentioning

confidence: 99%

The Role of the Gluten-Free Diet in the Management of Seronegative Enteropathy

Szaflarska-Popławska

2021

Nutrients

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The differential diagnosis and treatment of seronegative enteropathy, also termed seronegative villous atrophy (SNVA), is a clinical challenge. Although seronegative coeliac disease (CD) is a frequent cause of SNVA, the aetiology can include immune-mediated, inflammatory, infectious, and drug-related forms. As a misdiagnosis of SNVA can result in patients being unnecessarily placed on a lifelong strict gluten-free diet or even given incorrect immunosuppressive therapy, the aim of this paper is to provide an evidence-based and practical approach for the workup and management of SNVA.

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Clinical, endoscopic, and histological differentiation between celiac disease and tropical sprue: A systematic review

Abstract: Both patients with CD and TS have overlapping clinical, endoscopic, and histological characteristics, and there is no single diagnostic feature for differentiating CD from TS except for celiac specific serological tests.

Cited by 25 publications

References 41 publications

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The Value of Duodenal Biopsies in the Evaluation of Megaloblastic Anemia

The Role of the Gluten-Free Diet in the Management of Seronegative Enteropathy

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