Tissue is the Issue: Duodenal Biopsies to Elucidate Gut Structure and Function Among Undernourished Children in Low-Resource Settings

Syed, Sana; Moore, Sean R.

doi:10.1016/j.ebiom.2017.08.003

Cited by 1 publication

(1 citation statement)

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“… 3 Diminished intestinal absorption leads to growth faltering, neurodevelopmental disability, and poor response to oral vaccines and nutritional therapy. 4 , 5 The persistence of stark nutritional disparities in LMIC settings versus their high-income counterparts directly impacts childhood growth rates, which may be secondary to defects in intestinal absorptive capacity due to the abovementioned environmental factors. 6 Although health interventions are being deployed worldwide to tackle malnutrition, there is great disparity between the responses to these interventions in high-income and LMIC settings because of the prevalence of EED in resource-poor areas.…”

Section: Introductionmentioning

confidence: 99%

Quantitative Morphometry and Machine Learning Model to Explore Duodenal and Rectal Mucosal Tissue of Children with Environmental Enteric Dysfunction

Khan

Jamil

Ehsan

et al. 2023

The American Journal of Tropical Medicine and Hygiene

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Environmental enteric dysfunction (EED) is a subclinical enteropathy prevalent in resource-limited settings, hypothesized to be a consequence of chronic exposure to environmental enteropathogens, resulting in malnutrition, growth failure, neurocognitive delays, and oral vaccine failure. This study explored the duodenal and colonic tissues of children with EED, celiac disease, and other enteropathies using quantitative mucosal morphometry, histopathologic scoring indices, and machine learning–based image analysis from archival and prospective cohorts of children from Pakistan and the United States. We observed villus blunting as being more prominent in celiac disease than in EED, as shorter lengths of villi were observed in patients with celiac disease from Pakistan than in those from the United States, with median (interquartile range) lengths of 81 (73, 127) µm and 209 (188, 266) µm, respectively. Additionally, per the Marsh scoring method, celiac disease histologic severity was increased in the cohorts from Pakistan. Goblet cell depletion and increased intraepithelial lymphocytes were features of EED and celiac disease. Interestingly, the rectal tissue from cases with EED showed increased mononuclear inflammatory cells and intraepithelial lymphocytes in the crypts compared with controls. Increased neutrophils in the rectal crypt epithelium were also significantly associated with increased EED histologic severity scores in duodenal tissue. We observed an overlap between diseased and healthy duodenal tissue upon leveraging machine learning image analysis. We conclude that EED comprises a spectrum of inflammation in the duodenum, as previously described, and the rectal mucosa, warranting the examination of both anatomic regions in our efforts to understand and manage EED.

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