A clinico-endoscopic and histopathological correlation in suspected cases of malabsorption: A cross-sectional study

Introduction: Malabsorption is a complex medical condition with a diverse range of underlying etiologies posing a diagnostic challenge. The aim of the study was to investigate the correlation between endoscopic findings and histopathological diagnoses in patients with suspected malabsorption syndrome. Methods: This cross-sectional study was conducted over 12 months on 160 patients aged 2 to 60 years with chronic diarrhea and nutritional deficiencies. Endoscopic biopsies of the small intestine were performed and reported based on the following parameters including number and site of the biopsy specimens, villous height, and architecture, villous to crypt (V:C) ratio, presence of crypt hyperplasia and intra-epithelial lymphocyte (IEL) count. Results: Clinical presentations included chronic diarrhea (41.9%), weakness (12.9%), weight loss (9%), and constipation (2.5%). Endoscopic findings were normal in 49.69% of population. Histopathological examination revealed villous atrophy (18.6%), increased IEL count (16.9%) and crypt hyperplasia (6.2%). Chronic duodenitis was the most common diagnosis (64.4%). Celiac disease (3.1%) and tropical sprue (1.2%) were diagnosed based on specific criteria, emphasizing the need for histopathological confirmation. Conclusion: This study highlights the spectrum of histopathological changes in malabsorption and underscores the importance of its correlation with clinical and endoscopic findings. In clinical scenario of malabsorption, endoscopy findings vary from normal to abnormal mucosal morphology. Normal mucosal study may also reveal pathological changes on histopathological evaluation. Hence histopathology remains a crucial step for understanding etiopathogenesis thus helping to streamline the management.