title: Spectrum of malabsorption syndrome among adults & factors differentiating celiac disease & tropical malabsorption.
abstract: OBJECTIVE
  Aetiology of malabsorption syndrome (MAS) differs in tropical and temperate countries over time; clinical and laboratory parameters may differentiate between various causes. This study was undertaken to investigate the spectrum of MAS among Indian adults and to find out the features that may help to differentiate between TM and celiac disease.
  
  
  METHODS
  Causes of MAS, and factors differentiating tropical malabsorption (TM) from celiac disease (CD) were determined in 275 patients.
  
  
  RESULTS
  Using standard criteria, causes in 275 patients [age 37.5+13.2 yr, 170, (61.5%) male] were, TM 101 (37%), CD 53 (19%), small intestinal bacterial overgrowth 28 (10%), AIDS 15 (5.4%), giardiasis 13 (5%), hypogammaglobulinemia 12 (4%), intestinal tuberculosis 7 (2.5%), strongyloidiasis 6 (2%), immunoproliferative small intestinal disease 5 (2%), Crohn's disease 6 (2%), amyloidosis 4 (1.5%), intestinal lymphangiectasia 3 (1%) and unknown 22 (8%). On univariate analysis, patients with CD were younger than TM (30.6+12 vs. 39.3+12.6 yr, P<0.001), had lower body weight (41.3+11.8 vs. 49.9+11.2 kg, P<0.001), longer diarrhoea duration (median 36 inter-quartile range 17.8-120 vs. 24-months, 8-48, P<0.01), lower stool frequency (6/day, 5-8 vs. 8, 5-10, P<0.05), lower haemoglobin (9.4+3.2 vs. 10.4+2.7 g/dl, P<0.05), higher platelet count (2,58,000, range 1,35,500-3,23,500 vs. 1,60,000, 1,26,000-2,58,000/mm 3 , P<0.05), and more often had hepatomegaly (9/53, 17% vs. 4/101, 4%, P<0.01), and subtotal or partial villous atrophy (36/50, 72% vs. 28/87, 32%, P<0.001). Younger age (<35 yr), longer diarrhoea duration, higher platelet count and villous atrophy were significant on multivariate analysis.
  
  
  CONCLUSIONS
  TM and CD are common causes of MAS among Indian adults. Younger age (<35 yr), longer diarrhoea duration, higher platelet count and villous atrophy were found to be associated with CD.
authors.affiliation: Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India. udayghoshal@gmail.com
authors.forename: Uday C
authors.initials: UC
authors.lastname: Ghoshal
authors.forename: Mansi
authors.initials: M
authors.lastname: Mehrotra
authors.forename: Sunil
authors.initials: S
authors.lastname: Kumar
authors.forename: Ujjala
authors.initials: U
authors.lastname: Ghoshal
authors.forename: Narendra
authors.initials: N
authors.lastname: Krishnani
authors.forename: Asha
authors.initials: A
authors.lastname: Misra
authors.forename: Rakesh
authors.initials: R
authors.lastname: Aggarwal
authors.forename: Gourdas
authors.initials: G
authors.lastname: Choudhuri
mesh_terms: D000328:Adult; D001706:Biopsy; D002446:Celiac Disease / Q000150:complications*; D004386:Duodenum / Q000473:pathology; D005260:Female; D006801:Humans; D008286:Malabsorption Syndromes / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D013182:Sprue, Tropical / Q000150:complications*