Alterations in the histological features of the intestinal mucosa in malnourished adults of Bangladesh

Md Shabab Hossain,Mashud Parvez,Tahmeed Ahmed,Md Mehedi Hasan,Ramendra Nath Mazumder,Shah Mohammad Fahim,Mustafa Mahfuz,S M Khodeza Nahar Begum,Subhasish Das,Shafiqul Alam Sarker,Md Amran Gazi,M Masudur Rahman

doi:10.1038/s41598-021-82079-6

Md Shabab Hossain, Mashud Parvez + Show 10 more

Open Access

https://doi.org/10.1038/s41598-021-82079-6

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Abstract

There is paucity of knowledge on the histological features of the intestinal mucosa in malnourished adults of Bangladesh. The purpose of the study was to explore the histological features of the intestinal mucosa in malnourished adults of Bangladesh and to compare the findings with their well-nourished counterparts. 64 adults (37 malnourished with body mass index, BMI < 18.5 kg/m2 and 27 controls with BMI > 18.5 kg/m2) from the Bangladesh Environmental Enteric Dysfunction (BEED) study, who underwent upper-gastrointestinal endoscopy, were selected for this study. With a view to address the association of environmental enteric dysfunction (EED) with malnutrition, upper-gastrointestinal endoscopy was performed and mucosal biopsies from the distal duodenum were studied for histopathology. Villous height, crypt depth, and presence of inflammatory infiltrates in lamina propria were investigated. Bivariate analysis was performed to quantify the relation between malnutrition and the histological features. About 95% adults, irrespective of nutritional status, were diagnosed to have chronic non-specific duodenitis on histopathology. Malnourished adults suffered significantly more from chronic active duodenitis compared to their well-nourished counterparts (p = 0.003). Malnourished adults also had significantly higher frequency of subtotal villous atrophy, crypt hyperplasia and marked cellular infiltration in the lamina propria than the healthy controls (p < 0.05).

Highlights

There is paucity of knowledge on the histological features of the intestinal mucosa in malnourished adults of Bangladesh
The histological features of malnourished adults significantly pointed towards an active inflammation, which is chronic active duodenitis (p = 0.003)
There were 2 cases from the malnourished cohort who had specific duodenitis, one of them having diagnosed as celiac disease and the other with immuneproliferative small intestinal disease (IPSID)

Summary

Introduction

The purpose of the study was to explore the histological features of the intestinal mucosa in malnourished adults of Bangladesh and to compare the findings with their wellnourished counterparts. Alterations in small bowel function in children of developing countries in their early phases of life result from altered mucosal architecture and inflammation of the intestinal m ucosa[3]. These changes are said to be the result of factors related to environmental contamination and persist throughout life. The altered mucosal architecture and inflammation of the intestinal mucosa is thought to be the consequence of chronic exposure to enteric pathogens through fecal contamination, and is being referred to as environmental enteric dysfunction (EED)[3]. Because of this knowledge gap, we sought to evaluate these parameters in malnourished adults and compare the findings with their well-nourished counterparts

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