Clinical, endoscopic, and histological differentiation between celiac disease and tropical sprue: A systematic review
Pragya Sharma
Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
Search for more papers by this authorVandana Baloda
Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
Search for more papers by this authorGaurav PS Gahlot
Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
Search for more papers by this authorAlka Singh
Department of Gastroenterology and Human Nutritions, All India Institute of Medical Sciences, New Delhi, India
Search for more papers by this authorRitu Mehta
Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
Search for more papers by this authorSreenivas Vishnubathla
Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
Search for more papers by this authorKulwant Kapoor
Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
Search for more papers by this authorVineet Ahuja
Search for more papers by this authorSiddhartha Datta Gupta
Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
Search for more papers by this authorGovind K Makharia
Department of Gastroenterology and Human Nutritions, All India Institute of Medical Sciences, New Delhi, India
Search for more papers by this authorCorresponding Author
Prasenjit Das
Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
Correspondence
Dr Prasenjit Das, Department of Pathology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India.
Email: [email protected]
Dr Govind K Makharia, Department of Gastroenterology and Human Nutritions, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India.
Email: [email protected]
Search for more papers by this authorPragya Sharma
Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
Search for more papers by this authorVandana Baloda
Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
Search for more papers by this authorGaurav PS Gahlot
Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
Search for more papers by this authorAlka Singh
Department of Gastroenterology and Human Nutritions, All India Institute of Medical Sciences, New Delhi, India
Search for more papers by this authorRitu Mehta
Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
Search for more papers by this authorSreenivas Vishnubathla
Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
Search for more papers by this authorKulwant Kapoor
Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
Search for more papers by this authorVineet Ahuja
Search for more papers by this authorSiddhartha Datta Gupta
Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
Search for more papers by this authorGovind K Makharia
Department of Gastroenterology and Human Nutritions, All India Institute of Medical Sciences, New Delhi, India
Search for more papers by this authorCorresponding Author
Prasenjit Das
Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
Correspondence
Dr Prasenjit Das, Department of Pathology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India.
Email: [email protected]
Dr Govind K Makharia, Department of Gastroenterology and Human Nutritions, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India.
Email: [email protected]
Search for more papers by this authorAbstract
Background and Aim
While the prevalence of celiac disease (CD) is increasing globally, the prevalence of tropical sprue (TS) is declining. Still, there are certain regions in the world where both patients with CD and TS exist and differentiation between them is a challenging task. We conducted a systematic review of the literature to find out differentiating clinical, endoscopic, and histological characteristics between CD and TS.
Methods
Medline, PubMed, and EMBASE databases were searched for keywords: celiac disease, coeliac, celiac, tropical sprue, sprue, clinical presentation, endoscopy, and histology. Studies published between August 1960 and January 2018 were reviewed. Out of 1063 articles available, 12 articles were included in the final analysis.
Results
Between the patients with CD and TS, there was no difference in the prevalence and duration of chronic diarrhea, abdominal distension, weight loss, extent of abnormal fecal fat content, and density of intestinal inflammation. The following features were more common in CD: short stature, vomiting/dyspepsia, endoscopic scalloping/attenuation of duodenal folds, histological high modified Marsh changes, crescendo type of IELosis, surface epithelial denudation, surface mucosal flattening, thickening of subepithelial basement membrane and celiac seropositivity; while those in TS include anemia, abnormal urinary D-xylose test, endoscopic either normal duodenal folds or mild attenuation, histologically decrescendo type of IELosis, low modified Marsh changes, patchy mucosal changes, and mucosal eosinophilia.
Conclusions
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.
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