Diagnostic evaluation of microscopic enteritis in duodenal biopsies of suspected malabsorption cases with clinico-immunohistological correlation

Abstract

Microscopic Enteritis (ME) is characterized by increase in intraepithelial lymphocytes (IEL) in intestinal mucosa. It represents a common feature of broad group of diseases including gluten mediated and non gluten related diseases. Duodenal biopsies play an important role in diagnosing these group of disorders. To compare IEL counts in Hematoxylin and eosin (H & E) stain and CD3 immunohistochemical (IHC) stain in duodenal biopsies of suspected malabsorption cases and compare them with clinical, immunological and biochemical parameters. This was a prospective study of two years. 164 patients were studied. IEL counted at villous tip and base in H&E sections and IHC were compared in duodenal biopsy. Data of clinical history, other parameters were collected and correlated whenever available. To compare any two variables, Chi - square test and independent T test was used. Statistical significance was defined as p < 0.05. Out of 164 cases,105 cases had increased IEL. The age range was 4 to 94 years with mean age of 43.29 ± 17.96 years. Males (56, 53.3%) were affected more than females (49, 46.6%). The clinical and histological parameters showing statistical significance with raised IEL were pallor, dyspepsia, loss of appetite, crypt architecture, blunting, ulcer, villous crypt ratio, exudates, reactive atypia and edema with P< 0.05. IEL at villous tip in CD3 had highest sensitivity (100%) and specificity (92.20%) in our study.ME should be investigated and diagnosed in correlation with a detail clinical history, complete haematological, biochemical and serological findings.