Histologic findings in biopsies/resection specimens from the small intestine with special emphasis on celiac disease: Experience from a developing country in South Asia

Biopsies from the small intestine especially the duodenum are now being performed much more frequently than in the past. The most frequent reason for performing duodenal biopsies is to evaluate for malabsorption. In the last few years, increased awareness has resulted in more biopsies sent for evaluation of malabsorption, especially celiac disease (CD). In the duodenum, features of malabsorption (increased intraepithelial lymphocytes, villous shortening, and atrophy) were the most common histologic finding seen in 63.4% of cases. Serum tTG levels were available for correlation in 52.8% of cases. In patients with confirmed CD, 53.4% were MARSH IIIb, and 29.5% were MARSH IIIc. The most common specific condition diagnosed in the ileum was tuberculosis (35.6%), and 80.8% with ileal tuberculosis were women. Our findings, although preliminary, indicate that CD is not so rare in Pakistan. These are the first findings from Pakistan on this subject, and larger studies are required to determine the true frequency and impact of CD in Pakistan.