Environmental enteropathy and inflammatory bowel disease are not mutually exclusive

Area of Science:

• Gastroenterology
• Infectious Diseases
• Public Health

Background:

• Environmental enteropathy (EE) is a small intestine lesion linked to environmental factors and recurrent intestinal injury.
• Inflammatory bowel disease (IBD) incidence is rising in newly industrialized nations.
• EE is prevalent in low-income countries (LICs), while IBD is traditionally associated with developed nations, suggesting they might not co-exist.

Purpose of the Study:

• To investigate the co-occurrence of EE and IBD in adults residing in sub-Saharan Africa, a low-income region.
• To assess the prevalence of EE in Zambian individuals diagnosed with IBD.

Main Methods:

• Duodenal biopsies and biomarkers of intestinal and systemic inflammation were used to assess enteropathy in adult Zambians with IBD and controls.
• Socio-economic status (SES) was categorized into high and low groups for controls.
• Enteropathogen carriage rates were compared between IBD cases and control groups.

Main Results:

• Histological features of EE were observed in all participants (28 IBD cases and 59 controls), with a median villus height to crypt depth ratio <2.
• Enteropathogen carriage rates were lower in IBD cases compared to controls.
• EE was present in both high and low SES control groups.

Conclusions:

• The co-existence of IBD and EE in the same individuals can complicate the assessment of IBD in low-income settings.
• This finding may challenge the interpretation that improved environmental hygiene is not a significant factor in the emergence of IBD.
• EE should be considered a potential confounding factor in IBD diagnosis in regions like sub-Saharan Africa.