Structural and Hormonal Changes Associated With Starvation in Zambian Adult Patients With Esophageal Strictures: A...

Malnutrition disorders are associated with an enteropathy characterized by villus blunting, secretory cell loss, and mucosal inflammation. To investigate the contribution of undernutrition to enteropathy we conducted a case-control study of adult patients with starvation due to benign esophageal strictures, compared with non-malnourished community controls.

Fasting blood samples and duodenal biopsies were collected from 34 cases and 66 controls. Duodenal biopsies were evaluated by morphometry while circulating C-reactive protein and hormones were measured by ELISA or Luminex. Multivariable models were adjusted for stricture, body mass index, HIV, and C-reactive protein.

Epithelial surface area was reduced in cases (median 323 μm (IQR 271, 392) per 100 μm muscularis mucosae) compared to controls (448 μm (IQR 384, 516); p = 0.0001), even after adjustment in a linear regression model that included BMI, CRP, and HIV status. Hormonal analysis showed lower median concentrations of C-peptide (0.36 ng/mL vs. 0.7 ng/mL; p = 0.003), insulin (639 pg/mL vs. 2037 pg/mL; p = 0.0001), and GLP-2 (0 ng/mL vs. 2.3 ng/mL; p = 0.0063) in cases compared to controls. Cases also had higher glucagon (52.4 pg/mL vs. 36.6 pg/mL; p = 0.0012) and secretin concentrations (24.4 pg/mL vs. 11.7 pg/mL; p = 0.009).

Starvation and malnutrition consequent upon esophageal stricturing drives a further reduction in epithelial surface area, superimposed on environmental enteropathy. There was some evidence of abnormalities in secretion of pancreatic hormones and GLP-2.