ArticlePLoS neglected tropical diseases2020
A novel histological index for evaluation of environmental enteric dysfunction identifies geographic-specific features of enteropathy among children with suboptimal growth.
Article in PLoS neglected tropical diseases, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 50 papers.
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50 citing papers in PubMed, 86 citations in OpenAlex.
- Effects of lipid-based nutrient supplements on gut markers in stunted children: Secondary analysis of a randomised trial.Journal of pediatric gastroenterology and nutrition · 2025Trial
- Malnutrition enteropathy in Zambian and Zimbabwean children with severe acute malnutrition: A multi-arm randomized phase II trial.Nature communications · 2024Trial
- Effect of a Homestead Food Production and Food Hygiene Intervention on Biomarkers of Environmental Enteric Dysfunction in Children Younger Than 24 Months in Rural Bangladesh: A Cluster-Randomized Controlled Trial.The American journal of tropical medicine and hygiene · 2023Trial
- Environmental enteric dysfunction and small intestinal histomorphology of stunted children in Bangladesh.PLoS neglected tropical diseases · 2023Trial
- Bile Acid Profiling Reveals Distinct Signatures in Undernourished Children with Environmental Enteric Dysfunction.The Journal of nutrition · 2021Trial
- Small intestinal microbiota of undernourished women of reproductive age and microbiota-directed balanced energy protein (MD-BEP) supplementation in maternal environmental enteric dysfunction (EED): protocol for a community-based intervention study.BMC pregnancy and childbirth · 2026Article
- Short Ileal Microvillus Length Phenotype Associates with Progression from Inflammatory to Complicated Disease Behavior in Pediatric Crohn's Disease.Inflammatory bowel diseases · 2026Article
- Inflammation impairs post-hospital discharge growth among children hospitalised with acute illness in sub-Saharan Africa and south Asia.Nature communications · 2025Article
- Maternal undernutrition exacerbates microbiota-driven growth stunting through pre- and postnatal effects.Cell reports · 2025Article
- Effects of intergenerational transmission of small intestinal bacteria cultured from stunted Bangladeshi children with enteropathy.bioRxiv : the preprint server for biology · 2025Article
- Article
- Mild Duodenal Mucosal Injury and Increased Type I Interferon Signaling Are Preludes to Celiac Disease.Laboratory investigation; a journal of technical methods and pathology · 2025Article
- Is there dietary macronutrient malabsorption in children with environmental enteropathy?European journal of clinical nutrition · 2025Review
- A cross-sectional study of associations between theThe American journal of clinical nutrition · 2024Observational
- Performance of empirical and model-based classifiers for detecting sucrase-isomaltase inhibition using theJournal of breath research · 2024Article
- The Environmental Enteric Dysfunction Biopsy Initiative (EEDBI) Consortium: mucosal investigations of environmental enteric dysfunction.The American journal of clinical nutrition · 2024Article
- Duodenal quantitative mucosal morphometry in children with environmental enteric dysfunction: a cross-sectional multicountry analysis.The American journal of clinical nutrition · 2024Article
- Multiplexed immunohistochemical evaluation of small bowel inflammatory and epithelial parameters in environmental enteric dysfunction.The American journal of clinical nutrition · 2024Article
- Duodenal transcriptomics demonstrates signatures of tissue inflammation and immune cell infiltration in children with environmental enteric dysfunction across global centers.The American journal of clinical nutrition · 2024Article
- Biomarker relationships with small bowel histopathology among malnourished children with environmental enteric dysfunction in a multicountry cohort study.The American journal of clinical nutrition · 2024Article
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Authors and funding
19 authors at 8 institutions in 5 countries.
Funding
Abstract
backgroundA major limitation to understanding the etiopathogenesis of environmental enteric dysfunction (EED) is the lack of a comprehensive, reproducible histologic framework for characterizing the small bowel lesions. We hypothesized that the development of such a system will identify unique histology features for EED, and that some features might correlate with clinical severity.
methodsDuodenal endoscopic biopsies from two cohorts where EED is prevalent (Pakistan, Zambia) and North American children with and without gluten sensitive enteropathy (GSE) were processed for routine hematoxylin & eosin (H&E) staining, and scanned to produce whole slide images (WSIs) which we shared among study pathologists via a secure web browser-based platform. A semi-quantitative scoring index composed of 11 parameters encompassing tissue injury and response patterns commonly observed in routine clinical practice was constructed by three gastrointestinal pathologists, with input from EED experts. The pathologists then read the WSIs using the EED histology index, and inter-observer reliability was assessed. The histology index was further used to identify within- and between-child variations as well as features common across and unique to each cohort, and those that correlated with host phenotype.
resultsEight of the 11 histologic scoring parameters showed useful degrees of variation. The overall concordance across all parameters was 96% weighted agreement, kappa 0.70, and Gwet's AC 0.93. Zambian and Pakistani tissues shared some histologic features with GSE, but most features were distinct, particularly abundance of intraepithelial lymphocytes in the Pakistani cohort, and marked villous destruction and loss of secretory cell lineages in the Zambian cohort.
conclusionsWe propose the first EED histology index for interpreting duodenal biopsies. This index should be useful in future clinical and translational studies of this widespread, poorly understood, and highly consequential disorder, which might be caused by multiple contributing processes, in different regions of the world.
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