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Clinical profile of amoebic colitis and its association with malabsorption.

Introduction

Amoebiasis is as old as the development of human race but only about a century ago, it was suspected that Entamoeba histolytica, a protozoan, may be responsible for its causation. It remained controversial for some time that the organism causes damage to intestine or is present without that.

Since the organism involves basically large intestine, its role in production of malabsorption was not thought of till Lifitz and Holman [1] suggested that rapid transit time through bowel results in steatorrhoea in some individuals. Even after this concept much work has not been done in establishing the role of amoebiasis in creation of malabsorption of various substances. India being a tropical country and also a developing one, the incidence of amoebiasis as well as malnutrition is very high. Certain surveys have reported the incidence as high as 58%. [2] Because of economic conditions and poor sanitation, it is important to know how much of a role, amoebic colitis plays in the causation of malabsorption. Probably the workers studying the various aspects of amoebiasis have not given enough stress to this important aspect, because there is a lacuna in the knowledge about this part of the disease.

It was felt that the study of absorption of carbohydrates, fats, and proteins is needed in cases of amoebic colitis to advance our knowledge and improve the management of the disease. This study was done with the following aims and objectives:

* To study the clinical profile of chronic amoebic colitis.

* To find out the incidence of malabsorption for fats, carbohydrates and proteins in cases of chronic amoebic infection of the intestine.

Materials and Methods

The present study was carried out on 25 controls and 102 patients of chronic amoebic colitis attending tertiary care centre at Meerut (Uttar Pradesh) between 1978 to 1980 after consent of the patients and approval of institutional ethical committee. Control group was constituted of healthy subjects who had no abdominal symptoms, their stool examination for 6 days was normal and sigmoidoscopy was also normal. Initially 40 healthy subjects were taken up only 25 gave their consent for sigmoidoscopic examination. The diagnosis of amoebic colitis was based on the following criteria:

1. Patients having colonic symptoms for more than 6 weeks like disturbed bowel habits, gaseous dyspepsia, colonic pain etc.

2. Stool examination showing trophozoite and/or cysts of Entamoeba histolytica OR Sigmoidoscopic examination showing ulcerative mucosa intervening with healthy areas.

The patients were undergone stool examination, proctosigmoidoscopy, colonic swab of Entamoeba histolytica, faecal fat excretion, D-Xylose absorption test, serum proteins and jejunal biopsy.

Results

The present study comprised of 102 cases of chronic amoebic colitis and 25 age and sex matched controls. (Table 1 & 5) All the controls were subjected to faecal fat excretion test, D-Xylose test and estimation of serum proteins. (Table 2 & 3) On jejunal biopsy, partial villous atrophy was seen in only one case while in the rest, it was normal. (Table 4) Majority of cases were having symptoms for 6 months to 2 years. (Table 6) Analysis of the above shows that change in bowel habits and pain abdomen were the commonest symptoms presnt in 84% and 98% patients respectively. Pain in the abdomen was localized or diffuses and more often it was felt in the left iliac fossa. Tenesmus and increased gastrocolic reflex were also very common symptoms being complained of by 44% and 41% of cases respectively. (Table 7) Positive physical findings were present in a large number of cases. Palpable sigmoid colon being the commonest finding present in about 59%. 3 cases did not show any physical findings (Table 8). Stool examination was done consecutively for six days by simple method as well as by concentration method, for trophozoites and cysts of Entamoeba histolytica (Table 9).

Sigmoidoscopy was done in all the cases. More than half the cases had no abnormal findings on sigmoidoscopy.(Table 10) In those cases in whom ulcers were seen on sigmoidoscopy, swab was taken from the ulcerated area and examined for cyst and trophozoite of E. histolytica. (Table 11) Swab was positive for E. histolytica in 85.7% cases where ulcers were present; however, this number was only 30% of the total cases. Faecal fat excretion test was done in all the cases of chronic amoebic colitis. (Table 12) D-Xylose test was done in all cases. (Table 13) As evident from the above, D-Xylose Excretion was between 6.1-7 grams in about 74% cases. No female case showed malabsorption for carbohydrates. Total serum proteins and serum albumin was done in all the cases. (Table 14) There was not much difference with sex. There wass no case whose total protein was less than 5 and albumin less than 2.5 gm. When the results of faecal fat excretion and D-Xylose excretion test were combined the malabsorption was found in 7 cases (6.86%) out of 102 cases. Out of these 7 cases, 3 patients had malabsorption of both fats and carbohydrates. In one case there was malabsorption only for carbohydrates, while in three cases, only for fats. Total serum proteins and albumin were not statistically different (p < 0.05) in controls and in the cases.

Jejunal biopsy was carried out in the seven cases in whom malabsorption was detected by faecal fat excretion and D-Xylose excretion test. (Table 15) Even in those cases where malabsorption was present, jejunal biopsy showed abnormality in two cases, where one had parial villous atrophy and one had chronic nonspecific inflammatory changes. Duration of symptoms in the cases showing evidence of malabsorption by faecal fat excretion test and D-Xylose excretion test. (Table 16) As above, majority of the cases had symptoms for 5-7 years. There was no case having symptoms for less than 5 years and more than 10 years. The symptoms in these cases were analyzed in detail. (Table 17) All the cases have altered bowel habits in the form of mucus and blood in stool. Majority had tenesmus and abdominal pain with increased gastro colic reflex. None of these cases had constipation. The physical signs in these cases were analyzed in detail. (Table 18) Stool examination, sigmoidoscopic findings, faecal fat excretion, serum proteins, d-xylose excretion and jejuna biopsy in cases of malabsorption. (Table 19) Sigmoidoscopic findings in cases having malabsorption were similar to that of other cases of amoebiasis, and serum proteins were also within normal limits.

Discussion

Diarrhoea and dysentery are diseases known since time immemorial and their association with Entamoeba histolytica was also recognised about a century ago. In this study, in the majority of controls faecal fat excretion was between 4-5 gm and ranged between 3-6 gm. These subjects were taking diet with 50-100 gm fat per day. Other workers who have estimated faecal fat excretion in healthy population have reported similar findings. According to William Veale Thorpe [3], faecal fat excretion should be less than 5 gm in 24 hours, when a person is taking diet containing fats less than 100 gm per day. George H BellM also holds the same view regarding the excretion of fats in faeces.

D-Xylose excretion test in urine for 5 hours after ingestion of 25 gm D-Xylose in the controls revealed 5-6 gm excretion in urine in three fifth of the cases, whereas in a lesser number, it was higher but in no case more than 8 gm. The estimation test was developed by Roe and Rice [5] as a sensitive index for carbohydrate absorption. Other workers have also estimated D-Xylose in healthy persons and have shown similar results. According to G P Crean [6], 5 hours 5 hours excretion should be between 5-8 gm. However, H Sleisenger [7] observed lower limit up to 4.5 gm.

Total Serum proteins and albumin were also estimated in the present study, in healthy controls, which ranged from 6-7 gm/100 ml and 4-5 gm/100 ml, respectively. To find out the pattern of jejuna mucosa, jejuna biopsy was done in a few controls, which cooperated, and in spite of absence of symptoms and normal stool findings, one case had partial villous atrophy. A total of 102 cases of chronic amoebic colitis were studied, aged between 15-67 years with male to female ratio of 4 : 1.Majority of cases were between 20-40 years of age, which is not true incidence of the disease in our country because all the cases taken were from the medical outpatient department and indoors, and children were excluded. Male to female ratio of 4 : 1 also does not show prevalence of this disease in the two sexes, as the number of males attending hospital is much more than the number of females, and it is also difficult to get cooperation of females, especially sigmoidoscopy.

Patients were interrogated in detail for symptoms, which were present in the majority of cases. The commoner symptoms were pain in the abdomen (98%) and altered bowel habits (84.8%) present in cases with dysentery (64%) in the form of blood and mucus in stool. Diarrhoea was present in 16%, constipation in 2.94% and alternate diarrhoea and constipation in only one case. Other common symptoms were tenesmus, increased gastro colic reflex and flatulence (Gaseous dyspepsia).

Rangiah et al. [8] found diarrhoea in 105 cases which was commonest symptom followed by pain in abdomen in 101 cases and mucus in stools in 91 cases, in their study of 136 cases of amoebic colitis.

Nath et al. [9, 10] recorded the observation from a study of 102 cases of intestinal amoebiasis and found flatulence in 55.8%, generalised pain in abdomen 41.1%, constipation 32.3%, pain in left and right iliac fossa in 36.2% cases. In the present study of 102 cases, palpable colon was the commonest sign (88.6%). Sigmoid colon was palpable in 58.9% cases which were tender in 49% cases. Nath et aU9] found tenderness in left iliac fossa in 32.6% cases, while in right iliac fossa in 25.6% cases.

In the present series, sigmoidoscopy was done in all the cases and it was normal in 58%. However, ulcers were seen in 34.3% cases of which majority were in colon (30 cases) and only 5 cases in the rectum. Chatterjee [11] has described the ulcers may involve only the mucosa or there could be extensive superficial ulcers with hyperaemia or there could bt marked thinning, dilation and sacculation of intestinal wall with adhesion to neighbouring viscera and narrowing of lumen of bowel. Madan Gopalan N [11,12], in his study found amoebic ulcers in 17 cases out of 77 cases of chronic amoebic colitis. In 37 cases, it was normal. Other important findings were congestion and granularity of wall. Juniper [14] found ulcer in 16 out of 22 cases of amoebic dysentery. Mittal [15] found amoebic ulces in colon in 17 cases out of 46 cases of amoebic colitis, while it was normal in 23 cases.

To find out the evidence of malabsorption, the faecal fat was estimated in 3 days stool sample to find the average foe one day. In the present series out of 102, in 6 cases it was more than 6 gm, between 6-7 gm in three and more than 7 gm in three cases, so it seems likely that mild fat malabsorption may occur in cases of amoebiasis. Since none of the cases had more than 8 gm excretion of fat, it seems that amoebiasis does not cause severe malabsorption. Ravi Raman et al [16] studied 37 cases of chronic amoebiasis and 10 controls, for biochemical tests of intestinal absorption and jejuna biopsy. 4 out of 37 patients of chronic amoebiasis showed evidence of malabsorption. D-Xylose excretion was less than 5 gm in 3 out of 102 cases and all of them were males. Among the normal controls the 5 hours urinary excretion of D-Xylose is between 5-8 gm which is also reported by various workers like G.P. Crean. [6] Another important finding was that inspite of chronic symptoms of gastrointestinal tract in the form of diarrhoea and dysentery for many years none of the cases had low plasma protein or even low albumin. It seems that protein absorption was not affected much in amoebiasis.

Conclusion

Pain in abdomen was the most common symptom in amoebiasis. Amoebiasis does not cause significant malabsorption. Protein absorption was not affected much in amoebiasis.

References

[1.] Lifshitz F, Holman GH. Disaccharidase deficiencies with steatorrhea. J Pediatr 1964 Jan; 64:34-44.

[2.] Vaidhya ON. Observation on dysenteries. Medical Bulletin (Bombay) 10: 321-342.

[3.] Thorpe WV, Brey HG, James SP. Biochemistry for Medical Students. 19th Edi. Baltimore: Williams & Wilkins Co.

[4.] Bell GH, Smith DE, Patterson CR. Textbook of Physiology and Biochemistry. 9th Ed. Edinburgh: Churchill Livingstone. 1976.

[5.] Roe JH, Rice EW. A photometric method for the determination of free pentoses in animal in tissues. J Biol Chem 1978;173:507-512.

[6.] MacLeod J. Davidson's principles and practice of Medicine, 12th Ed. Edinburgh: ELBS/Churchill Livingstone. 1977.

[7.] Beeson PB, MeDermott W, Sleisenger MH. Cecil-Loeb Textbook of Medicine. 14th Ed. Philadelphia: WB Saunders Company. 1975.

[8.] Rangiah PN. The Three Madras first in extra elimentary amoebiasis. Ind. Pract. 1968; 21: 793.

[9.] Nath K, Samuel KC, Sehgal KK. Study of bacterial flora of human Large intestine in normal subjects and in patients with chronic colitis. Ind. Med. Gaz. 1969;9:736.

[10.] Nath K, Agarwal BL, Agarwal SN. Amoebiasis. Jour. A.P.I. 1964;12:523-529.

[11.] Chatterjee K.D. Parasitology, Protozoology and Helminthology. 6th Ed. Calcutta: Guha Ray Sree Saraswaty Press Ltd. 1967. p. 24-25.

[12.] Madan GN. Colonic manifestations of amoebiasis. Antiseptic 1970;67:709.

[13.] Madan GN, Subramanium R, Vedachalari SP, Murugesan RG. Rectal and colonic mucosal biopsy in amoebiasis and other colitis. J Assoc Phy Ind 1968;16:325.

[14.] Juniper K Jr., Worrell CL, Minshew MC, Roth LS, Cypert H, Lloyd RE. Serologic diagnosis of amoebiasis. Am J Trop Med Hyg 1972;21:157-168.

[15.] Mitttal SK. Lactose malabsorption in chronic colitis and irritable bowel syndrome. A thesis for M.D. 1976;4(4):156-61.

[16.] Ravi R. A study of small intestinal function in chronic amoebiasis. A paper presented in xxxv Joint annual conference association of Physician of India, Trivandrum. 1980.

Source of Support: Nil

Conflict of interest: None declared

Anoop Kumar, Kaushal Dwivedi

PG Department of Medicine, Rohilkhand Medical College & Hospital, Bareilly, UP, India

Correspondence to: Anoop Kumar (doctoranoop10@gmail.com)

DOI: 10.5455/ijmsph.2013.2.453-459

Received Date: 08.02.2013

Accepted Date: 11.02.2013
Table-1: Age and Sex Distribution of Controls

Age Groups     Male     Female    Total   Percentage
(in years)

15-20           2          0        2         8
21-30           10         3       13         52
31-40           5          1        6         24
41-50           2          1        3         12
51-60           1          0        1         4
Total        20 (80%)   5 (20%)    25         --

Table-2: Faecal Fat Excretion in the Controls

Faecal Fat      Male   Female   Total   Percentage
Excretion
(gm/24 hours)

3-3.9            4       2        6         24
4-5              12      3       15         60
5.1-6            4       0        4         16
More than 6      0       0        0         0
Total            20      5       25         --

Table--3: D-Xylose Excretion in Controls

D-Xylose Excretion   Male   Female   Total   Percentage
(in 5 hrs) in gm

Less than 5           0       0        0         0
5-6                   13      2       15         60
6.1-7                 3       2        5         20
7.1-8                 4       1        5         20
Total                 20      5       25

Table--4: Jejunal Biopsy in Controls

Jejunal Biopsy Findings   Male   Female   Total

Normal                     3       1        4
Partial Villous Atrophy    0       1        1
Total                      3       2        5

Table--5: Age and Sex Distribution of the Cases of
Chronic Amoebic Colitis

Age Groups      Male        Female     Total   Percentage
(in years)

15-20            8            2         10        9.80
21-30            36           9         45       44.11
31-40            23           7         30       29.41
41-50            7            2          9        8.82
51-60            5            1          6        5.88
Above 60         2            0          2        1.96
Total        81 (79.4%)   21 (20.6%)    102

Table--6: Duration of Symptoms in Cases

Duration of Symptoms   Male   Female   Total   Percentage

2-6 months              5       1        6        5.88
6 months-1 year         12      2       14       13.72
1-2 years               34      6       40       39.21
2-3 years               6       3        9        8.82
3-4 years               7       2        9        8.82
4-5 years               6       2        8        7.84
5-6 years               4       2        6        5.88
6-7 years               3       1        4        3.92
7-8 years               2       1        3        2.94
More than 8 years       2       1        3        2.94
Total                   81      21      102

Table-7: Symptoms in Chronic Amoebic Colitis

Symptoms                                           Male   Female
COLONIC
                  Total                             69      17
Altered Bowel   Dysentery          Total            50      15
  Habits                         With Mucus         40      10
                                 With Blood         3       2
                            With Mucus and Blood    7       3
                Diarrhoea                           15      2
                Constipation                        3       0
                Alternate diarrhoea and             1       0
                constipation

Abdominal         Total                             79      21
  Pain           Diffuse                            2       3
                  Lower            Total            50      10
                 Abdomen      Rt. Iliac fossa       10      5
                              Lt. Iliac fossa       40      5
                  Upper            Total            25      7
                abdominal       Epigastrium         18      4
                             Rt. Hypochondrium      6       2
                             Lt. Hypochondrium      1       1
                No pain but generalised             2       1
                discomfort

Tenesmus          Total                             39      6
                Pain at defecation                  9       1
                Unsatisfactory bowel                30      5
                evacuation feeling

Increased Gastro colic reflex                       36      6

Belching          Total                             4       14
                Gaseous Dyspepsia                   3       13
                Excessive Flatus                    1       1
Nausea                                              1       2
Anorexia                                            2       3
Others          Headache                            0       1
                Pyrosis and Regurgitation           10      5

             FOOD DISAGREEMENT

Milk                                                2       3
Others          Fried Food                          1       4
                Non Vegetarian                      6       2
                Vegetarian                          1       9
                Cooked outside                      15      3

PSYCHOLOGICAL

Anxiety                                             1       2
Obsession                                           2       3
Phobia (Liver)                                      2       6

OTHERS (MISC)

Extra Intestinal Amoebiasis                         0       0

Symptoms                                           Total     %
COLONIC
                  Total                             86     84.31
Altered Bowel   Dysentery          Total            65     63.72
  Habits                         With Mucus         50     49.01
                                 With Blood          5      4.9
                            With Mucus and Blood    10      9.8
                Diarrhoea                           17     16.66
                Constipation                         3     2.94
                Alternate diarrhoea and              1     0.98
                constipation

Abdominal         Total                             100    98.03
  Pain           Diffuse                             5     4.90
                  Lower            Total            60     58.82
                 Abdomen      Rt. Iliac fossa       15     14.70
                              Lt. Iliac fossa       45     44.11
                  Upper            Total            32     31.37
                abdominal       Epigastrium         22     21.56
                             Rt. Hypochondrium       8     7.84
                             Lt. Hypochondrium       2     1.96
                No pain but generalised              3     2.94
                discomfort

Tenesmus          Total                             45     44.11
                Pain at defecation                  10     9.80
                Unsatisfactory bowel                35     34.31
                evacuation feeling

Increased Gastro colic reflex                       42     41.17

Belching          Total                             16     17.64
                Gaseous Dyspepsia                   16     15.68
                Excessive Flatus                     2     1.98

Nausea                                               3     2.94
Anorexia                                             5     4.90
Others          Headache                             1     0.98
                Pyrosis and Regurgitation           15     14.70

             FOOD DISAGREEMENT

Milk                                                 5     4.90
Others          Fried Food                           5     4.90
                Non Vegetarian                       8     7.84
                Vegetarian                          10     9.80
                Cooked outside                      18     17.64

PSYCHOLOGICAL

Anxiety                                              3     2.94
Obsession                                            5     4.90
Phobia (Liver)                                       8     7.84

OTHERS (MISC)

Extra Intestinal Amoebiasis                          0       0

Table-8: Physical Findings in the Cases

Signs                                        Male   Female

Palpable Colon       Total                    73      17
                    Sigmoid       Total       50      10
                     Colon        Tender      43      7
                                Non tender    7       3
                   Ascending      Total       13      2
                     Colon        Tender      10      1
                                Non tender    3       1
                  Ascending &     Total       12      1
                  Descending      Tender      10      1
                     Colon      Non tender    2       0

Palpable Caecum      Total                    7       2
                    Tender                    3       1
                  Non tender                  1       0
                   Gurgling                   3       1

Non colonic          Liver                    5       1
  amoebiasis        Others                    0       0

No Positive                                   2       1
  Signs

Signs                                        Total     %

Palpable Colon       Total                    90     88.23
                    Sigmoid       Total       60     58.82
                     Colon        Tender      50     49.01
                                Non tender    10     9.80
                   Ascending      Total       15     14.70
                     Colon        Tender      11     10.78
                                Non tender     4     3.92
                  Ascending &     Total       13     12.75
                  Descending      Tender      11     10.78
                     Colon      Non tender     2     1.96

Palpable Caecum      Total                     9     8.82
                    Tender                     4     3.82
                  Non tender                   1     0.98
                   Gurgling                    4     3.82

Non colonic          Liver                     6     5.88
  amoebiasis        Others                     0       0

No Positive                                    3     2.94
  Signs

Table-9: Stool Examination Findings in Cases

Stool Examination Findings            Male   Female   Total     %

Positive for Trophozoites              23      3       26     25.49
Positive for Trophozoites and Cysts    48      17      65     63.72
Positive for Cysts only                10      1       11     10.78
Total                                  81      21      102

Table-10: Sigmoidoscopic Findings in Cases

Sigmoidoscopic          Male   Female   Total     %
Findings

Normal                   45      16      61     59.86
Ulceration   Total       30      5       35     34.31
             Colon       28      2       30     29.41
             Rectum      2       3        5     4.90

Congestion/Oedema of     2       0        2     1.98
  mucosa

Granular mucosa          1       0        1     0.98

Pale mucosa              2       0        2     1.98

Spasm of Rectosigmoid    1       0        1     0.98
  Junction
Total                    81      21      102

Table-11: Colonic Swab in Chronic Amoebic Colitis Cases

Colonic Swab       Male   Female   Total     %

Positive for        26      4       30     85.71
  E. histolytica

Negative for        4       1        5     14.28
  E. histolytica

Total               30      5       35

Table-12: Faecal Fat Excretion in Cases

Faecal Fat      Male   Female   Total   Percentage
Excretion
(gm/24 hours)

3-4              6       3        9        8.82
4.1-5            59      15      74       73.54
5.1-6            11      2       13       12.74
6.1-7            3       0        3        2.94
7.1-8            2       1        3        2.94
Total            81      21      102

Table-13: D-Xylose Excretion in Cases

D-Xylose     Male   Female   Total     %
Excretion
(in 5 hrs)
in gm

3-4           1       0        1     0.98
4.1-5         2       0        2     1.96
5.1-6         7       2        9     8.82
6.1-7         60      15      75     73.52
7.1-8         6       2        8     7.84
8.1-9         5       2        7     6.86
Total         81      21      102

Table-14: Total Serum Proteins and Serum Albumin in
Cases

Protein (gm %)        Male   Female   Total     %

Total Serum   5.1-6    14      5       19     18.62
  Proteins    6.1-7    64      14      78     76.47
              7.1-8    3       2        5     4.90
              Total    81      21      102

Serum         2.5-3    13      4       17     16.66
  Albumin     3.1-4    60      16      76     74.50
              4.1-5    8       1        9     8.82
              Total    81      21      102

Table-15: Jejunal Biopsy Findings in Cases

Jejunal Biopsy Findings    Male   Female   Total     %

Normal Intestinal Mucosa    5       0        5     71.44
Chronic non-specific        1       0        1     14.28
  inflammatory changes
Partial Villous Atrophy     0       1        1     14.28
Total                       6       1        7

Table-16: Duration of Symptoms in Cases

             Male   Female   Total

< 5 years     0       0        0
5-6 years     2       0        2
6-7 years     2       0        2
7-8 years     1       1        2
8-9 years     0       0        -
9-10 years    1       0        1
Total         6       1        7

Table-17: Symptoms in Cases Showing Malabsorption

No.          Symptoms         Case Number

                              26   27    31   37   67   78    80

I.     COLONIC

1.     Altered Bowel Habits   +    +     +    +    +    +     +
a.     Dysentery
i.     With Mucus             +    -     +    +    -    +     +
ii.    With Blood             -    +     -    -    +    -     -
iii.   With Mucus and Blood   -    +     -    -    -    -     -
b.     Diarrhoea              -    -     -    -    -    -     -
c.     Constipation           -    -     -    -    -    -     -
d.     Alternate diarrhoea    -    -     -    -    -    -     -
         and constipation
2.     Abdominal Pain         +    +     +    +    +    +     -
a.     Diffuse                -    -     -    -    -    -     -
b.     Lower Abdomen          +    -     +    +    +    -     -
i.     Rt. Iliac fossa        +    -     -    +    -    -     -
ii.    Lt. Iliac fossa        +    +     +    +    +    -     -
c.     Upper abdominal        -    +     +    -    -    +     -
i.     Epigastrium            -    +     +    -    -    -     -
ii.    Rt. Hypochondrium      +    -     -    -    -    -     -
iii.   Lt. Hypochondrium      -    -     -    -    -    -     -
d.     No pain but            -    -     -    -    -    -     -
         generalised
         discomfort
3.     Tenesmus               +    -     +    +    +    +     +
a.     Pain at defecation     +    -     +    -    -    -     -
b.     Unsatisfactory bowel   -    -     -    +    +    +     +
         evacuation feeling
4.     Increased Gastro       +    +     +    +    -    +     -
         colic reflex
5.     Belching               +    -     -    -    -    +     -
a.     Gaseous Dyspepsia      +    -     -    -    -    +     -
b.     Excessive Flatus       -    -     -    -    -    -     -
6.     Nausea                 -    -     -    -    -    -     -
7.     Others                 -    -     -    -    -    -     -
8.     Anorexia               -    -     -    -    -    -     -

II.    FOOD DISAGREEMENT

1.     Milk                   -    -     -    -    -    -     -
2.     Others
a.     Fried Food             +    -     -    -    -    -     -
b.     Non Vegetarian         -    -     -    +    -    -     -
c.     Vegetarian             -    -     -    -    -    -     -

III.   PSYCHOLOGICAL

1.     Anxiety                -    +     -    -    -    -     -
2.     Obsession              -    -     -    -    +    -     -
3.     Phobic (Liver)         +    -     -    +    -    -     -

Table-18: Physical Signs in Cases of Malabsorption

S. No.   Physical Signs

                              26   27   31   37   67   78   80

1.       Palpable Colon       +    +    +    +    +    -    +
a.       Sigmoid Colon        +    +    +    -    +    -    +
-        Tender               -    +    +    -    -    -    +
-        Non tender           +    -    -    -    +    -    -
b.       Ascending Colon      -    -    -    -    -    -    -
-        Tender               -    -    -    -    -    -    -
-        Non tender           -    -    -    -    -    -    -
c.       Ascending and        +    -    -    -    -    -    -
           Descending Colon
-        Tender               -    -    -    -    -    -    -
-        Non tender           +    -    -    -    -    -    -
2.       Palpable Caecum      -    +    -    +    -    +    -
-        Tender               -    +    -    -    -    -    -
-        Non tender           -    -    -    +    -    -    -
-        Gurgling             -    -    -    -    -    +    -
3.       No Positive Signs    -    -    -    -    -    -    -

Table-19: Stool Examination (SE), Sigmoidoscopic
Findings (SF), Faeacal Fat Excretion (FFE), Serum
Proteins (SP), D-Xylose Excretion (DXE) and Jejunal
Biopsy (JB) in Cases of Malabsorption

Case       SE             SF        FFE    DXE
No.

       V   C   Both

26     -   -    +       Normal      6.67   4.18

27     -   -    +     Ulceration    6.73   3.77

31     -   -    +     Ulceration    6.45   5.32

37     +   -    -       Normal      7.23   5.24

67     -   -    +       Normal      7.81   6.10

78     -   -    +       Normal      5.66   4.24

80     +   -    -       Normal      7.20   5.22

Case      SP            JB
No.

        T     A

26     7.2   3.1      Normal

27     7.0   3.1     Partial
                     Villous
                     Atrophy

31     6.9   3.5      Normal

37     7.2   3.2      Normal

67     7.6   3.2     Chronic
                       Non
                     Specific
                   Inflammatory
                     Changes

78     7.7   4.2      Normal

80     6.3   3.2      Normal

Figure-1: Age and Sex Distribution
of the Cases of Chronic Amoebic
Colitis

        Male   Female

15-20   2      2
21-30   36     9
31-40   23     7
41-50   7      2
51-60   1      5
> 60    2      0

Note: Table made from bar graph.

Figure-2: Symptoms in Chronic Amoebic Colitis

                                Number Of
                                Cases

Pain Abdomen                    100
Altered Bowel Habits            86
Tenesmus                        45
Increased Gastro Colic Reflex   42
Belching                        18
Psychological Symptoms          16
Others                          16
Anorexia                        5
Nausea                          3

Note: Table made from bar graph.

Figure-3: Physical Findings in the Cases

                                        Physical Signs
                                        In Cases Of
                                        Chronic Amoebic
                                        Colitis

Palpable Sigmoid Colon                  60
Palpable Ascending Colon                15
Palpable Ascending & Descending Colon   13
Palpable Caecum                         9
No Physical Signs                       3

Note: Table made from bar graph.

Figure-4: Faecal Fat Excretion in the Cases

           Male   Female

3 to 4     3      6
4.1 to 5   15     59
5.1 to 6   2      11
6.1 to 7   3      0
7.1 to 8   2      1

Note: Table made from bar graph.

Figure-5: D-Xylose Excretion in Cases

           Male   Female

3 to 4     0      1
4.1 to 5   0      2
5.1 to 6   2      7
6.1 to 7   15     60
7.1 to 8   6      2
8.1 to 9   2      5

Note: Table made from bar graph.
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Article Details
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Title Annotation:RESEARCH ARTICLE
Author:Kumar, Anoop; Dwivedi, Kaushal
Publication:International Journal of Medical Science and Public Health
Article Type:Report
Geographic Code:9INDI
Date:Apr 1, 2013
Words:4219
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