Aims
Chronic diarrhea, common in clinical practice and potentially serious, has multiple causes. In the absence of contributory laboratory findings, EGD with duodenal biopsies represents a major diagnostic tool, particularly in cases of malabsorption syndromes. The aim of this study was to assess the diagnostic value of EGD with duodenal biopsies in chronic diarrhea and to evaluate their usefulness in guiding patient management.
Methods
This was a retrospective study based on EGD reports collected over a 4-year period, from January 2022 to August 2025. All patients presenting with chronic diarrhea who underwent EGD with duodenal biopsies were included.
Results
Among 2499 patients who underwent EGD, 85 patients presented with chronic diarrhea, with a female predominance of 60% (n=51), corresponding to a ratio M/F of 1.5. The median age was 33 years [range: 14–70 years].
Regarding medical history, diabetes was present in 8.2% (n=7), systemic disease in 10.5% (n=9), and inflammatory joint disease in 7% (n=6).
Clinically, epigastric pain was reported in 24.7% (n=21), growth retardation in 5.8% (n=5), and vomiting in 4.7% (n=4).
In biological findings, iron-deficiency anemia was observed in 20% (n=17). Anti-transglutaminase antibodies, tested prior to endoscopy, were positive in 15.2% (n=13) and negative in 5.8% (n=5).
On endoscopic examination, erythematous gastritis was seen in 74.1% of cases (n=63), duodenal fold atrophy in 17.6% (n=15), erosive gastritis in 5.8% (n=5), and congestive gastritis, fundic fold effacement, and grade A esophagitis in 2.3% (n=2). Aphthoid duodenal ulcers were observed in only one case.
On histological examination, Helicobacter pylori infection was identified in 42.3% (n=36), celiac disease in 23.5% (n=20), pernicious anemia in 4.7% (n=4), and inflammatory bowel disease (IBD) in 2.3% (n=2).
Conclusions
This study confirms the relevance of duodenal biopsies in the evaluation of chronic diarrhea. In our series, 23.5% of cases were consistent with celiac disease, highlighting the central role of EGD in the diagnostic approach.