Abstract
            Introduction: Malabsorption is a complex medical condition with a diverse range of underlying  etiologies posing a diagnostic challenge. The aim of the study was to investigate the correlation  between endoscopic findings and histopathological diagnoses in patients with suspected  malabsorption syndrome.  
  Methods: This cross-sectional study was conducted over 12 months on 160 patients aged 2 to  60 years with chronic diarrhea and nutritional deficiencies. Endoscopic biopsies of the small  intestine were performed and reported based on the following parameters including number  and site of the biopsy specimens, villous height, and architecture, villous to crypt (V:C) ratio,  presence of crypt hyperplasia and intra-epithelial lymphocyte (IEL) count.  
  Results: Clinical presentations included chronic diarrhea (41.9%), weakness (12.9%), weight  loss (9%), and constipation (2.5%). Endoscopic findings were normal in 49.69% of population.  Histopathological examination revealed villous atrophy (18.6%), increased IEL count (16.9%)  and crypt hyperplasia (6.2%). Chronic duodenitis was the most common diagnosis (64.4%).  Celiac disease (3.1%) and tropical sprue (1.2%) were diagnosed based on specific criteria,  emphasizing the need for histopathological confirmation.  
  Conclusion: This study highlights the spectrum of histopathological changes in malabsorption  and underscores the importance of its correlation with clinical and endoscopic findings. In  clinical scenario of malabsorption, endoscopy findings vary from normal to abnormal mucosal  morphology. Normal mucosal study may also reveal pathological changes on histopathological  evaluation. Hence histopathology remains a crucial step for understanding etiopathogenesis thus  helping to streamline the management.