peptic duodenitis

peptic duodenitis

A condition caused by chronic exposure to excess hydrochloric acid, which is characterised by inflammation, and most prominent in the duodenal bulb (D1), associated with Helicobacter pylori infection, chronic active gastritis and peptic ulcer disease. Peptic duodenitis is at the banal end of the spectrum of upper GI inflammation, at the other end of which is peptic ulcer disease.

Endoscopy
Erythema (blood is shunted to the tips of the villi), mucosal friability, regional nodularity (Brunner’s gland hyperplasia). There is often a poor correlation between endoscopy and histology; extreme cases are eroded and ulcerated.

DiffDx, duodenitis
Coeliac disease, Crohn’s disease, drug-induced inflammation, parasites, ulcerative colitis.
References in periodicals archive ?
The duodenal biopsy appearances of peptic duodenitis are usually those of a Marsh type 1 lesion (epithelial lymphocytosis with normal villi).
Peptic duodenitis is the main differential diagnosis of NSAID-associated duodenitis.
Gastric metaplasia in peptic duodenitis. The mucosal surface is covered by gastric type epithelium with columnar cells containing neutral mucin.
Our resected specimen showed extensive gastric metaplasia, consistent with peptic duodenitis. Moreover, areas of focal ectopic gastric mucosa were observed, a possible cause of increased acidity and the peptic duodenitis.
Histopathologic examination also showed ectopic gastric mucosa in the duodenum as well as gastric metaplasia, a sign ofpossible peptic duodenitis. While the etiology of Brunner's gland hamartoma remains unclear, damage to the duodenal mucosa has been suggested as a possible pathologic mechanism.
In contrast, there were no significant differences between the 2 groups in any of the other histopathologic features, including villous and crypt intraepithelial lymphocytosis, crypt apoptoses, basal plasmacytosis, neutrophilic cryptitis/villitis, erosion/ulcers, increased mucosal eosinophils, presence of goblet and Paneth cells, or peptic duodenitis (Figures 2, B, and 3).
(%) P Any histologic abnormality 32 (48) 20 (36) .27 v:c ratio (<3:1) 16 (24) 4 (7) .01 Intraepithelial lymphocytosis (a) Villi 15 (22) 8 (15) .35 Crypts 3 (4) 1 (2) .63 Increased eosinophils 10 (15) 8 (15) >.99 Basal plasmacytosis 5 (7) 2 (4) .46 Peptic duodenitis 3 (4) 4 (7) .70 Neutrophilic cryptitis/villitis 3 (4) 3 (5) >.99 Crypt apoptoses (>5 per 10 crypts) 3 (4) 2 (4) >.99 Erosions/ulcers 0 (0) 0 (0) >.99 Absent goblet/Paneth cells 0 (0) 0 (0) >.99 Abbreviations: SIBO, small intestinal bacterial overgrowth; v:c ratio, villous to crypt ratio.