Importance of scattered white spots detected in the duodenum and their relationship with zonulin.

Abstract

Scattered white spots (SWS) seen in the duodenum during esophagogastroduodenoscopy are rare lesions. The histopathologic examination of SWS lesions reveals normal duodenal mucosa (ND), chronic nonspecific duodenitis, and intestinal lymphangiectasia (IL). The intestinal epithelium, through its barrier function, is responsible for tightly controlling antigen traffic from the intestinal lumen to the submucosa. Zonulin plays a crucial role in intestinal barrier function. In this study, we aimed to determine whether there is a relationship between zonulin, the most important marker of leaky gut syndrome, and SWS lesions associated with lymphatic stasis and inflammation in the duodenum. This cross-sectional study at Dr. Abdurrahman Yurtaslan Oncology Hospital in Turkey, conducted from September to December 2023, included 63 patients with SWS and 30 control patients with ND. SWS lesions were categorized into two groups, Grade-1 and Grade-2, based on the degree of density and endoscopic appearance. Biopsies were taken from the duodenum, antrum, and corpus. Blood samples were taken for serum zonulin levels. The difference between zonulin values was not significant in the control and patient groups (p>0.05). Metaplasia in the antrum was significantly higher in the SWS group than in the control group (p<0.05). There was no relationship between duodenal biopsy results and zonulin values (p>0.05). Patients with identified SWS more frequently exhibit IL and gastric metaplasia. There is no relationship between SWS and serum zonulin levels.