Chronic Non-specific Duodenitis Research Articles

Environmental enteric dysfunction and small intestinal histomorphology of stunted children in Bangladesh.

There is lack of information on the histological characteristics of the intestinal mucosa in Bangladeshi children. Collection of intestinal biopsy samples and assessment of the histomorphological features is considered to be the traditional gold standard for diagnosis of environmental enteric dysfunction (EED). The purpose of the study was to evaluate the intestinal histological characteristics of stunted children aged between 12-18 months with possible EED. 110 children with chronic malnutrition (52 stunted with length-for-age Z score, LAZ<-2 and 58 at risk of stunting with LAZ <-1 to -2) from the Bangladesh Environmental Enteric Dysfunction (BEED) study protocol who underwent upper gastrointestinal (GI) endoscopy were selected for this study. To explore the association of EED with childhood stunting, upper GI endoscopy was done and the biopsy specimens were studied for histopathology. Villous height and crypt depth were measured and the presence and intensity of inflammatory infiltrates in the lamina propria was investigated. Bivariate analysis was performed to examine the relationship between stunting and histologic morphology. More than 90% children irrespective of nutritional status were diagnosed to have chronic non-specific duodenitis on histopathology. Half of the children from both groups had villous atrophy as well as crypt hyperplasia and lymphocytic infiltration was present in more than 90% children, irrespective of groups. However, no statistically significant difference was observed when compared between the groups. The prevalence of chronic non-specific duodenitis in Bangladeshi children, irrespective of nutritional status, was high. A significant number of these children had abnormal findings in intestinal histomorphology. Trial registration number: ClinicalTrials.gov ID: NCT02812615 Date of first registration: 24/06/2016. https://clinicaltrials.gov/ct2/results?cond=NCT02812615&term=&cntry=&state=&city=&dist.

Evaluation of the relationship between Helicobacter pylori and duodenal scattered white spots lesions in dyspeptic patients

Giriş ve Amaç: Rutin endoskopik değerlendirmede genellikle karşılaştığımız ve intestinal lenfanjiektazi olarak değerlendirdiğimiz duodenumun dağınık beyaz noktasal lezyonlarının çoğunlukla belirgin bir nedeni veya klinik karşılığı bilinmemektedir. Çalışmamızda dağınık beyaz noktasal lezyonların sıklığını, patolojik karşılığını ve Helicobacter pylori ile olan ilişkisini değerlendirmeyi amaçladık. Gereç ve Yöntem: İç Hastalıkları ve Gastroenteroloji Bilim Dalımız polikliniklerine başvuran ve aynı endoskopist tarafından dispeptik yakınma şikayeti ile gastroskopileri uygulanan toplam 445 hastanın endoskopi bulguları retrospektif olarak değerlendirildi. Endoskopik bulgularında dağınık beyaz noktasal lezyonlar saptanan hastaların antrum ve duodenal biyopsileri alınarak histolojik olarak incelendi. Bulgular: Tüm hastaların %60’ı kadın (n = 245) ve yaşları ortalaması 47.1 yıl idi. İncelenen endoskopik raporlarda 39 (%8.8) hastada dağınık beyaz noktasal lezyonların olduğu saptandı. Dağınık beyaz noktasal lezyonlar saptanan hastaların biyopsilerinde 10 hastada (%26.3) intestinal lenfanjiektazi, 21 hastada (%55.2) kronik nonspesifik duodenit ve 7 hastada (%18.5) Giardia enfeksiyonu saptandı. Dağınık beyaz noktasal lezyonların saptandığı hastaların yarısında (n = 19) Helicobacter pylori pozitif olarak saptandı (p = 0.695). Helicobacter pylori sıklığı patolojik olarak intestinal lenfanjiektazi saptanmış grupta da istatiksel olarak farklı bulunmadı. Sonuç: Dispeptik yakınmalar ile gelen hastaların gastroskopilerinde dağınık beyaz noktasal lezyonların sıklığı %8.8 olarak bulundu. Bu hastaların ancak dörtte birinde patoloji ile konfirme intestinal lenfanjiektazi görülmektedir. Dağınık beyaz noktasal lezyonlar ve intestinal lenfanjiektazi saptanması ile Helicobacter pylori pozitifliği arasında bir ilişki saptanmamıştır. &#x0D; Dispepsi, duodenal dağınık beyaz noktasal lezyonlar, Helicobacter pylori

An Audit of more than a Thousand uppergastrointestinal Endoscopy in a Tertiary Care Teaching Hospital in South India

Background: Esophagogastroduodeno (EGD) scopy is a benchmark in the modern era of medicine. It is a sensitive tool used to evaluate the upper gastrointestinal (GI) symptoms. Application of EGDscopy is not merely restricted to diagnosis but as well used for therapeutic purpose. Aim of the Study: To find out the common indications for EGDscopy and its findings in a large tertiary care hospital attached to Bangalore medical college and research institute (BMCRI), Bengaluru. Materials and Methods: A retrospective study was conducted on 1030 patients either admitted or seen on outpatient basis at the Bowring and Lady Curzon hospital attached to BMCRI, Bengaluru with the upper GI symptoms like dyspepsia, dysphagia, epigastric pain abdomen, hematemesis etc from September 2016 to August 2018 and the data was analyzed using appropriate statistical methods. Results: Out of 1030 patients who underwent EGDscopy 62% were male and 61% were 31-59year old. The major indications for EGDscopy were epigastric abdominal pain (18%), dyspepsia (18%), chronic liver disease (15%), dysphagia (11%) and hematemesis (8%). The common pathological findings in the above mentioned indications were gastritis and esophagitis in patient with both epigastric abdominal pain and dyspepsia, portal hypertensive gastropathy and esophageal varices in chronic liver disease, esophageal growth in dysphagia and esophageal varices (EV) in cases of hematemesis. Conclusions: The following insights/observations were made during the course of our study-dysphagia is not just oropharyngeal or esophageal in origin but H. pylori gastritis can cause similar complaints, eradication of which relieves the symptoms in our observation. Chronic abdominal pain associated with postprandial urgency which is deemed as Inflammatory Bowel Disease-Diarrhea (IBS-D) may actually be H. pylori gastritis with exaggerated gastro-colic reflex which gets relieved with anti- H. pylori treatment; further studies are needed to prove this claim. Mosaic like pattern with focal areas of hyperemia in the gastric body mucosa is not just typical of portal hypertensive gastropathy but also can be seen with H. pylori gastritis. Corrosive acid ingestion as a mode of suicidal attempt is common in this part of India which can lead to morbidity and even mortality in severe cases, legislative measures need to be put in place to check the sale and use of corrosive acid. Diffuse white spots in duodenum were mostly due to chronic nonspecific duodenitis rather than intestinal lymphangiectasia in our study.

Alterations in the histological features of the intestinal mucosa in malnourished adults of Bangladesh

There is paucity of knowledge on the histological features of the intestinal mucosa in malnourished adults of Bangladesh. The purpose of the study was to explore the histological features of the intestinal mucosa in malnourished adults of Bangladesh and to compare the findings with their well-nourished counterparts. 64 adults (37 malnourished with body mass index, BMI < 18.5 kg/m2 and 27 controls with BMI > 18.5 kg/m2) from the Bangladesh Environmental Enteric Dysfunction (BEED) study, who underwent upper-gastrointestinal endoscopy, were selected for this study. With a view to address the association of environmental enteric dysfunction (EED) with malnutrition, upper-gastrointestinal endoscopy was performed and mucosal biopsies from the distal duodenum were studied for histopathology. Villous height, crypt depth, and presence of inflammatory infiltrates in lamina propria were investigated. Bivariate analysis was performed to quantify the relation between malnutrition and the histological features. About 95% adults, irrespective of nutritional status, were diagnosed to have chronic non-specific duodenitis on histopathology. Malnourished adults suffered significantly more from chronic active duodenitis compared to their well-nourished counterparts (p = 0.003). Malnourished adults also had significantly higher frequency of subtotal villous atrophy, crypt hyperplasia and marked cellular infiltration in the lamina propria than the healthy controls (p < 0.05).

Comparative Study of Platelet Indices in Normal Pregnant and Non-Pregnant Women in a Tertiary Care Hospital in Northern India

Background Patients presenting with gastrointestinal (GI) symptoms are very common in clinical practice. The advent of modern flexible endoscopes has made entry as well as visualization inside the upper GI tract easy, thereby facilitating the effective management of these patients. This study was conducted to determine the frequency as well as to study the spectrum of the histopathological lesions of upper GI tract. The clinical symptoms, endoscopic findings, and histopathological findings were also correlated. Methods This is a cross sectional study conducted in the Department of Pathology, in a tertiary care hospital, from July 2014 to June 2016. All the full mucosal thickness endoscopic biopsies, incorporating muscularis mucosae, of the upper GI tract were included in the study. Results The upper GI endoscopic biopsies constituted 0.93% of all surgical pathology specimens. Stomach was the most common biopsied site (55%), followed by esophagus (39%), and duodenum (6%). In esophagus, squamous cell carcinoma (82.60%) was more common as compared to adenocarcinoma (17.40%). Amongst gastric carcinoma, most common histological pattern noted was tubular adenocarcinoma (61.90%), followed by poorly cohesive carcinoma. All the duodenal biopsies showed chronic non-specific duodenitis. Overall, 91% concordance was noted between endoscopic and histopathological diagnosis. Conclusions Upper GI endoscopy is an effective and appropriate initial investigation to assess patients with upper GI symptoms. Histopathology is the gold standard for the diagnosis of endoscopically detected lesions.

Histopathological spectrum of upper gastrointestinal endoscopic biopsies

Background: Upper gastrointestinal tract disorders are one of the most commonly encountered problems in the clinical practice. A variety of disorders can affect the upper gastrointestinal tract. Endoscopy, in combination with biopsy, plays an important role in the exact diagnosis for further management.Objectives: To determine the spectrum of histopathological lesions of upper gastrointestinal tract.Methods: A prospective study was conducted in the Department of Pathology, Kathmandu Medical College and Teaching Hospital, Nepal from January 2015 to December 2016 (2 years).Results: A total 243 endoscopic biopsies were evaluated. Out of which, 219 cases were from gastric, 15 were from esophagus and 9 were from duodenum. Among the gastric biopsies, 77 cases (35.16%) were chronic active gastritis and 27 cases (12.33%) were malignant. The most common malignancy was adenocarcinoma. Among the 15 oesophageal biopsies, 12 cases (80%) were of non-neoplastic and 3 cases (20%) were of neoplastic nature. The most common malignancy was squamous cell carcinoma. Among 9 cases of duodenum biopsies, all were non-neoplastic, of which chronic non-specific duodenitis (66.66%) was the commonest.Conclusion: Endoscopy is incomplete without histopathological examination of biopsy and so, the combinations of methods play an important role in diagnosis and management of upper gastrointestinal tract disorders.Journal of BP Koirala Institute of Health Sciences, Vol. 1, No. 1, 2018, Page: 67-74

The endoscopic course of scattered white spots in the descending duodenum: A prospective study

AimScattered white spots (SWSs) in the descending duodenum are an uncommon finding of upper gastrointestinal system endoscopy (UGSE). Intestinal lymphangiectasia, chronic nonspecific duodenitis and giardiasis are associated with a SWS appearance. The aim of this study was to determine the frequency of SWS during routine endoscopy, as well as to evaluate the effect of treatment on this finding. Materials and methodsPatients undergoing UGSE with a SWS appearance in the descending duodenum were included prospectively. Appearance of SWSs was graded endoscopically based on density, after which patients were divided into two groups; group 1 (treated group) and group 2 (untreated group). Patients with Helicobacter pylori infection were given eradication therapy, whereas a diet was recommended to patients with intestinal lymphangiectasia. Proton pump inhibitors were initiated for patients with H. pylori negative gastritis. All patients were re-evaluated three months after therapy for the presence of any changes in the SWS appearance. ResultsSWSs were observed in 97 (3.2%) out of 3010 patients. This appearance was most commonly associated with chronic non-specific duodenitis followed by intestinal lymphangiectasia. While in the untreated group no statistically significant change in SWS appearance was observed, the decrease in endoscopic grade seen in the treated group was statistically significant (p<0.001). ConclusionThe prevalence of SWSs during routine UGSE was 3.2%, with this finding being more commonly associated with chronic non-specific duodenitis and intestinal lymphangiectasia. Treatment of the underlying causes, including H. pylori eradication, proton pump inhibitors and diet decreased the density of the SWSs.

Do scattered white spots in the duodenum mark a specific gastrointestinal pathology?

To discover whether scattered white spots (SWS) in the duodenum are related to a specific kind of disease. We also scrutinized other upper endoscopic findings which might be associated with SWS. Among the patients who were admitted for upper gastrointestinal system endoscopy, those having the endoscopic appearance of SWS in duodenum were enrolled in this study. In total 107 patients [70 women, 37 men, mean age: 51.6 +/- 16.88 years (range: 17-82 years)] were included. At least three duodenal biopsies were taken from each patient and histopathological examinations were done by experienced pathologists. The histopathological examination revealed that 39 (36.4%) patients had intestinal lymphangiectasia (IL), 15 (14%) patients had giardiasis (G) and 30 (28.1%) patients had chronic non-specific duodenitis (CD). Two patients with IL were also found to have G. Twenty patients had both IL and CD. One had both G and CD. G was the least common etiology for SWS in the duodenum. The most common reasons for SWS in the duodenum in this study group were IL and CD, in order of decreasing frequency. There was no significant relationship with the other upper endoscopic findings in all these patients. Histopathological examinations should be provided for each patient with SWS in the duodenum to assess the etiology.

FAILURE TO THRIVE: THE ENDOSCOPIC VIEW

This is a 5 year retrospective study of endoscopic findings in 16 children with failure to thrive referred to rule out malabsorption. The inclusion criteria were flattening of the growth curve with crossing of at least 2 major percentiles and evaluation by the same endoscopist. There were 5 females and 11 males, ages 9 months to 4.5 years. Weight for height was < 5th percentile for 7 cases [43.7%], 5-10th percentile in 5 cases [31.2%] and 10th-25th percentile in 4 cases [25%]. Gestational age was > 36 weeks for all cases except 2 twins born at 30 weeks. All except one were AGA. There were no reported symptoms of acid peptic disease and no other underlying medical condition. Laboratory work up included CBC and biochemical profiles in all cases; D-xylose test [14 cases], gluten enteropathy antibody profile [15 cases], sweat tests [12 patients, all normal] and quantitative immunoglobulins [8 cases]. At endoscopy, 14 cases [87.5%] had abnormal findings which included mucosal erythema, friability, nodularity, exudate or other mucosal irregularities at one or more levels [esophagus, stomach, duodenum]. 13 cases [81.2%] had histological abnormalities: of these, 6 cases [46%] had more than one level affected. Among all cases, the histological findings included: 6 cases [37.5%] of reflux esophagitis; 2 cases [12.5%] with antral gastritis: one of which had H. pylori bacilli identified. 5 cases [31.2%] had chronic gastritis, 4 cases [25%] had chronic non-specific duodenitis and 3 cases [18.7%] had intestinal villous atrophy. There was correlation of endoscopic and histological findings in 11 cases [68.7%]. The majority of patients in this series were found to have subclinical acid-peptic disease. A small percentage had celiac disease and one case had H. pylori infection. Conclusions: Endoscopic abnormalities are frequent in children with growth deceleration initially suspected of having malabsorption. Upper endoscopy with biopsies at all levels should be considered as part of the initial work up.

Mucosal cell proliferation in duodenal ulcer and duodenitis.

Mucosal cell proliferation in the first part of the duodenum was studied in 24 patients using a tissue culture technique in which endoscopic biopsies were subjected to autoradiography after exposure to tritiated thymidine. Eight patients had a normal duodenum, eight had duodenal ulcer, and eight had symptomatic chronic non-specific duodenitis. The mean crypt labelling index (LI) in normal duodenum was 8.8 0.4% (SEM). Increased labelling indices of 15.6 +/- 1.7% were found near the edge of duodenal ulcers and 17.8 1.8% in duodenitis. Treatment with cimetidine reduced both the severity of duodenitis and the mean crypt LI. The LI of histologically normal duodenal mucosa distal to ulcer of duodenitis was similar to that of the control subjects' mucosa. The increased mucosal cell proliferation seen in severe duodenitis, either alone or associated with duodenal ulceration, suggested that erosions and ulcers arose when the crypts passed into 'high output failure' and were unable to compensate for further epithelial cell loss. There was no evidence in out study for a generalised failure of mucosal cell proliferation in duodenal ulcer or duodenitis.

Inflammation in Gut: Esophagitis, Duodenitis, Segmental Colitis

This small volume is composed of 15 selected papers dealing with esophagitis, duodenitis, and segmental colitis prepared for presentation at the Eighth International Congress of Gastroenterology held in Prague, July 1968. In regard to esophagitis, the anatomy, histology, and pathology are discussed in detail; the interrelationship of pathophysiology and symptomatology are based on roentgen, endoscopic, and especially direct vision and blind biopsy findings. This sheds considerable light on a subject that continues to be a source of controversy. The topic of duodenitis is excessively belabored. Diagnosis based on biopsy fails to establish chronic nonspecific duodenitis as an entity, but, as expected, the duodenum may be affected by diffuse diseases of the small bowel and intestinal parasites such as giardiasis, ancylstomiasis, and strongyloidiasis. Finally, for segmental colitis a review of the incidence, symptomatology, diagnosis, pathology, and treatment is given.