Duodenal Pathologies Research Articles

Imaging spectrum of non-neoplastic and neoplastic conditions of the duodenum: a pictorial review.

Given its crucial location at the crossroads of the gastrointestinal tract, the hepatobiliary system and the splanchnic vessels, the duodenum can be affected by a wide spectrum of abnormalities. Computed tomography and magnetic resonance imaging, in conjunction with endoscopy, are often performed to evaluate these conditions, and several duodenal pathologies can be identified on fluoroscopic studies. Since many conditions affecting this organ are asymptomatic, the role of imaging cannot be overemphasized. In this article we will review the imaging features of many conditions affecting the duodenum, focusing on cross-sectional imaging studies, including congenital malformations, such as annular pancreas and intestinal malrotation; vascular pathologies, such as superior mesenteric artery syndrome; inflammatory and infectious conditions; trauma; neoplasms and iatrogenic complications. Because of the complexity of the duodenum, familiarity with the duodenal anatomy and physiology as well as the imaging features of the plethora of conditions affecting this organ is crucial to differentiate those conditions that could be managed medically from the ones that require intervention.

Pancreas-preserving limited duodenal resection: Minimizing morbidity without compromising oncological adequacy.

Backgrounds/AimsPancreaticoduodenectomy is the most common procedure for the management of duodenal pathologies. However, it is associated with substantial morbidity and a low risk of mortality. Pancreas-preserving limited duodenal resection (PPLDR) can be performed under specific scenarios. We share our experience with PPLDR and its outcome.MethodsWe retrospectively analyzed a prospectively maintained database of patients undergoing limited duodenal resection in the form of wedge (sleeve) resection or segmental resection of one or more duodenal segments from March 2016 to March 2021 at a tertiary care center in North India.ResultsDuring the study period, 10 patients (including 9 males) underwent PPLDR. Five of these 10 patients showed primary duodenal or proximal jejunal pathology, while the remaining five had duodenal pathology involving an adjacent organ tumor. Four patients underwent wedge (sleeve) resection, while the remaining six underwent segmental duodenal resection of one or more duodenal segments. Mean hospital stay was 6 days (range, 3-11 days) without 30-day mortality. Morbidity occurred in 4 patients (Grade I-II, n = 3; Grade III, n = 1). All patients were alive and disease-free at the time of last follow-up. The mean follow-up duration was 23 months (range, 2-48 months).ConclusionsPPLDR is a safe and effective alternative for pancreaticoduodenectomy when selected carefully for specific tumor types and location.

The Place of Histochemical Stains for Differential Diagnosis in Duodenal Biopsies

The biopsy is the primary examination method in diagnosing duodenal pathologies and Gluten enteropathy that can cause symptoms such as gas, diarrhea, weight loss, anemia, osteoporosis. Allows monitoring of response to therapy. Histochemical studies are inevitable in specific findings such as reactive changes, giardia, subepithelial collagen thickening, fibrosis, and gastric metaplasia. We aimed to understand the contribution of histochemical applications to differential diagnosis and to show their superiority compared to hematoxylin-eosin sections in routine use by simultaneously making histomorphological evaluations on hematoxylin and eosin sections. This research is a retrospective study conducted in 2011, using the archives of Yüzüncü Yıl University, Faculty of Medicine, Department of Pathology, between 2001-2010. Ten normal, 50 Gluten enteropathy and 50 duodenitis samples; Along with histopathological examinations, we applied Masson Trichrome, Periodic acid-Schiff, Periodic acid-Schiff with diastasis, Periodic acid Schiff-Alcian Blue, High Iron Diamine-Alcian Blue. Chi-square, likelihood ratio tests, and SPSS (ver: 13) statistical package program used. We detected microscopic findings parallel to diagnostic criteria. While the number of goblet cells and intraepithelial neutrophils did not differ in the groups (P =0.176 and P=0.096), there was a significant variation in the intraepithelial lymphocyte count (P=0.010). The frequency of flattening and blunting of the villi, crypt hyperplasia, and Brunner gland hyperplasia were significant in gluten enteropathies (P=0.000). Conclusion We could not find any difference in specific pathologies associated with histochemical studies in our group, so hematoxylin-eosin sections are more valuable in the differential diagnosis.

Role of Preoperative Esophagogastroduodenoscopy (EGD) in Bariatric Treatment.

Background: The recommendations for routine preoperative esophagogastroduodenoscopy (EGD) in patients qualified for bariatric surgeries are still a matter of debate. The aim of this study was to analyze the pathologies on preoperative EGD in patients qualified for bariatric surgeries. Materials and Methods: This study included 222 patients, divided into two groups. The obesity group consisted of patients with obesity (BMI ≥ 40 kg/m2), for whom EGD was a routine part of the preparation for laparoscopic sleeve gastrectomy (LSG). The control group of patients with normal body weight (BMI) qualified for EGD because of gastrointestinal ailments. Results: Regarding preoperative EGD in patients qualified for bariatric surgeries, we analyzed the prevalence of endoscopic pathologies in various gastrointestinal tract segments. Patients with obesity were shown to present with esophageal pathologies significantly more often than persons in the control group (n = 23, 20.91% vs. n = 12, 10.91%, p = 0.042). The odds ratio of esophageal pathologies in patients with obesity versus the control group equaled 2.15 (95%CI: 1.01–4.59). In turn, the odds ratio of duodenal pathologies in patients from the control group was 3.31 (95%Cl: 1.16–9.47), which means that persons from this group were approximately three times more likely to be diagnosed with those pathologies compared to obese patients. Moreover, patient sex was a significant predictor of duodenal pathologies, with an odds ratio of 4.03 (95%CI: 1.53–10.61). Conclusions: Preoperative EGD can identify a broad spectrum of pathologies in obese patients, which suggests a routine examination before bariatric surgery.

Routine Multiple Duodenal Biopsy during Endoscopy of Dyspeptic Patients Seems Unnecessary for Screening of Celiac Disease.

Introduction Celiac disease (CD) is a chronic and common cause of dyspepsia with a rising prevalence worldwide. This study is aimed at investigating the prevalence of CD in dyspeptic patients based on serology and biopsy, determining the associated factors, and assessing the necessity of regular duodenal biopsies from normal mucosa in diagnosis of CD among dyspeptic patients. Methods This cross-sectional study was performed on 530 adult dyspeptic patients who underwent gastroduodenoscopy in Imam Reza hospital, Mashhad, during 2016-2018. Demographic characteristics, clinical data, and laboratory analyses were extracted from hospital records. CD was diagnosed based on intestinal biopsy and serum antitissue transglutaminase (anti-TTG) levels. Mucosal lesions were classified according to the modified Marsh classification. Data were analyzed in SPSS with P < 0.05 being considered significant. Results Overall, 163 males (30.8%) and 367 females (69.2%) with an average age of 46.38 ± 15.54 years were studied. High anti-TTG levels were seen in 36 (6.8%) patients, and duodenal pathologies were seen in 23 (4.5%) patients. Fifteen (2.8%) were diagnosed with CD based on both serology and biopsy. Bloating was the most common type of dyspepsia in CD patients (7, 46.7%), followed by epigastric pain (6, 40%), and postprandial fullness (2, 13.3%). Two CD patients (13.3%) reported a positive family history for CD. Logistic regression model showed that iron deficiency anemia (IDA), anti-TTG level, and Helicobacter pylori infection were predictors of histological changes of CD, whereas IDA was the only independent predictor of CD in dyspeptic patients (OR = 17.65, 95%CI = 1.53‐202.52, and P = 0.021). Conclusion CD is prevalent in dyspeptic patients, but routine biopsy from normal-appearing duodenal mucosa is not recommended for all patients. Serological studies, complete history, and careful endoscopic evaluation may provide better cost-effective clinical solutions to improve the diagnostic yield of celiac disease in dyspeptic patients.

S3413 Cholangioscopy Through the PTC Route: Suddenly I See

INTRODUCTION: Black esophagus is a rare endoscopic finding caused by acute esophageal necrosis (AEN). Studies suggest the incidence of AEN is less than 1%. We describe a case of a patient presenting with coffee ground emesis and black esophagus. CASE DESCRIPTION/METHODS: A 60-year-old male with a past medical history of HIV on HAART (CD4 count of 399 and undetectable VL), alcohol abuse, ESRD, DMII and HTN presented to the ED for intermittent hematemesis. The patient described several episodes of coffee ground emesis associated with worsening abdominal distention, pain and diarrhea. Two days prior, he was discharged from another hospital after being treated for the same condition, however EGD was not performed. His surgical history was significant for G-tube placement, one year prior. He was afebrile and hemodynamically stable. His abdomen was soft, distended, non-tender with normal BS. His rectal exam revealed melena. Initial labs were significant for a leukocytosis of 15.4 K/uL, Hg of 8.2 (MCV 83), Platelets 373, INR 1.3 and lactate of 1.8. CT demonstrated distal esophageal wall thickening, suggestive of esophagitis. EGD confirmed esophagitis with eschar (LA Grade D) at the mid and distal esophagus (45 cm from the incisors.) There was no extension of the lesion beyond the GE junction. No blood, clots or old heme was seen in the stomach. However, multiple non-bleeding clean base ulcers (Forrest Class III) were visualized in the duodenum. The patient's hematemesis was caused by acute esophageal necrosis. The patient was treated with fluid resuscitation and intravenous proton pump inhibitors. The patient declined further workup. He was discharged to a skilled nursing facility with plan for repeat upper endoscopy in 4-6 weeks. He declined repeat endoscopy. DISCUSSION: The pathogenesis of AEN is not fully understood however poor vascular perfusion may be a contributor. AEN manifests in the distal portion of the esophagus and frequently coexists with duodenal pathologies. Treatment begins with nil-per-os (NPO) restriction, intravenous proton pump inhibitors, fluid resuscitation and treatment of underlying medical comorbidities. Follow-up upper endoscopy is recommended in 4–6 weeks. Although uncommon, clinicians should consider AEN when evaluating patients with an upper GI bleed, as early recognition and prompt treatment may improve outcomes. Further studies are needed on treatment outcomes and survival when multiple comorbidities coexist.

Histopathologic ─ Endoscopic Concordance of Pediatric Duodenal Biopsy; How to Be Improved?

Objective Few studies have correlated pediatric endoscopic and histologic impressions of duodenal biopsies. Method: This is a retrospective study on children undergoing upper gastrointestinal endoscopy over a period of 11 years. We investigated concordance between the gross endoscopic and histopathologic characteristics of pediatric duodenal biopsies. Results: Of 1793 children enrolled in the study, duodenal pathology was observed in 72.3%. The gross endoscopic findings showed a low sensitivity of 38.9%, specificity of 99.2%, PPV of 99.2%, and NPV of 38.3%. Concordance between the gross endoscopic and histopathologic analysis was 55.6%. Conclusion: This study showed a higher rate of pediatric duodenal pathologies than gross assessment. This emphasizes the value for acquiring routine duodenal biopsies from grossly normal mucosa.

Endoscopic findings in patients presenting with dysphagia: An observational study

Background: Dysphagia is a symptom of an underlying disease with a variety of conditions linked to it. Therefore, its early evaluation is of prime importance. The objective of this study was to present the endoscopic findings in patients presenting with dysphagia. Material and Methods: After ethical approval, a retrospective observational study using non-probability convenient sampling technique was carried out at the Department of Medicine, Hamdard University Hospital, Karachi for a period of 1 year from 01-07-2018 to 30-06-2019. From a sample of 400 patients, 232 were selected who were above 25 years of age and presented with dysphagia. Pregnant mothers, patients previously diagnosed with GI malignancy, patients with a neurological cause of dysphagia or with normal upper GI endoscopy within last 3 months were excluded. SPSS version 20.0 was used for data analysis. Frequency and percentages of the categorical variables such as gender and the common GI Endoscopic findings were reported. Results: Apart from dysphagia, 8.2% of patients complained of abdominal pain, 6.5% of dyspepsia and 4.3% of weight loss. Of all the endoscopies performed, 6.5% were normal, 65.4% revealed oesophageal pathologies, 25% gastric and 2.6% duodenal pathologies. Of those with abnormal endoscopies, the most common diseases were oesophageal mass lesion (28.4%), gastritis (22.8%), oesophagitis (12.9%), oesophageal motility disorders (8.2%) and oesophageal structural disorders (8.2%). Conclusion: Apart from normal endoscopies, oesophageal disorders were most frequently found on endoscopy of patients who presented with dysphagia. Oesophageal mass lesions were the most common finding followed by gastritis.

Exploring the neglected segment of the intestine: the duodenum and its pathologies.

Herein we reviewed the computed tomography (CT) findings of a spectrum of pathological entities affecting the duodenum. We discuss the CT findings of some congenital, inflammatory, traumatic, and neoplastic pathologies of the duodenum along with the conventional barium studies of selected conditions. Pathologies of this C-shaped intestinal segment, derived from both foregut and midgut, are often overlooked in clinical practice and radiological literature. While congenital anomalies like duplication cysts and diverticula are usually asymptomatic, annular pancreas and malrotation may manifest in the first decade of life. Primary as well as secondary involvement of the duodenum by various disease processes can be evaluated by careful CT technique and proper attention to the duodenum. Among congenital conditions, annular pancreas, duplication cyst, superior mesenteric artery syndrome, midgut volvulus, and diverticula are presented. Duodenal involvement in adenocarcinoma, lymphoma, gastrointestinal stromal tumours, Crohn’s disease, and groove pancreatitis are discussed. Duodenal wall haematoma and traumatic duodenal perforation causing pneumoretroperitoneum in two patients after blunt trauma of the abdomen are also illustrated. CT provides superb anatomic detail and offers high diagnostic specificity for the detection of duodenal pathologies because it allows direct imaging of the intestinal wall, secondary signs of bowel disease within the surrounding mesentery, and abnormal findings in adjacent structures. Primary duodenal malignancies and local extension from adjacent malignancies can be diagnosed by CT reliably. CT also plays a vital role in the diagnosis of traumatic duodenal injury by differentiating between mural haematoma and a duodenal perforation because the latter requires immediate surgical intervention.

Histopathological spectrum of duodenal biopsies: Experience at a tertiary care hospital

Objective: Endoscopic duodenal biopsies constitute a significant load of specimens in the histopathological section of a tertiary care hospital. Most of these diseases comprise non-neoplastic lesions causing significant morbidity. The purpose of this study was to see the frequency of these diseases in our patient population and to compare and analyze our results with similar other studies.&#x0D; Methods: In this retrospective study records of all duodenal biopsies reported from Feb 2017- Jan 2018 were retrieved. Both non neoplastic and neoplastic conditions along with biopsies with unremarkable findings were included. Various histological parameters like villous blunting, IEL count per 100 enterocytes, crypt hyperplasia, inflammation in lamina propria, and presence of microorganisms, any dysplasia or malignancy were studied. Data was statistically analyzed using SPSS v.23.&#x0D; Results: A total of 159 duodenal biopsies were included in the study. Normal duodenal morphology was noted in 85 (53.45%) cases while 74 (46.83%) cases revealed abnormal duodenal pathology. There were 46 (28.93%) cases consistent with celiac disease. Twenty eight (17.61%) cases were of other duodenal pathologies of which non-specific duodenitis was most common. There were 22 (13.83%) cases of duodenitis and 2 (1.26%) cases were of duodenal ulcer. One case (0.62%) each was seen of Brunner gland hyperplasia, adenocarcinoma, signet ring carcinoma and one case was of metastatic adenocarcinoma.&#x0D; Conclusion: In our study we found a significant percentage of 46.83% exhibiting abnormal duodenal pathology. Cases consistent with celiac disease were 28.93% while 13.83% of the cases had duodenitis. The percentage of malignant cases was minimal (1.88%).

Analysis of gastric and duodenal biopsy results in patients presenting with dyspepsia: a cross-sectional study in a middle eastern population

ObjectiveCorrea’s cascade is a ‘Model for Gastric Cancer Development’ described by Peleyo Correa. The reversibility of Correa’s cascade remains debatable. The literature contains insufficient data on the specific stage of...

Duodenal pathologies in children: a single‐center experience

ObjectiveSeveral studies have been performed concerning pathologies of the stomach and esophagus in the pediatric age group. However, there have been very few studies of duodenal pathologies in children. The authors aimed to examine the clinical, endoscopic, and histopathological characteristics, as well as the etiology of duodenal pathologies in children. MethodPatients aged between 1 and 17 years undergoing esophagogastroduodenoscopy during two years at this unit, were investigated retrospectively. Demographic, clinical, endoscopic data, and the presence of duodenal pathologies, gastritis, and esophagitis were recorded in all of the children. ResultsOut of 747 children who underwent endoscopy, duodenal pathology was observed in 226 (30.3%) patients. Pathology was also present in the esophagus in 31.6% of patients and in the stomach in 58.4%. The level of chronic diarrhea was higher in patients with duodenal pathology when compared with those without duodenal pathology (p=0.002, OR: 3.91, 95% CI: 1.59–9.57). Helicobacter pylori infection was more common in patients with pathology in the duodenum (59.3%). ConclusionDuodenal pathology was detected in 30.3% of the present patients. A significantly higher level of chronic diarrhea was observed in subjects with duodenal pathologies compared to those with no such pathology. The rate of Helicobacter pylori infection was considerably higher than that in previous studies. In addition, there is a weak correlation between endoscopic appearance and histology of duodenitis.

Epidemiology of H. pylori and its Relation with Gastrointestinal Disorders, A Community-based Study in Dhaka, Bangladesh

Helicobacter pylori infection is common worldwide and its prevalence is higher in the developing countries. Earlier studies in using urea breath test showed a high prevalence (67%) of H. pylori in early childhood in Bangladesh. Data on H. pylori prevalence using bacterial culture is limited in Bangladesh. The aim of the study was to investigate the prevalence of H. pylori in Bangladeshi subjects using bacterial culture. We also determined the prevalence of infection among different age groups and find out the correlation between the prevalence of H. pylori and the related sociodemographic parameters. A cross-sectional study was conducted among randomly selected households from a peri-urban community in Dhaka, Bangladesh to get an idea about H. pylori status in the lower socioeconomic area. Sociodemographic and clinical information and stool specimen for screening H. pylori infection by stool antigen test were collected. Gastric biopsy was collected for culture from those positive in stool antigen test. A total of 287 subjects were screened by stool antigen test, of them, 92.7% were positive for stool antigen test. Of 259 stool antigen positive sample, 59.1% (n=153) were H. pylori culture positive. Our data suggest that H. pylori infection is significantly associated with age and smoking habit ( P value <0.05). In addition, dyspeptic symptoms are significantly higher in H. pylori culture positive subjects than the H. pylori culture negative subjects. Endoscopic examination suggests that the gastroesophageal pathologies are significantly associated ( P value <0.05) and duodenal pathologies are moderately associated ( P value 0.059) with H. pylori infection. So, H. pylori culture test is auspicating the significant colonization that might lead to pathological outcomes.

Duodenal pathologies in children: a single-center experience

ObjectiveSeveral studies have been performed concerning pathologies of the stomach and esophagus in the pediatric age group. However, there have been very few studies of duodenal pathologies in children. The authors aimed to examine the clinical, endoscopic, and histopathological characteristics, as well as the etiology of duodenal pathologies in children. MethodPatients aged between 1 and 17 years undergoing esophagogastroduodenoscopy during two years at this unit, were investigated retrospectively. Demographic, clinical, endoscopic data, and the presence of duodenal pathologies, gastritis, and esophagitis were recorded in all of the children. ResultsOut of 747 children who underwent endoscopy, duodenal pathology was observed in 226 (30.3%) patients. Pathology was also present in the esophagus in 31.6% of patients and in the stomach in 58.4%. The level of chronic diarrhea was higher in patients with duodenal pathology when compared with those without duodenal pathology (p=0.002, OR: 3.91, 95% CI: 1.59–9.57). Helicobacter pylori infection was more common in patients with pathology in the duodenum (59.3%). ConclusionDuodenal pathology was detected in 30.3% of the present patients. A significantly higher level of chronic diarrhea was observed in subjects with duodenal pathologies compared to those with no such pathology. The rate of Helicobacter pylori infection was considerably higher than that in previous studies. In addition, there is a weak correlation between endoscopic appearance and histology of duodenitis.

HOW TO REDUCE GASTROINTESTINAL BLEEDING RISK ON ANTICOAGULATION THERAPY IN NON-VALVULAR ATRIAL FIBRILLATION?

Atrial fibrillation (AF) is a significant risk factor for stroke and systemic embolism. For prevention of these complications, most AF patients are indicated to take anticoagulants, that reduce the risk cardioembolic strokes, but increase the risk of bleedings, and the most prevalent are gastrointestinal (GIB). Aim. To assess the rate of pathological changes in esophagus, stomach and duodenum, predisposing for GID, in AF patient with higher risk of stroke and absolute indications for anticoagulation therapy. Material and methods. The analysis done, of case histories of hospitalized patients in the therapeutical university clinics, in the year 2016; of those — 263 with non-valvular AF. Among 222 patients with AF and higher risk of stroke, who had indications for anticoagulants, 103 underwent screening fibroesophagogastroduodenoscopy (FEGDS). Results. The FEGDS, performed in 103 patients with non-valvular AF and high risk of stroke, in 45,6% revealed diseases predisposing to GIB, including esophageal cancer — 1 (2,1%), gastric ulcer — 4 (8,5%), duodenal ulcer — 2 (4,3%), erosive esophagitis and reflux disease — 5 (10,6%), varicose veins of esophagus — 4 (8,5%), erosive gastritis — 31 (66,0%) and erosive duodenitis — 3 (6,4%). Combination of diseases was found in 10 (21,3%) patients. Conclusion. Patients with non-valvular AF and high stroke risk, before starting therapy with anticoagulants, it is aimworthy to perform FEGDS for on-time screening for esophageal, gastric, duodenal pathologies predisposing to GIB.

Pancreas preserving distal duodenectomy: A versatile operation for a range of infra-papillary pathologies.

AIMTo investigate the range of pathologies treated by pancreas preserving distal duodenectomy (PPDD) and present the outcome of follow-up.METHODSNeoplastic lesions of the duodenum are treated conventionally by pancreaticoduodenectomy. Lesions distal to the major papilla may be suitable for a pancreas-preserving distal duodenectomy, potentially reducing morbidity and mortality. We present our experience with this procedure. Selective intraoperative duodenoscopy assessed the relationship of the papilla to the lesion. After duodenal mobilisation and confirmation of the site of the lesion, the duodenum was transected distal to the papilla and beyond the duodenojejunal flexure and a side-to-side duodeno-jejunal anastomosis was formed. Patients were identified from a prospectively maintained database and outcomes determined from digital health records with a dataset including demographics, co-morbidities, mode of presentation, preoperative imaging and assessment, nutritional support needs, technical operative details, blood transfusion requirements, length of stay, pathology including lymph node yield and lymph node involvement, length of follow-up, complications and outcomes. Related published literature was also reviewed.RESULTSTwenty-four patients had surgery with the intent of performing PPDD from 2003 to 2016. Nineteen underwent PPDD successfully. Two patients planned for PPDD proceeded to formal pancreaticoduodenectomy (PD) while three had unresectable disease. Median post-operative follow-up was 32 mo. Pathologies resected included duodenal adenocarcinoma (n = 6), adenomas (n = 5), gastrointestinal stromal tumours (n = 4) and lipoma, bleeding duodenal diverticulum, locally advanced colonic adenocarcinoma and extrinsic compression (n = 1 each). Median postoperative length of stay (LOS) was 8 d and morbidity was low [pain and nausea/vomiting (n = 2), anastomotic stricture (n = 1), pneumonia (n = 1), and overwhelming post-splenectomy sepsis (n = 1, asplenic patient)]. PPDD was associated with a significantly shorter LOS than a contemporaneous PD series [PPDD 8 (6-14) d vs PD 11 (10-16) d, median (IQR), P = 0.026]. The 30-d mortality was zero and 16 of 19 patients are alive to date. One patient died of recurrent duodenal adenocarcinoma 18 mo postoperatively and two died of unrelated disease (at 2 mo and at 8 years respectively).CONCLUSIONPPDD is a versatile operation that can provide definitive treatment for a range of duodenal pathologies including adenocarcinoma.

Spectrum of upper GI disease in rural Kerala-Upper GI endoscopy assisted clinical study

Introduction: Upper gastrointestinal tract disorders are one of the most commonly encountered problems in clinical practice. The definitive diagnosis of upper gastrointestinal disorders rest on endoscopic evaluation and biopsy if required for planning proper treatment. Objectives: To determine the spectrum of disease in upper gastrointestinal tract. To establish endoscopy as an effective tool in the proper diagnosis of various upper gastrointestinal tract disorders. Materials and Methods: A prospective study was conducted among patients who presented with upper gastrointestinal symptoms at Dr. S.M.C.S.I. Medical College, Karakonam, Trivandrum from November 2009 to July 2012. Results : Out of the 378 cases, 246 cases (65.1%) had normal finding and 132 cases (34.9%) had abnormal findings. Among the 132 abnormal finding 85 cases had oesophageal, 50 cases had gastric and 11 had duodenal pathologies. Among these cases, 14 cases had both oesophageal and gastric diseases. Conclusion : In our study, the commonest pathology in patients with upper gastrointestinal symptoms was esophageal followed by gastric and duodenal diseases. We therefore conclude that upper GI endoscopic evaluation is a must in all patients who present with upper gastrointestinal tract symptoms.

Emerging role of narrow band imaging in duodenum.

Endoscopy using magnification narrow band imaging (mNBI) allows detailed assessment of mucosal surface and vascular pattern. This may help in better identification and prediction of the nature of the lesion. The role of this technology in duodenum is still evolving. Studies have shown that mNBI has high accuracy in predicting villous atrophy in the duodenum. Limited data suggests that this technique can provide additional information on duodenal polyps, nodules and ampullary tumour which can help guide their management. In this paper we describe the technique for duodenal assessment using NBI and review the existing literature evaluating its role in diagnosis of various duodenal pathologies.

Multimodality imaging of diseases of the duodenum.

The duodenum is a unique segment of intestine, occupying both intra and extra-peritoneal locations. There is a wide spectrum of abnormalities of the duodenum that range from congenital anomalies to traumatic, inflammatory, and neoplastic entities. The duodenum may be overlooked on cross-sectional imaging due to its location and small size. Duodenal pathologies may, therefore, be missed or wrongly diagnosed. Knowledge about duodenal pathologies and optimal imaging techniques can increase diagnostic yield and permit optimal patient management. Conventionally, the duodenum was evaluated with upper GI studieson fluoroscopy; however, endoluminal evaluation is better performed with endoscopy. Additionally, a broad array of cross-sectional imaging modalities permits comprehensive assessment ofthe duodenum and surrounding viscera. While endoscopic sonography is increasingly used to locally stage duodenal malignancies, MDCT remains the primary modality widely used in the detection and characterization of duodenal abnormalities. MRI is used as a "problem solving" modality in select conditions. We present a comprehensive review of duodenal abnormalities with an emphasis on accurate diagnosis and management.

Novel insights on the role of CD8+ T cells and cytotoxic responses during Helicobacter pylori infection

Helicobacter pylori chronically persists in 50% of the human population and causes serious gastric and duodenal pathologies in 15% of infected people. Research on the immune response to the infection has mainly focused on the induction of CD4+ T cell responses. Human studies emphasize the potential clinical relevance of CD8+ cytotoxic T lymphocytes, however this cell type has barely been reported in studies employing mouse or gerbil models. Traditionally characterized as an extracellular bacterium, H. pylori has been identified inside epithelial and immune cells. Similarly to other intracellular bacteria, H. pylori infection of macrophages can alter autophagy and phagosome processing. A novel animal model of H. pylori infection demonstrates for the first time the induction of cytotoxic CD8+ T cell responses in pigs and localization of intracellular H. pylori within lymphoid aggregates. Here, we discuss novel mechanisms of host-H. pylori interactions that could lead to the induction of cytotoxic responses.