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Chapter 14 - Duodenitis

Published online by Cambridge University Press:  06 June 2020

Roger M. Feakins
Affiliation:
Royal Free London NHS Foundation Trust, London, UK
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Summary

A wide variety of insults including infectious agents, medications and endogenous and environmental chemical substances may cause injury to the gastric mucosa. This may take the form of inflammation (gastritis), reactive changes without inflammation (termed gastropathy by some authors), or a combination of the two. The histological appearances may be a ‘pattern’ of injury that is non-specific and can be seen in association with several aetiologies, or there may be histological features that are highly characteristic of a single injurious agent. In this chapter, ‘gastritis’ is considered in three sections – patterns of injury (with many potential causes), specific types of gastritis, and gastric mucosal injury related to medical therapies. A practical approach to diagnosis including potential diagnostic pitfalls is emphasised, as is the need for accurate endoscopic and clinical information when interpreting these specimens. Common entities, such as Helicobacter pylori gastritis and reactive gastritis, as well as rare conditions and other infections are considered. The discussion focuses on endoscopic biopsies (the most common specimen seen in practice) but these changes may be present in the resected stomach in the setting of both benign and malignant disease and also, increasingly, in specimens removed at the time of bariatric surgery.

Type
Chapter
Information
Non-Neoplastic Pathology of the Gastrointestinal Tract
A Practical Guide to Biopsy Diagnosis
, pp. 206 - 214
Publisher: Cambridge University Press
Print publication year: 2020

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References

Dubin, SM, Kwong, WT, Kalmaz, D, Savides, TJ. Low yield of routine duodenal biopsies for evaluation of abdominal pain. World J Gastroenterol. 2015;21(24):7495–9.CrossRefGoogle ScholarPubMed
Serra, S, Jani, PA. An approach to duodenal biopsies. J Clin Pathol. 2006;59(11):1133–50.CrossRefGoogle ScholarPubMed
Yang, YX, Brill, J, Krishnan, P, Leontiadis, G, American Gastroenterological Association Clinical Practice Guidelines C. American Gastroenterological Association Institute guideline on the role of upper gastrointestinal biopsy to evaluate dyspepsia in the adult patient in the absence of visible mucosal lesions. Gastroenterology. 2015;149(4):1082–7.Google Scholar
Stoven, SA, Choung, RS, Rubio-Tapia, A, et al. Analysis of biopsies from duodenal bulbs of all endoscopy patients increases detection of abnormalities but has a minimal effect on diagnosis of celiac disease. Clin Gastroenterol Hepatol. 2016;14(11):1582–8.CrossRefGoogle Scholar
Husnoo, N, Ahmed, W, Shiwani, MH. Duodenal biopsies for the diagnosis of coeliac disease: are we adhering to current guidance? BMJ Open Gastroenterol. 2017;4(1):e000140.Google Scholar
Genta, RM, Kinsey, RS, Singhal, A, Suterwala, S. Gastric foveolar metaplasia and gastric heterotopia in the duodenum: no evidence of an etiologic role for Helicobacter pylori. Hum Pathol. 2010;41(11):1593–600.CrossRefGoogle ScholarPubMed
Noach, LA, Rolf, TM, Bosma, NB, et al. Gastric metaplasia and Helicobacter pylori infection. Gut. 1993;34(11):1510–14.Google Scholar
Wyatt, JI, Rathbone, BJ. Gastric metaplasia in the duodenum and Campylobacter pylori. Gastroenterol Clin Biol. 1989; 13(1 Pt 1): 78B82B.Google Scholar
Leonard, N, Feighery, CF, Hourihane, DO. Peptic duodenitis–does it exist in the second part of the duodenum? J Clin Pathol. 1997;50(1):54–8.CrossRefGoogle ScholarPubMed
Wysocki, A, Budzynski, P, Kulawik, J, Drozdz, W. Changes in the localization of perforated peptic ulcer and its relation to gender and age of the patients throughout the last 45 years. World J Surg. 2011;35(4):811–16.Google Scholar
Bardhan, KD, Royston, C. Time, change and peptic ulcer disease in Rotherham, UK. Dig Liver Dis. 2008;40(7):540–6.CrossRefGoogle ScholarPubMed
Rosenstock, S, Jorgensen, T, Bonnevie, O, Andersen, L. Risk factors for peptic ulcer disease: a population based prospective cohort study comprising 2416 Danish adults. Gut. 2003;52(2):186–93.CrossRefGoogle ScholarPubMed
Taha, AS, Dahill, S, Nakshabendi, I, Lee, FD, Sturrock, RD, Russell, RI. Duodenal histology, ulceration, and Helicobacter pylori in the presence or absence of non-steroidal anti-inflammatory drugs. Gut. 1993;34(9):1162–6.Google ScholarPubMed
Miwa, H, Sakaki, N, Sugano, K, et al. Recurrent peptic ulcers in patients following successful Helicobacter pylori eradication: a multicenter study of 4940 patients. Helicobacter. 2004;9(1):916.CrossRefGoogle ScholarPubMed
Hobsley, M, Tovey, FI, Holton, J. Precise role of H. pylori in duodenal ulceration. World J Gastroentero. 2006;12(40):6413–19.Google Scholar
Mahadeva, S, Wyatt, JI, Howdle, PD. Is a raised intraepithelial lymphocyte count with normal duodenal villous architecture clinically relevant? J Clin Pathol. 2002;55(6):424–8.Google Scholar
Ierardi, E, Losurdo, G, Iannone, A, et al. Lymphocytic duodenitis or microscopic enteritis and gluten-related conditions: what needs to be explored? Ann Gastroenterol. 2017;30(4):380–92.Google ScholarPubMed
Prussin, C. Eosinophilic gastroenteritis and related eosinophilic disorders. Gastroenterol Clin North Am. 2014;43(2):317–27.CrossRefGoogle ScholarPubMed
Public Health England. Giardia: guidance and data: Public Health England; 2014 Available from: https://www.gov.uk/guidance/giardia.Google Scholar
Nabarro, LE, Lever, RA, Armstrong, M, Chiodini, PL. Increased incidence of nitroimidazole-refractory giardiasis at the Hospital for Tropical Diseases, London: 2008–2013. Clin Microbiol Infect. 2015;21(8):791–6.CrossRefGoogle ScholarPubMed
Rumsey, P, Waseem, M. Giardia lamblia enteritis. StatPearls. Treasure Island, FL, 2018.Google Scholar
Panarelli, NC. Other forms of esophagitis: it is not gastroesophageal reflux disease, so now what do I do? Surg Pathol Clin. 2017;10(4):765–79.CrossRefGoogle Scholar
Greaves, D, Coggle, S, Pollard, C, Aliyu, SH, Moore, EM. Strongyloides stercoralis infection. BMJ. 2013;347:4610.CrossRefGoogle ScholarPubMed
Schar, F, Trostdorf, U, Giardina, F, et al. Strongyloides stercoralis: global distribution and risk factors. PLoS Negl Trop Dis. 2013;7(7):e2288.CrossRefGoogle ScholarPubMed
Rivasi, F, Pampiglione, S, Boldorini, R, Cardinale, L. Histopathology of gastric and duodenal Strongyloides stercoralis locations in fifteen immunocompromised subjects. Arch Pathol Lab Med. 2006;130(12):1792–8.CrossRefGoogle ScholarPubMed
Field, AS, Milner, DA Jr. Intestinal microsporidiosis. Clin Lab Med. 2015;35(2):445–59.CrossRefGoogle ScholarPubMed
Lamps, LW, Bronner, MP, Vnencak-Jones, CL, Tham, KT, Mertz, HR, Scott, MA. Optimal screening and diagnosis of microsporida in tissue sections: a comparison of polarization, special stains, and molecular techniques. Am J Clin Pathol. 1998;109(4):404–10.CrossRefGoogle ScholarPubMed
Marth, T, Raoult, D. Whipple’s disease. Lancet. 2003;361(9353):239–46.Google Scholar
Gunther, U, Moos, V, Offenmuller, G, et al. Gastrointestinal diagnosis of classical Whipple disease: clinical, endoscopic, and histopathologic features in 191 patients. Medicine. 2015;94(15):e714.Google Scholar
Dolmans, RA, Boel, CH, Lacle, MM, Kusters, JG. Clinical manifestations, treatment, and diagnosis of Tropheryma whipplei infections. Clin Microbiol Rev. 2017;30(2):529–55.Google Scholar
Fenollar, F, Puechal, X, Raoult, D. Whipple’s disease. N Engl J Med. 2007;356(1):5566.Google Scholar
Maiwald, M, von Herbay, A, Persing, DH, et al. Tropheryma whippelii DNA is rare in the intestinal mucosa of patients without other evidence of Whipple disease. Ann Intern Med. 2001;134(2):115–19.Google Scholar
Debi, U, Ravisankar, V, Prasad, KK, Sinha, SK, Sharma, AK. Abdominal tuberculosis of the gastrointestinal tract: revisited. World J Gastroenterol. 2014;20(40):14831–40.Google Scholar
Rafailidis, PI, Mourtzoukou, EG, Varbobitis, IC, Falagas, ME. Severe cytomegalovirus infection in apparently immunocompetent patients: a systematic review. Virol J. 2008;5:47.CrossRefGoogle ScholarPubMed
Shen, L, Youssef, D, Abu-Abed, S, et al. Cytomegalovirus duodenitis associated with life-threatening duodenal hemorrhage in an immunocompetent patient: a case report. Int J Surg Case Rep. 2017;33:102–6.Google Scholar
Terada, T. Pathologic observations of the duodenum in 615 consecutive duodenal specimens: I. benign lesions. Int J Clin Exp Pathol. 2012;5(1):4651.Google ScholarPubMed
Betzler, A, Mees, ST, Pump, J, et al. Clinical impact of duodenal pancreatic heterotopia – Is there a need for surgical treatment? BMC Surg. 2017;17(1):53.Google Scholar
de Magalhaes Costa, MH, Fernandes Pegado Mda, G, Vargas, C, et al. Pseudomelanosis duodeni associated with chronic renal failure. World J Gastroenterol. 2012;18(12):1414–16.Google Scholar
Kang, JY, Wu, AY, Chia, JL, Wee, A, Sutherland, IH, Hori, R. Clinical and ultrastructural studies in duodenal pseudomelanosis. Gut. 1987;28(12):1673–81.Google Scholar
Siderits, R, Hazra, A, Mikhail, N, Chiaffarano, J, Lou, W, Fyfe, B. Endoscopically identified Pseudomelanosis duodeni: striking yet harmless. Gastrointest Endosc. 2014;80(3):508–10.CrossRefGoogle ScholarPubMed

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