Clinical Significance of Duodenal Erosions

Abstract

In 2436 duodenoscopies performed in 1979-1980, 142 cases of duodenal erosions were found. In 68% of the cases erosions were autonomous, while in the remaining 32% they were associated with peptic ulcer. Either autonomous or associated erosions were mainly present in males with prevalence of the 4th, 5th and 6th decades of life. Moreover, autumn and spring were the most common times of appearance. With respect to symptomatology, 125 cases complained of dyspepsia with a prevalence of ulcer-like symptoms in both autonomous and associated erosions: in the remaining 17 patients hematemesis and melena were the main symptoms. The intake of alcohol and of coffee, as well as the smoking habit did not reveal any particular pattern in these cases, while the association with recent consumption of potentially mucolytic drugs was frequent. In addition, the last 38 cases of autonomous duodenal erosions were studied from the anatomo-functional point of view, revealing the presence of normochlorhydria in 42%, hyperchlorhydria in 47% and hypochlorhydria in 11%: in contrast, fasting gastrinemia was always within normal limits. The histological evaluation of the fundic mucosa showed normal patterns in 71% of the cases, superficial gastritis in 18%, and preatrophic gastritis in 11%. The parietal index was normal in 42% of the cases, high in 47% and low in 11%. The results would seem to suggest that duodenal erosions should be included in the wide spectrum of peptic pathology.

Focus on Duodenitis

“…Furthermore, patients with erosive duo denitis unrelated to duodenal ulcer showed a very poor endoscopic response to powerful acid-inhibiting treatment with ranitidine, whereas good results were observed with pirenzepine, an antimuscarinic agent with only a weak antisecretory activity but exerting cytoprotective effects [40], This supports the view that in autonomous erosive duodenitis acid secretion is generally normal [41] and that -contrary to what happens in duodenal ulcer -gastric acid plays a minor role in the pathogenesis of this disorder [42], It seems reasonable to conclude that non specific duodenitis, either moderate or ero sive, can indeed represent a focal reaction to duodenal ulcer ('satellite duodenitis')-On the other hand, duodenitis can occur as an autonomous, ulcer-independent disorder, the pathogenesis of which, although still ob scure, appears not to be related to acid hy persecretion. The autonomous type of ero sive duodenitis accounts for 46-68% of duo denal erosions detectable at upper gastroin testinal endoscopy [43].…”

“…General measures such as abstinence from smoking and from alcohol and with drawal of salicylate and other antiinflamma tory drugs have been suggested [8], but the role of these factors in the pathogenesis of duodenitis is doubtful [41,42],…”

Seropositivity to a major allergen of Anisakis simplex, Ani s 1, in dyspeptic patients with Helicobacter pylori infection: histological and laboratory findings and clinical significance

“…Erosive duodenitis is considered to be a variant form of duodenal ulcer, with symptomatic and histological improvement after eradication of H. pylori infection. For these reasons, this condition was included in the group of ulcer dyspepsia (UD) conditions [13,14]. Patients with normal endoscopy findings (i.e., five or fewer gastric erosions and no gastric or duodenal ulcer) were diagnosed with non‐ulcer dyspepsia (NUD) [15].…”