Identification of distinctive clinical significance in hospitalized patients with endoscopic duodenal mucosal lesions

Abstract

Background/AimsDuodenitis is not infrequent finding in patient undergoing endoscopy. However, hospitalized patients have a higher incidence of secondary duodenal mucosal lesions that might be related with inflammatory bowel disease (IBD), cytomegalovirus (CMV) infection, tuberculosis, immunologic disorders, or other rare infections. We aimed to identify clinicopathologic features of duodenal mucosal lesions in hospitalized patients.MethodsAll hospitalized patients having duodenal mucosal lesions were identified by endoscopic registration data and pathologic data query from 2011 to 2014. The diagnostic index was designed to be sensitive; however, a detailed review of medical record and endoscopic findings was undertaken to improve specificity. Secondary duodenal lesion was defined as having specific reason to explain the duodenal lesion.ResultsAmong 6,334 hospitalized patients have undergone upper endoscopy, endoscopic duodenal mucosal lesions was detected in 475 patients. Secondary duodenal lesions was 21 patients (4.4%) and the most frequent secondary cause was IBD (n = 7). The mean age of secondary group was significantly lower than that in primary group (42.3 ± 18.9 years vs. 58.5 ± 16.8 years, p = 0.00), and nonsteroidal anti-inflammatory drugs were less frequently used in secondary group, but there was no differences of gender or presence of Helicobacter pylori. The involvement of distal part of duodenum including postbulbitis or panduodenitis was more frequently detected in secondary group than in primary group. By multivariate regression analysis, younger age of 29 years and the disease extent were significant predictors for the secondary mucosal lesions.ConclusionsSecondary duodenal mucosal lesions with different pathophysiology, such as IBD or CMV infection, are rare. Disease extent and age seems the most distinctive feature of secondary duodenal mucosal lesions.

Significance of duodenal mucosal lesions: can they be a clue to a systemic disease?

“…[ 3 ] Non- H. pylori and non-NSAID duodenal ulcers are reportedly associated with multiple ulcers; in contrast, H. pylori -related ulcers usually occur singly [ 9 ]. This result is similar to the finding of Han et al [ 5 ].…”

“…In previous studies, NSAIDs were found to affect the duodenal mucosa in only 13% of patients with H. pylori -negative duodenal ulcers [ 11 ], and histologic changes in the duodenum were negligible [ 12 ]. These results may explain the findings of Han et al [ 5 ].…”

“…In the current issue of the Korean Journal of Internal Medicine, Han et al [ 5 ] report a retrospective study of the characteristics of duodenitis and duodenal ulcers relating to primary and secondary duodenal lesions. They enrolled 475 patients hospitalized in a single institution due to duodenal mucosal lesions from 2011 to 2014.…”

“…Other diseases were cytomegalovirus, Behcet’s disease, Henoch-Shonlein purpura, radiation-induced duodenitis, candida, tuberculosis enteritis, eosinophilic enteritis, and parasitic infection. Han et al [ 5 ] reported that age and the extent of duodenal lesions were significant predictors of secondary duodenal lesions.…”

“…Because NSAIDs can influence the upper to lower gastrointestinal tract, instead of being confined to the bulb their effect may extend to the distal duodenum. In the study by Han et al [ 5 ], although the primary duodenal lesion group contained a greater number of patients taking NSAIDs, the extent of duodenal mucosal lesions was greater in the secondary group. In previous studies, NSAIDs were found to affect the duodenal mucosa in only 13% of patients with H. pylori -negative duodenal ulcers [ 11 ], and histologic changes in the duodenum were negligible [ 12 ].…”