Difference between revisions of "Peptic duodenitis"

Revision as of 12:39, 3 May 2016

Peptic duodenitis is controversial type of chronic duodenitis. This article deals with that controversy and foveolar metaplasia of the duodenum.

General

A somewhat controversial type of chronic duodenitis.
Considered to be a consequence of peptic ulcer disease (Helicobacter gastritis).
One of the key components of the diagnosis is foveolar metaplasia and it is disputed that this is really due to Helicobacter.
- Genta et al. consider gastric foveolar metaplasia a congenital lesion.^[1]

Microscopic

Features:^[2]

Gastric foveolar metaplasia - key feature.
Brunner's gland hyperplasia.
+/-Inflammation - neutrophils.^{[citation needed]}
Ulceration.^{[citation needed]}

DDx:

Chronic duodenitis not otherwise specified - no foveolar metaplasia, abundant plasma cells.
Acute duodenitis.
Brunner's gland hyperplasia.
Gastric heterotopia of the duodenum.

Images

Duodenum with foveolar metaplasia - low mag. (WC/Nephron)
Duodenum with foveolar metaplasia - intermed. mag. (WC/Nephron)
Duodenum with foveolar metaplasia - very high mag. (WC/Nephron)

Stains

Foveolar metaplasia:

PAS stain +ve.^[2]
Mucicarmine stain +ve.

Sign out

Foveolar metaplasia only

DUODENUM, BIOPSY:
- SMALL BOWEL MUCOSA WITH FOCAL GASTRIC FOVEOLAR METAPLASIA.
- BRUNNER'S GLANDS NOT IDENTIFIED.
- VILLI AND INTRAEPITHELIAL LYMPHOCYTES WITHIN NORMAL LIMITS (NEGATIVE FOR CELIAC DISEASE).
- NEGATIVE FOR ACUTE DUODENITIS.
- NEGATIVE FOR DYSPLASIA.

DUODENUM, BIOPSY:
- SMALL BOWEL MUCOSA WITH FOCAL GASTRIC FOVEOLAR METAPLASIA.
- BRUNNER'S GLANDS NOT IDENTIFIED.
- NEGATIVE FOR ACUTE DUODENITIS.
- NEGATIVE FOR DYSPLASIA.

Chronic duodenitis

Duodenum, Biopsy:
- Small bowel mucosa with Brunner’s gland in the lamina propria and gastric foveolar metaplasia, consistent with chronic duodenitis.
- NEGATIVE for acute duodenitis.
- NEGATIVE for dysplasia and NEGATIVE for malignancy.

DUODENUM, BIOPSY:
- SMALL BOWEL MUCOSA WITH BRUNNER'S GLAND IN THE LAMINA PROPRIA AND
  GASTRIC FOVEOLAR METAPLASIA -- CONSISTENT WITH CHRONIC DUODENITIS.
- NEGATIVE FOR ACUTE DUODENITIS.
- NEGATIVE FOR MALIGNANCY.

 DUODENUM, BIOPSY:
- SMALL BOWEL MUCOSA WITH PROMINENT BRUNNER'S GLANDS AND FOCAL GASTRIC
  FOVEOLAR METAPLASIA.
- NEGATIVE FOR ACUTE INFLAMMATION.
- NEGATIVE FOR DYSPLASIA.

Micro

The sections show small bowel mucosa and a small amount of submucosa. Brunner's glands are abundant and found focally in the lamina propria. Gastric foveolar-type epithelium is identified. Intraepithelial neutrophils are not identified.

The epithelium matures appropriately. There is no increase in intraepithelial lymphocytes.

References

↑ Genta, RM.; Kinsey, RS.; Singhal, A.; Suterwala, S. (Nov 2010). "Gastric foveolar metaplasia and gastric heterotopia in the duodenum: no evidence of an etiologic role for Helicobacter pylori.". Hum Pathol 41 (11): 1593-600. doi:10.1016/j.humpath.2010.04.010. PMID 20656325.
↑ ^2.0 ^2.1 Iacobuzio-Donahue, Christine A.; Montgomery, Elizabeth A. (2005). Gastrointestinal and Liver Pathology: A Volume in the Foundations in Diagnostic Pathology Series (1st ed.). Churchill Livingstone. pp. 145. ISBN 978-0443066573.

[pmid20656325-1] Genta, RM.; Kinsey, RS.; Singhal, A.; Suterwala, S. (Nov 2010). "Gastric foveolar metaplasia and gastric heterotopia in the duodenum: no evidence of an etiologic role for Helicobacter pylori.". Hum Pathol 41 (11): 1593-600. doi:10.1016/j.humpath.2010.04.010. PMID 20656325.

[Ref_GLP145-2] 2.0 ^2.1 Iacobuzio-Donahue, Christine A.; Montgomery, Elizabeth A. (2005). Gastrointestinal and Liver Pathology: A Volume in the Foundations in Diagnostic Pathology Series (1st ed.). Churchill Livingstone. pp. 145. ISBN 978-0443066573.

[1]

[2]

@@ Line 1: / Line 1: @@
-#redirect [[Duodenum#Peptic_duodenitis]]
+'''Peptic duodenitis''' is controversial type of [[chronic duodenitis]].  This article deals with that controversy and '''foveolar metaplasia of the duodenum'''.
+==General==
+*A somewhat controversial type of [[chronic duodenitis]].
+*Considered to be a consequence of [[peptic ulcer disease]] ([[Helicobacter gastritis]]).
+*One of the key components of the diagnosis is foveolar metaplasia and it is disputed that this is really due to Helicobacter.
+**Genta ''et al.'' consider gastric foveolar metaplasia a congenital lesion.<ref name=pmid20656325>{{Cite journal  | last1 = Genta | first1 = RM. | last2 = Kinsey | first2 = RS. | last3 = Singhal | first3 = A. | last4 = Suterwala | first4 = S. | title = Gastric foveolar metaplasia and gastric heterotopia in the duodenum: no evidence of an etiologic role for Helicobacter pylori. | journal = Hum Pathol | volume = 41 | issue = 11 | pages = 1593-600 | month = Nov | year = 2010 | doi = 10.1016/j.humpath.2010.04.010 | PMID = 20656325 }}</ref>
+==Microscopic==
+Features:<ref name=Ref_GLP145>{{Ref GLP|145}}</ref>
+*Gastric foveolar metaplasia - '''key feature'''.
+*[[Brunner's gland hyperplasia]].
+*+/-Inflammation - neutrophils.{{fact}}
+*Ulceration.{{fact}}
+DDx:
+*[[Chronic duodenitis]] not otherwise specified - no foveolar metaplasia, abundant plasma cells.
+*[[Acute duodenitis]].
+*[[Brunner's gland hyperplasia]].
+*[[Gastric heterotopia of the duodenum]].
+===Images===
+<gallery>
+Image:Duodenum_with_foveolar_metaplasia_-_low_mag.jpg | Duodenum with foveolar metaplasia - low mag. (WC/Nephron)
+Image:Duodenum_with_foveolar_metaplasia_-_intermed_mag.jpg | Duodenum with foveolar metaplasia - intermed. mag. (WC/Nephron)
+Image:Duodenum_with_foveolar_metaplasia_-_alt_-_very_high_mag.jpg | Duodenum with foveolar metaplasia - very high mag. (WC/Nephron)
+</gallery>
+==Stains==
+Foveolar metaplasia:
+*[[PAS stain]] +ve.<ref name=Ref_GLP145>{{Ref GLP|145}}</ref>
+*[[Mucicarmine stain]] +ve.
+==Sign out==
+===Foveolar metaplasia only===
+<pre>
+DUODENUM, BIOPSY:
+- SMALL BOWEL MUCOSA WITH FOCAL GASTRIC FOVEOLAR METAPLASIA.
+- BRUNNER'S GLANDS NOT IDENTIFIED.
+- VILLI AND INTRAEPITHELIAL LYMPHOCYTES WITHIN NORMAL LIMITS (NEGATIVE FOR CELIAC DISEASE).
+- NEGATIVE FOR ACUTE DUODENITIS.
+- NEGATIVE FOR DYSPLASIA.
+</pre>
+<pre>
+DUODENUM, BIOPSY:
+- SMALL BOWEL MUCOSA WITH FOCAL GASTRIC FOVEOLAR METAPLASIA.
+- BRUNNER'S GLANDS NOT IDENTIFIED.
+- NEGATIVE FOR ACUTE DUODENITIS.
+- NEGATIVE FOR DYSPLASIA.
+</pre>
+===Chronic duodenitis===
+<pre>
+Duodenum, Biopsy:
+- Small bowel mucosa with Brunner’s gland in the lamina propria and gastric foveolar metaplasia, consistent with chronic duodenitis.
+- NEGATIVE for acute duodenitis.
+- NEGATIVE for dysplasia and NEGATIVE for malignancy.
+</pre>
+<pre>
+DUODENUM, BIOPSY:
+- SMALL BOWEL MUCOSA WITH BRUNNER'S GLAND IN THE LAMINA PROPRIA AND
+  GASTRIC FOVEOLAR METAPLASIA -- CONSISTENT WITH CHRONIC DUODENITIS.
+- NEGATIVE FOR ACUTE DUODENITIS.
+- NEGATIVE FOR MALIGNANCY.
+</pre>
+<pre>
+ DUODENUM, BIOPSY:
+- SMALL BOWEL MUCOSA WITH PROMINENT BRUNNER'S GLANDS AND FOCAL GASTRIC
+  FOVEOLAR METAPLASIA.
+- NEGATIVE FOR ACUTE INFLAMMATION.
+- NEGATIVE FOR DYSPLASIA.
+</pre>
+====Micro====
+The sections show small bowel mucosa and a small amount of submucosa. Brunner's glands are abundant and found focally in the lamina propria. Gastric foveolar-type epithelium is identified. Intraepithelial neutrophils are not identified.
+The epithelium matures appropriately. There is no increase in intraepithelial lymphocytes.
+==See also==
+*[[Chronic duodenitis]].
+*[[Gastric heterotopia of the duodenum]].
+==References==
+{{Reflist|1}}
+[[Category:Duodenum]]
+[[Category:Diagnosis]]