Peptic duodenitis

Peptic duodenitis is controversial type of chronic duodenitis.

This article deals with that controversy and foveolar metaplasia of the duodenum.

General

• Peptic duodenitis is 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.

Microscopic

Features:

• 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.
• Helicobacter duodenitis.

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.
• 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.

See also

• Chronic duodenitis.
• Gastric heterotopia of the duodenum.