Acute duodenitis

Acute duodenitis
	Diagnosis in short
	; Acute duodenitis. H&E stain.
LM	neutrophils - "found without searching", eosinophils - "found without searching", plasma cells (increased), intraepithelial lymphocytes
Site	duodenum
Associated Dx	Helicobacter gastritis
Prevalence	uncommon
Endoscopy	erythema
Prognosis	benign
Treatment	dependent on underlying cause

Acute duodenitis, abbreviated AD, is an acute inflammatory process of the duodenum. It is relatively uncommon.

General

DDx:

Infection.
- Helicobactor organisms in the stomach.
  - Helicobacter not seen unless gastric metaplasia is present.^[1]
Medications (NSAIDs).
Crohn's disease (usually focal/patchy).
Portal hypertension (portal hypertensive duodenopathy).^[2]
Celiac sprue.

Microscopic

Features:

Intraepithelial lymphocytes.
Neutrophils - "found without searching" - key feature.
Eosinophils - "found without searching" - key feature.
Plasma cells (increased).

Notes:

One needs stomach concurrent biopsies to r/o Helicobactor.
Erosions make celiac sprue much less likely.
Presence of chronic inflammation useful for NSAIDs vs. Helicobacter organisms:
- NSAIDs not commonly assoc. with acute inflammation;^[3] thus, without chronic inflammation NSAIDs are unlikely.
  - Acute NSAID-related duodenitis reported.^[4]

Images

AD - low mag.
AD - intermed. mag.
AD - high mag.
AD - very high mag.

Sign out

DUODENUM, BIOPSY:
- ACUTE DUODENITIS.

Acute on chronic duodenitis

DUODENUM, BIOPSY:
- ACUTE ON CHRONIC DUODENITIS.

Micro

The sections show small bowel mucosa with intraepithelial neutrophils. The epithelium shows nuclear hyperchromasia, pseudostratification and nuclear enlargement; however, it matures toward the surface (reactive changes of the epithelium).

Brunner's glands are found focally in the lamina propria. Gastric foveolar-type epithelium is identified. Lamina propria plasma cells are abundant.

References

↑ Madsen, JE.; Vetvik, K.; Aase, S. (Nov 1991). "Helicobacter-associated duodenitis and gastric metaplasia in duodenal ulcer patients.". APMIS 99 (11): 997-1000. PMID 1683540.
↑ Shudo, R.; Yazaki, Y.; Sakurai, S.; Uenishi, H.; Yamada, H.; Sugawara, K. (Apr 2002). "Duodenal erosions, a common and distinctive feature of portal hypertensive duodenopathy.". Am J Gastroenterol 97 (4): 867-73. doi:10.1111/j.1572-0241.2002.05602.x. PMID 12003421.
↑ Taha AS, Dahill S, Nakshabendi I, Lee FD, Sturrock RD, Russell RI (September 1993). "Duodenal histology, ulceration, and Helicobacter pylori in the presence or absence of non-steroidal anti-inflammatory drugs". Gut 34 (9): 1162–6. PMC 1375446. PMID 8406146. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1375446/.
↑ Hashash JG, Atweh LA, Saliba T, et al. (November 2007). "Acute NSAID-related transmural duodenitis and extensive duodenal ulceration". Clin Ther 29 (11): 2448–52. doi:10.1016/j.clinthera.2007.11.012. PMID 18158085.

[1] Madsen, JE.; Vetvik, K.; Aase, S. (Nov 1991). "Helicobacter-associated duodenitis and gastric metaplasia in duodenal ulcer patients.". APMIS 99 (11): 997-1000. PMID 1683540.

[pmid12003421-2] Shudo, R.; Yazaki, Y.; Sakurai, S.; Uenishi, H.; Yamada, H.; Sugawara, K. (Apr 2002). "Duodenal erosions, a common and distinctive feature of portal hypertensive duodenopathy.". Am J Gastroenterol 97 (4): 867-73. doi:10.1111/j.1572-0241.2002.05602.x. PMID 12003421.

[pmid8406146-3] Taha AS, Dahill S, Nakshabendi I, Lee FD, Sturrock RD, Russell RI (September 1993). "Duodenal histology, ulceration, and Helicobacter pylori in the presence or absence of non-steroidal anti-inflammatory drugs". Gut 34 (9): 1162–6. PMC 1375446. PMID 8406146. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1375446/.

[pmid18158085-4] Hashash JG, Atweh LA, Saliba T, et al. (November 2007). "Acute NSAID-related transmural duodenitis and extensive duodenal ulceration". Clin Ther 29 (11): 2448–52. doi:10.1016/j.clinthera.2007.11.012. PMID 18158085.

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Acute duodenitis

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