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Int J Clin Exp Pathol 2012;5(6):581-587

Original Article
An examination of the relationship between the endoscopic appearance of duodenitis
and the histological findings in patients with epigastric pain

Stephen Lewis, William Stableforth, Rachana Awasthi, Ashish Awasthi, Narrie Pitts, Janet Ottaway, Sherwood AJ, Robertson N, Sean
Cochrane, Stephen Wilkinson

Department of Gastroenterology; Department of Histopathology, Derriford Hospital, Plymouth, UK

Received June 20, 2012; Accepted July 19, 2012; Epub July 29, 2012; Published August 15, 2012

Abstract: The endoscopic appearance of duodenitis is a common finding in patients undergoing endoscopy because of epigastric pain
however, the relationship of the visual findings to histology is poorly defined. We set out to ascertain if there was a correlation between the
endoscopic and histological appearances of the duodenal mucosa. Consecutive patients with epigastric pain referred for diagnostic
gastroduodenoscopy were studied. The visual appearances of ‘duodenitis’ (erythema, erosions and sub-epithelial haemorrhage) were
reported independently by two endoscopists. Duodenal biopsies were taken and assessed for: neutrophil infiltrate, mononuclear infiltrate,
gastric metaplasia, villous atrophy and a breach in the mucosa. H pylori status was determined. Of the 93 patients with endoscopic features of
duodenitis an increase in histological markers of inflammation was found in 75 (81%). However, histological inflammation was absent or
minimal in 68 (73%). Conversely, biopsies from normal-looking mucosa revealed histological evidence of inflammation in 26 (27%). For
patients with the endoscopic features of duodenitis the positive & negative predictive value for neutrophilic infiltrate was 39% and 98%
respectively. Biopsies from erosions confirmed a breach in the mucosa in only 2 of 40 patients. Neutrophilic infiltrate occurred with NSAI
ingestion and infection with H pylori. The endoscopic appearance of the duodenal mucosa is unreliable in determining the presence of
histological inflammation. The endoscopic appearance of ‘erosions’ is not usually associated with a mucosal breach.(IJCEP1206008).

Keywords: Duodenitis, endoscopy, histology

Address all correspondence to:
Dr. Stephen Lewis
Department of Gastroenterology
Derriford Hospital, Plymouth
Devon, PL6 8DH, UK.
Tel: 01752-431117; Fax: 01752-792240
E-mail: sjl@doctors.org.uk