Duodenal strongyloidiasis – Our 15-year histopathological experience at a tertiary gastrointestinal centre

2020 ◽  
pp. 004947552096274
Author(s):  
Latika Gupta ◽  
Kavita Gaur ◽  
Puja Sakhuja ◽  
Barjesh C Sharma ◽  
Ravindra K Saran ◽  
...  
Keyword(s):  
Duodenal Biopsy ◽  
Cholestatic Jaundice ◽  
Histopathological Findings ◽  
Young Females ◽  
Eosinophilic Infiltrate ◽  
Elderly Males ◽  
Immunocompromised State ◽  
Duodenal Biopsies

In order to emphasise the importance of histopathology in the clinically unsuspected diagnosis of duodenal strongyloidiasis, we report six cases diagnosed on duodenal biopsies identified from the database over a period of 15 years, and clinical, endoscopic and histopathological findings were analysed retrospectively. Four were elderly males and the remainder young females. Only one patient had an underlying immunocompromised state. Three presented with cholestatic jaundice and simulated hepatobiliary malignancy. In all cases, endoscopy provided non-specific findings. Only one case showed a predominant eosinophilic infiltrate. Eggs, larvae and adult forms of strongyloides were seen in crypts and showed intense basophilic staining on HE stain. It is concluded that since mostly undetected clinically, duodenal biopsy serves as the first step in the diagnosis of strongyloidiasis. Hepatobiliary manifestations, though very infrequent, should raise the suspicion for strongyloidiasis and thus necessitate the need for duodenal biopsy.

Histopathologic Manifestations of Crohn Disease in Duodenal Endoscopy Biopsy: The Value of Different Patterns of Involvement of Brunner Glands

2021 ◽  
pp. 106689692199843
Author(s):  
Badr AbdullGaffar ◽  
Hoda Quraishi
Keyword(s):  
Crohn Disease ◽  
Duodenal Biopsy ◽  
Inflammatory Lesions ◽  
Specific Sign ◽  
Mucosal Erosion ◽  
Transmural Inflammation ◽  
Active Inflammation ◽  
Upper Gastrointestinal ◽  
Brunner Glands ◽  
Duodenal Biopsies

Crohn disease (CD) not uncommonly involves the upper gastrointestinal tract, usually gastric antrum and proximal duodenum. The most consistent histopathologic manifestations of CD in duodenal biopsies are mucosal erosion, focal active inflammation, and granulomas. Since CD is a transmural inflammation and since duodenal biopsy may include submucosal Brunner glands, we aimed to find if CD has any specific histopathologic manifestations in Brunner gland lobules and their ducts compared to other duodenal inflammatory lesions. We carried out a retrospective review study over 6 years retrieving duodenal biopsy specimens in CD patients. We compared duodenal specimens involved by CD with other inflammatory lesions, for example, ulcerative colitis (UC), Helicobacter pylori-associated gastritis, non-Helicobacter gastritis, Celiac sprue, infections, and drugs. We found focal active duodenitis and erosion in CD cases and non-CD cases. Granulomas were found in CD cases. Five cases of CD showed inflammatory and degenerative changes of Brunner glands. Focal patchy active inflammation of only portion of submucosal Brunner gland lobule, mucosal Brunner glands, and their ducts was solely found in CD cases. This focally enhanced inflammation of Brunner glands was not found in other lesions. Whether this phenomenon of focal active “lobulitis” and “ductitis” is a specific sign of duodenal CD compared to UC and other inflammatory lesions warrants verification. We encourage endoscopists to include submucosal Brunner lobules in their duodenal biopsy samples and pathologists to look for these patterns of involvement particularly in patients suspected of CD.

Is duodenal biopsy always necessary for the diagnosis of coeliac disease in adult patients with high anti-tissue transglutaminase (TTG) antibody titres?

2021 ◽  
pp. flgastro-2020-101728
Author(s):  
Junaid Beig ◽  
Kamran Rostami ◽  
David T S Hayman ◽  
Summer Hassan ◽  
Stephen Gerred ◽  
...  
Keyword(s):  
Coeliac Disease ◽  
Linear Models ◽  
Tissue Transglutaminase ◽  
Signs And Symptoms ◽  
Duodenal Biopsy ◽  
Adult Patients ◽  
Antibody Titres ◽  
Red Flag ◽  
The Relationship ◽  
Duodenal Biopsies

ObjectiveAvoiding duodenal biopsy in adults for coeliac disease (CD) diagnosis is controversial. Some retrospective and prospective studies have shown that CD can be reliably diagnosed in adults with serology rather than duodenal biopsies. This study aimed to check the accuracy of a cut-off value of ≥10 upper limit of normal of anti-tissue transglutaminase antibody (anti-TTG IgA) titres for CD diagnosis in adult patients.MethodWe retrospectively analysed adult patients (≥16 years) who underwent gastroscopy from 2013 to 2018 for positive coeliac serology. The relationship between titres and disease was determined by using linear models, whereas sensitivity and specificity were assessed by receiver operator curve.ResultsWe analysed 144 newly anti-TTG antibody-positive adult patients with a median age of 48.5 years (IQR 32–62); among them, 86 (60%) patients had CD (Marsh III: n=68 and Marsh II and I: n=18) with a higher prevalence in females (n=59 (69%)) and Europeans (n=60 (70%)). Fifty (58%) patients with CD had colonoscopy and five (6%) had imaging; only six patients were diagnosed with additional conditions. An anti-TTG IgA titre cut-off value of 150 U/L was 100% specific for CD in our dataset, with 70% (95% CI: 60% to 88%) sensitivity for this patient group.ConclusionCoeliac serology using anti-TTG IgA with titres ≥10× normal value is an excellent predictor of CD, irrespective of age, gender and ethnicity. Duodenal biopsy may not be necessary in selected adult patients with CD, especially younger than 50 years of age without additional gastrointestinal red-flag signs and symptoms.

scholarly journals The role of serological tests and biopsy in the diagnosis of celiac disease: retrospective review of 1137 duodenal biopsies

2020 ◽  
Vol 9 (1) ◽  
pp. 27
Author(s):  
Feridun Gurlek ◽  
Eyyup Tasdemir ◽  
Taskın Erkinuresin
Keyword(s):  
Celiac Disease ◽  
Serological Test ◽  
Young Female ◽  
Duodenal Biopsy ◽  
Gluten Sensitivity ◽  
Biopsy Result ◽  
Serological Tests ◽  
Number Of Patients ◽  
Significant Difference ◽  
Duodenal Biopsies

Background: The aim of this study is to evaluate gluten sensitivity and/or celiac disease (CD) on the basis of serological tests and duodenal biopsy and to draw attention to the prevalence in the population and the correlation between serological tests and biopsy results.Methods: Patients who applied to Health Sciences University Bursa High Specialization Training and Research Hospital between 2015-2019 and who underwent serological tests and duodenal biopsies with a diagnosis of CD or gluten sensitivity were retrospectively analyzed.Results: The study was conducted with a total of 1137 cases, 61.2% (n = 696) of who were women and 38.8% (n = 441) were men. Their ages range from 17 to 91, with a mean of 40.16 ± 16.18 years. Of the 178 patients with gluten sensitivity, 122 (68%) were female and 56 (32%) were male. According to the results of duodenal biopsy, an average of 8% Marsh 3, 5% Marsh 1-2 was detected in the last five years. For the whole study, a significant difference was found between celiac autoantibody positivity rates according to the biopsy results (p = 0.001; p <0.01). The rate of serological test positivity was higher in patients with biopsy result Marsh 3 than those with normal biopsy result, peptic duodenitis and Marsh 1 and 2. No statistically significant difference was found between the rates of Marsh 3 biopsy results and serological test positivity by years (p> 0.05).Conclusions: The number of patients applied with a diagnosis of CD in the last five years has gradually increased (3.4-33.7%). Of the patients with Marsh 3 and Marsh 1-2 biopsy results, 78% were under 50 years old. This suggests that gluten enteropathy in young female patients having digestive system complaints should not be ignored during the diagnosis. Serological test results were highly correlated with the biopsy results in patients with Marsh 3 biopsy results. We think that if clinical findings are supported with serological tests and directed for biopsy in the diagnosis of celiac disease, it will be more cost effective and the workload and time loss will be prevented.

scholarly journals Analysis of gastric and duodenal biopsy results in patients presenting with dyspepsia: a cross-sectional study in a middle eastern population

2019 ◽  
Vol 6 (1) ◽  
pp. e000330
Author(s):  
Youssef Ghosn ◽  
Mohammed Hussein Kamareddine ◽  
Antonios Tawk ◽  
Naseem Bou-Ayash ◽  
Haneen Bou-Ayash ◽  
...  
Keyword(s):  
Middle Eastern ◽  
Cross Sectional Study ◽  
Gastric Biopsy ◽  
Duodenal Biopsy ◽  
Sectional Study ◽  
Cross Sectional ◽  
Eastern Population ◽  
Middle Eastern Population ◽  
H Pylori ◽  
Duodenal Biopsies

ObjectiveCorrea’s cascade is a ‘Model for Gastric Cancer Development’ described by Peleyo Correa. The reversibility of Correa’s cascade remains debatable. The literature contains insufficient data on the specific stage of the cascade during which Helicobacter pylori is detected, treated, and the effect on prognosis. Herein, we aim to determine the prevalence of various precancerous and cancerous gastric lesions in patients presenting with dyspepsia, the prevalence of gastritis and H. pylori infection, the prevalence of duodenal pathology in patients presenting with dyspepsia, identify the stage of H. pylori detection in relation to Correa’s cascade, and investigate a possible relationship between H. pylori and celiac disease.DesignRetrospective cross-sectional study conducted on a middle eastern population at a Lebanese tertiary hospital centre. 1428 patients presenting with dyspepsia underwent gastroscopy with gastric and duodenal biopsies. Variables include age, sex, presence/absence of H. pylori infection, and histopathological analysis of gastric and duodenal biopsies.ResultsBeing above 40 years of age was associated with increased likelihood of exhibiting abnormal gastric biopsy result. Gastritis and metaplasia were detected more frequently than glandular atrophy (p<0.001) with gastritis being present the most (p<0.001). The presence of H. pylori and the gastric biopsy results were not associated with any of the duodenal biopsy results.ConclusionThe burden of H. pylori infection in patients with dyspepsia was high. H. pylori was detected at various precancerous lesions with varying significance. The prevalence of duodenal adenocarcinoma in dyspeptic patients is unexpectedly high. No association between gastric and duodenal pathologies was found.

Metropolitan Out-Migration of Elderly Females in Canada: Characterization and Explanation

1987 ◽  
Vol 19 (12) ◽  
pp. 1659-1671 ◽  
Author(s):  
H Y-F Cheung ◽  
K-L Liaw
Keyword(s):  
Older Persons ◽  
Metropolitan Areas ◽  
The Elderly ◽  
Destination Choice ◽  
Young Females ◽  
Housing Growth ◽  
Female Migrants ◽  
Elderly Males ◽  
Choice Pattern ◽  
Elderly Migrants

This paper contains an analysis of the 1971–1976 out-migration pattern of Canadian elderly females from the 23 Census Metropolitan Areas (CMAs). Migration is conceptualized as a three-level choice process. The major findings are as follows: Elderly females are substantially less migratory than young females but are slightly more mobile than elderly males. In addition, the elderly females in the more recently settled western region tend to be more mobile than those in other regions. Elderly migrants show substantially less preference for the metropolitan destinations than the young migrants; however, among the elderly, females have stronger preference for metropolitan areas than males. The destination choice pattern of metropolitan-bound out-migrants is less dispersed for the elderly than for the young. Among the older persons, in most CMAs, female migrants have a larger dispersion than male migrants. With respect to metropolitan-bound elderly migrants from the CMAs, the probability of choosing a particular destination is positively related to population size, brightness, and housing growth, and negatively related to the logarithm of distance, cultural dissimilarity, coldness, and gross rent. Environmental variables are more important than the housing variables in determining the destination choice pattern of the elderly migrants.

scholarly journals Coeliac Disease and the Liver: Spectrum of Liver Serology, Histology and Response of Treatment with Gluten-Free Diet

2021 ◽  
Vol 15 (5) ◽  
pp. 1517-1521
Author(s):  
M. J. Iqbal ◽  
M. A. Anjum ◽  
I. Joher ◽  
M. Usman ◽  
A. Rabbani ◽  
...  
Keyword(s):  
Coeliac Disease ◽  
Laboratory Tests ◽  
Full Range ◽  
Duodenal Biopsy ◽  
Gluten Free Diet ◽  
Gluten Free ◽  
Non Invasive ◽  
Liver Histopathology ◽  
Before And After ◽  
Duodenal Biopsies

Aim: To evaluate the histological spectrum of "celiac hepatitis" and the likelihood that these features will return after GFD. Methods: The laboratory tests, Clinical profile, liver and duodenal biopsy were studied with the patients with hepatic derangement and CD among 35 patients. Whenever possible, a histological comparison of before and after GFD treatmenton liver and duodenal biopsies were performed. Results: In the records of the pathology and gastroenterology departments of our institute, CD and ECM were found in 35 patients. There were twenty-four men and 11 women with a mean age of 24.3 (10-50 range). Twenty-four patients were primarily identified with celiac disease and later diagnosed with CLD. At diagnosis, this feature was currently associated with small bowel diarrhea in 13 (65%) and CD without diarrhea in the remaining seven patients (35%). 10 of these 20 patients had anemia. Antibodies to TTG were positive in 21 patients (87.5%), AGA in 17 patients (70.8%), and EMA in 4 patients. Severe villous abnormality (Marsh-Oberhuber type 3C) in eleven patients (45.8.3%) on duodenal biopsy, moderate villous abnormality (type 3B) in seven patients (29.2%), 5 patients (20.8%) have mild abnormality of the villi (type 3A). The clinical topographies indicating the progress of liver ailment in these 24 cases are as follows: 8 have ascites (33.3%), 6(25%) patients have jaundice, hepatomegaly in 5 (20.8%) and 5(20.8%) Patients have splenomegaly. Conclusion: There has been a problematic case of coeliac disease that has undergone an unnoticed distinction. This is one of the few researches that shows the full range of Coeliac Disease liver histopathology, from non-invasive to invasive hepatitis’. Experiment of a GFD may outcome in clinicopathological enhancement of ’coeliac hepatitis’. Keywords: Gluten-free diet, coeliac disease, duodenal biopsies, hepatomegaly.

scholarly journals The Value of Duodenal Biopsies in the Evaluation of Megaloblastic Anemia

2021 ◽  
Author(s):  
Nasrin Nisha N. ◽  
Sakthisankari Shanmugasundaram ◽  
Kartikayan R. K.
Keyword(s):  
Bone Marrow ◽  
Vitamin B12 ◽  
Megaloblastic Anemia ◽  
Serum Vitamin ◽  
Folate Deficiency ◽  
Duodenal Biopsy ◽  
Tropical Sprue ◽  
Bone Marrow Biopsies ◽  
Endoscopic Findings ◽  
Duodenal Biopsies

Abstract Introduction Megaloblastic anemia is one of the common causes of anemia in India. Duodenal biopsies are routinely performed in the investigation of megaloblastic anemia. The present study was undertaken to analyze the value of duodenal biopsy in megaloblastic anemia and to correlate endoscopic findings with biopsy. As a secondary aim, the study has also analyzed the hematological profile and vitamin B12 and folate status of these patients. Materials and methods All the cases of megaloblastic anemia with bone marrow studies diagnosed at PSG Institute of Medical Sciences and Research during the two year period from January 2016 to December 2017 were retrieved. Clinical and laboratory findings (serum vitamin B12 and folate levels) and endoscopic findings were retrieved from hospital records of the patients. Duodenal biopsies of these patients reported in the histopathology department were retrieved and reviewed. Statistical analysis was done using SPSS software 20.0. Results There were 93 cases of megaloblastic anemia diagnosed on bone marrow biopsies. Tropical sprue was diagnosed in 49.5% of cases, followed by intraepithelial lymphocytosis (17.2%), peptic duodenitis (17.2%), and no significant pathology in 16% of cases. Pancytopenia was present in 54.8% of cases. Isolated vitamin B12 deficiency including low levels was present in 48.38% and folate deficiency was seen in 4.3% cases; 34.48% cases had both vitamin B12 and folate deficiency. Conclusion The incidence of tropical sprue in megaloblastic anemia is 49.5% in the study. Duodenal biopsy is valuable in the work up of megaloblastic anemia, irrespective of the endoscopic changes in identifying the etiology.

scholarly journals Celiac Disease and Other Causes of Duodenitis

2017 ◽  
Vol 142 (1) ◽  
pp. 35-43 ◽  
Author(s):  
Daniel R. Owen ◽  
David A. Owen
Keyword(s):  
Celiac Disease ◽  
Laboratory Testing ◽  
Villous Atrophy ◽  
Duodenal Mucosa ◽  
Endoscopic Examination ◽  
Duodenal Biopsy ◽  
Patient History ◽  
Careful Patient ◽  
Upper Gastrointestinal ◽  
Duodenal Biopsies

Context.— Patients who receive an upper gastrointestinal endoscopic examination frequently have biopsies taken from the duodenum. Accurate interpretation of duodenal biopsies is essential for patient care. Celiac disease is a common clinical concern, but pathologists need to be aware of other conditions of the duodenum that mimic celiac disease. Objective.— To review the normal histologic features of duodenal mucosa and describe the clinical and histologic findings in celiac disease and its mimics, listing the differentiating features of biopsies with villous atrophy and epithelial lymphocytosis. Data Sources.— The study comprises a literature review of pertinent publications as of November 30, 2016. Conclusions.— Celiac disease is a common cause of abnormal duodenal histology. However, many of the histologic features found in the duodenal biopsy of patients with celiac disease are also present in other conditions that affect the small bowel. Diagnostic precision may be enhanced by obtaining a careful patient history and by ancillary laboratory testing, particularly for the presence of antitissue transglutaminase antibodies.

scholarly journals The Use of Biopsy and “No-Biopsy” Approach for Diagnosing Paediatric Coeliac Disease in the Central European Region

2019 ◽  
Vol 2019 ◽  
pp. 1-6 ◽  
Author(s):  
Petra Riznik ◽  
Márta Balogh ◽  
Piroska Bódi ◽  
Luigina De Leo ◽  
Jasmina Dolinsek ◽  
...  
Keyword(s):  
Coeliac Disease ◽  
Signs And Symptoms ◽  
Final Diagnosis ◽  
Duodenal Biopsy ◽  
Diagnostic Approach ◽  
The Family ◽  
Espghan Guidelines ◽  
Upper Level ◽  
Diagnostic Delays ◽  
Duodenal Biopsies

Objectives. The current European Society for Paediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) guidelines introduced the option to diagnose coeliac disease (CD) in children and adolescents without upper endoscopy if the defined criteria are met. The aim of our study was to evaluate how frequently paediatric gastroenterologists in Central Europe used the “no-biopsy” approach and how often the duodenal biopsy could have been omitted. Methods. Medical records of patients aged<19 years diagnosed with CD in 2016 from five European countries were analysed, focusing on levels of transglutaminase antibodies (TGA) at the time of diagnosis and on whether the diagnosis was confirmed using duodenal biopsy or “no-biopsy” approach. Clinical presentation and delays until final diagnosis were analysed according to diagnostic approach. Results. Data from 653 children (63.9% female, median age: 7 years, range: 7 months-18.5 years) from Croatia, Hungary, Germany, Italy, and Slovenia were analysed. One fifth (n=134) of included children were asymptomatic at diagnosis. Of 519 symptomatic children, 107 (20.6%) were diagnosed by the “no-biopsy” approach. Out of the remaining 412 children who underwent duodenal biopsies, 214 (51.9%) had TGA≥10 times upper level of normal (ULN) and would have been eligible for the “no-biopsy” approach. Signs and symptoms of malabsorption were more frequent in children diagnosed without duodenal biopsies. There were no differences in diagnostic delays with respect to the diagnostic approach. Conclusion. In this cohort, about 60% of symptomatic CD patients could have been diagnosed without duodenal biopsies. The aim of the “no-biopsy” approach was to make the diagnostic procedure less challenging without compromising its reliability. However, this option was applied only in 20%, in spite of fewer burdens to the family and reduced costs. The reasons for this discrepancy are unknown. Physicians should be made more aware about the reliability of CD diagnosis without biopsies when the ESPGHAN guidelines for CD diagnosis are followed.

scholarly journals Giardiasis in Endoscopy Patients: A Comparison of Diagnostic Techniques

1990 ◽  
Vol 4 (1) ◽  
pp. 1-4
Author(s):  
Doone R Watson ◽  
Lloyd Sutherland ◽  
A Dean Befus
Keyword(s):  
Small Bowel ◽  
Diagnostic Techniques ◽  
Abdominal Discomfort ◽  
Duodenal Biopsy ◽  
Diagnostic Endoscopy ◽  
The Third ◽  
Duodenal Biopsies

The results of a study comparing techniques for diagnosis of giardiasis during endoscopy are presented. Methods of diagnosis included examination of duodenal biopsy impression smears, culture of both biopsies and aspirates, and examination of preserved aspirate. Giardiasis was diagnosed in three of 80 patients; in each case the impression smear was positive. Cultures of duodenal biopsies were positive in two patients; in the third patient a biopsy was not available. The preserved aspirate was positive in only one patient, while the aspirate cultures were never positive. It is proposed that during diagnostic endoscopy, routine submission of a duodenal biopsy impression smear from patients with unexplained small bowel diarrhea or abdominal discomfort is appropriate.

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