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.

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.

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.

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.

Clinical and Histopathologic Predictors of Disaccharidase Deficiency in Duodenal Biopsy Specimens

2019 ◽  
Vol 152 (6) ◽  
pp. 742-746 ◽  
Author(s):  
Robyn C Reed ◽  
M Cristina Pacheco
Keyword(s):  
Predictive Value ◽  
Gold Standard ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Mucosal Injury ◽  
Clinical Suspicion ◽  
Duodenal Biopsy ◽  
Biopsy Specimens ◽  
Active Inflammation ◽  
Intraepithelial Lymphocytosis

Abstract Objectives Disaccharidase (DS) activity in duodenal biopsy specimens is the gold standard for diagnosing DS deficiency. We investigated strategies to reduce the need for DS testing and whether clinical or histopathologic factors predict DS deficiency. Methods A retrospective chart review analyzed 1,678 DS results in children, biopsy indication(s), and duodenal histopathology. Results One or more DSs were abnormal in 42.8%. Sufficient lactase predicted sucrase, palatinase, and maltase sufficiency (negative predictive value 97.7%). Three patients had sucrase-isomaltase deficiency (0.2%). DS deficiency was more common in biopsy specimens for positive celiac serology (78.0%). Villous blunting, intraepithelial lymphocytosis, and active inflammation predicted DS deficiency; a combination of any two had an 81.4% positive predictive value. Conclusions Utilization could be reduced by only testing cases with normal duodenal histopathology and ongoing clinical suspicion for DS deficiency after reviewing pathology. In cases with suspected celiac disease and/or mucosal injury, DS deficiency is common and likely secondary, limiting test utility.

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.

Crohn Disease Active Inflammation Assessment with Iodine Density from Dual-Energy CT Enterography: Comparison with Histopathologic Analysis

Radiology ◽  
2021 ◽  
pp. 204405
Author(s):  
Bari Dane ◽  
Suparna Sarkar ◽  
Matthew Nazarian ◽  
Hayley Galitzer ◽  
Thomas O’Donnell ◽  
...  
Keyword(s):  
Crohn Disease ◽  
Dual Energy ◽  
Dual Energy Ct ◽  
Ct Enterography ◽  
Histopathologic Analysis ◽  
Active Inflammation

High Incidence of Upper Gastrointestinal Tract Involvement in Children With Crohn Disease

PEDIATRICS ◽  
1989 ◽  
Vol 83 (5) ◽  
pp. 777-781
Author(s):  
C. Lenaerts ◽  
C. C. Roy ◽  
M. Vaillancourt ◽  
A. M. Weber ◽  
C. L. Morin ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Gastrointestinal Tract ◽  
Children And Adolescents ◽  
Chronic Ulcerative Colitis ◽  
Crohn Disease ◽  
Bowel Disease ◽  
Upper Gastrointestinal Tract ◽  
Indeterminate Colitis ◽  
Gastrointestinal Lesions ◽  
Upper Gastrointestinal

This retrospective study of Crohn disease in 230 children and adolescents with a mean age of 12.5 years at the time of diagnosis and an average follow-up of 6.6 years showed that 30% had lesions of the esophagus, stomach, and duodenum. Three patients had Crohn disease isolated to the upper gastrointestinal tract. The 169 patients with both small and large bowel disease were at greater risk (33%, P &lt; .05) of having upper gastrointestinal lesions than the 37 with isolated small bowel disease and the 21 with disease limited to the colon and/ or rectum. An aggregate of symptoms and signs more likely present in those with upper gastrointestinal involvement included: dysphagia, pain when eating, nausea and/or vomiting, and aphthous lesions of the mouth. Furthermore, weight loss was more severe and hypoalbuminemia more frequent. Because upper gastrointestinal series x-ray studies failed to detect upper gastrointestinal lesions in 13 patients of 69 of those with upper gastrointestinal disease, endoscopy should be considered in all children and adolescents in whom a diagnosis of Crohn disease is entertained. Endoscopy and biopsy of the upper gastrointestinal tract should be done in any patient with symptoms suggestive of proximal involvement. Finally, in view of the fact that endoscopy established the diagnosis of Crohn disease in five patients previously thought to have chronic ulcerative colitis, the procedure should routinely be performed in all patients with chronic ulcerative colitis or indeterminate colitis before surgery is performed.

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