Endoscopic Study of Duodenitis

Abstract

475 patients were examined through forward-viewing fiberscope by single examiner from November 1971 to February 1974. In 130 cases of these patients, we could find some changes other than duodenal ulcer or its scar in their duodenal bulb endoscopically, such as diffuse hyperemia, dotted redness, so-called salami appearance, erosions, irregularity of villi, appearance of blood vessels or liver area and small elevations or depressions with various sizes and figures. We are not sure whether all of these endoscopic findings would indicate the inflammatory changes of the duodenal mucosa or reversely, whether the duodenal mucosa might be normal in the cases without these endoscopic findings.
Among these endoscopically detectable changes, diffuse hyperemia, dotted redness, salami appearance and some type of villous irregularities corresponded histopathologically to cell infiltration, extravasation of red cells, hyperemia or congestion of small vessels, and/or erosions of the mucosa. These findings indicated the superficial duodenitis from the reason that these changes were mainly observed in the villous layer although it was difficult to estimate from small biopsy particles whether these changes were limited only in the villous layer or invaded into deeper interstitial layer. There were some evidences to suggest some relationship between the superficial duodenitis and the superficial gastritis.
On the other hand, visible blood vessels, appearance of liver area or villous atrophy might relate to the atrophic duodenitis. Unfortunately, frequency of typical atrophic duodenitis is extremely rare in Japan. Moreover, to clarify the relationship between these endoscopic findings and atrophic changes, histopathological study should be necessary, but in our experiences, endoscopic biopsy study was not contributive so far, because of the difficulty of estimation of atrophic changes by small biopsy particles.
The other endoscopic findings might have the possibility to indicate traces of the superficial changes or relation to the atrophic duodenitis, but further investigations are necessary.