Caris Diagnostics, Gastrointestinal Pathology, Irving, TX 75039, USA.
Hum Pathol. 2010 Nov;41(11):1593-600. doi: 10.1016/j.humpath.2010.04.010. Epub 2010 Jul 24.
Gastric-type epithelium and islands of oxyntic mucosa in duodenal biopsies are considered by some to be part of a spectrum of metaplastic change related to peptic disorders. This study was designed to assess prevalence and associations of metaplastic-heterotopic gastric mucosa in the duodenum. Demographic, clinical, and histopathologic data from patients who had duodenal biopsy specimens for a 12-month period were collected from a national database. The duodenal findings of patients with duodenitis, gastric metaplasia, and gastric heterotopia were correlated with gastric pathology, Helicobacter pylori status, and clinical information. Of 28,210 patients with duodenal biopsy specimens, 80.9% were healthy, 2.1% had active duodenitis, 2.2% gastric foveolar metaplasia without active inflammation ("peptic duodenopathy"), 4.8% gastric foveolar metaplasia with active inflammation ("peptic duodenitis"), and 1.9% gastric heterotopia. Helicobacter pylori was documented in 9.8% of patients with normal duodenum, 6.9% of those with gastric metaplasia without active inflammation, 15.8% of those with active duodenitis, and 29.1% of those with gastric foveolar metaplasia with active inflammation; 2.2% of 543 patients with gastric heterotopia had H pylori gastritis. Helicobacter pylori was detected in the metaplastic epithelium of 67.6% of patients with active inflammation and in 16.4% of those with metaplasia without inflammation. Gastric heterotopia was strongly associated with concurrent fundic gland polyps. In conclusion, active duodenitis was more common in patients with H pylori infection, but gastric metaplasia was not. We suggest that there is insufficient evidence to ascribe duodenitis with foveolar metaplasia to a "peptic" disorder, as "peptic duodenopathy" and "peptic duodenitis" seem to imply. Gastric heterotopia is likely a congenital lesion; its association with fundic gland polyps suggests that use of proton pump inhibitors may enhance its endoscopic detection.
胃型上皮和十二指肠胃黏膜岛被一些人认为是与消化性疾病相关的化生改变的一部分。本研究旨在评估十二指肠化生-异位胃黏膜的患病率和相关性。从一个全国性数据库中收集了在 12 个月期间进行十二指肠活检的患者的人口统计学、临床和组织病理学数据。将患有十二指肠炎、胃化生和胃异位的患者的十二指肠发现与胃病理学、幽门螺杆菌状态和临床信息相关联。在 28210 例接受十二指肠活检的患者中，80.9%为健康者，2.1%患有活动性十二指肠炎，2.2%为无活动性炎症的胃小凹上皮化生（“消化性十二指肠炎”），4.8%为有活动性炎症的胃小凹上皮化生（“消化性十二指肠炎”），1.9%为胃异位。在正常十二指肠的患者中，9.8%有幽门螺杆菌，在无活动性炎症的胃化生的患者中为 6.9%，在活动性十二指肠炎的患者中为 15.8%，在有活动性炎症的胃小凹上皮化生的患者中为 29.1%；543 例胃异位患者中有 2.2%存在 Hp 胃炎。在活动性炎症患者的化生上皮中，67.6%的患者检测到幽门螺杆菌，在无炎症的化生患者中为 16.4%。胃异位与同时存在的胃底腺息肉强烈相关。总之，幽门螺杆菌感染的患者更常见活动性十二指肠炎，但胃化生并不常见。我们认为，没有足够的证据将伴有小凹上皮化生的十二指肠炎归因于“消化性”疾病，正如“消化性十二指肠炎”和“消化性十二指肠炎”所暗示的那样。胃异位可能是一种先天性病变；它与胃底腺息肉的关联表明，质子泵抑制剂的使用可能会增强其内镜检测。
