Department of Histopathology, Imperial College London, St Mary's Campus, London W2 1PG, UK.
Pathol Res Pract. 2011 Sep 15;207(9):538-44. doi: 10.1016/j.prp.2011.08.001. Epub 2011 Sep 22.
At upper gastrointestinal endoscopy to investigate unexplained diarrhea and iron deficiency anemia, duodenal biopsies are often taken to exclude a diagnosis of coeliac disease. While histology remains the gold standard for this diagnosis, recent developments in serological testing may overtake this as a first line test and biopsy restricted to confirming the diagnosis. Established coeliac disease on biopsy is straightforward, but early lesions may pose a challenge. Newer endoscopic procedures such as push-pull enteroscopy (balloon enteroscopy) with biopsy allow access to the small bowel beyond the second part of the duodenum. Controversy remains as to what constitutes the normal histology of the duodenum, and small bowel. Lymphocytic duodenosis (increased intraepithelial lymphocytes with normal villous architecture) in patients with negative coeliac serology can be associated with Helicobacter pylori, drugs, autoimmune and other diseases including food allergy. Full thickness small intestinal biopsies can aid in investigation of enteric neuropathies in severe dysmotility disorders. Biopsies are also taken to investigate malabsorption due to suspected infectious and metabolic disorders. Despite highly active anti-retroviral therapy (HAART), immunosuppressed patients may be affected by duodenal pathogens. The histology of duodenal mucosa in acid related disorders reflects the damage seen at endoscopy. Although the prevalence of duodenal ulcer disease is decreasing, drugs causing ulceration remain an important disease entity. Recent observations in functional bowel disorders suggest that the duodenum may be a key site for pathology. In functional dyspepsia, patients with early satiety may have excess eosinophil infiltration, and the mast cell is probably a key player in the irritable syndrome in the small intestine.
在上消化道内镜检查中，对于不明原因的腹泻和缺铁性贫血，常取十二指肠活检以排除乳糜泻的诊断。虽然组织学仍然是该诊断的金标准，但最近在血清学检测方面的进展可能会取代这一标准，使活检仅限于确诊。活检明确的乳糜泻较为简单，但早期病变可能具有挑战性。新的内镜检查方法，如推进式（球囊）小肠镜检查和活检，可以对十二指肠第二段之后的小肠进行检查。对于什么构成十二指肠和小肠的正常组织学，仍存在争议。在乳糜泻血清学阴性的患者中，淋巴细胞性十二指肠炎（上皮内淋巴细胞增多，绒毛结构正常）可与幽门螺杆菌、药物、自身免疫性疾病和其他疾病（包括食物过敏）有关。全层小肠活检有助于研究严重运动障碍疾病中的肠神经病变。也可进行活检以研究疑似感染性和代谢性疾病引起的吸收不良。尽管有高效抗逆转录病毒治疗（HAART），但免疫抑制患者可能会受到十二指肠病原体的影响。与酸相关疾病相关的十二指肠黏膜组织学反映了内镜检查所见的损伤。尽管十二指肠溃疡的患病率正在下降，但导致溃疡的药物仍然是一个重要的疾病实体。最近在功能性肠病中的观察结果表明，十二指肠可能是病理学的关键部位。在功能性消化不良中，早饱患者可能有过多的嗜酸性粒细胞浸润，而肥大细胞可能是小肠易激综合征的关键参与者。
