Lewis Stephen, Stableforth William, Awasthi Rachana, Awasthi Ashish, Pitts Narrie, Ottaway Janet, Sherwood Anthea, Robertson Neil, Cochrane Sean, Wilkinson Stephen
Dept of Gastroenterology, Derriford Hospital, Plymouth, UK.
Int J Clin Exp Pathol. 2012;5(6):581-7. Epub 2012 Jul 29.
The endoscopic appearance of duodenitis is a common finding in patients undergoing endoscopy because of epigastric pain however, the relationship of the visual findings to histology is poorly defined. We set out to ascertain if there was a correlation between the endoscopic and histological appearances of the duodenal mucosa. Consecutive patients with epigastric pain referred for diagnostic gastroduodenoscopy were studied. The visual appearances of 'duodenitis' (erythema, erosions and sub-epithelial haemorrhage) were reported independently by two endoscopists. Duodenal biopsies were taken and assessed for: neutrophil infiltrate, mononuclear infiltrate, gastric metaplasia, villous atrophy and a breach in the mucosa. H pylori status was determined. Of the 93 patients with endoscopic features of duodenitis an increase in histological markers of inflammation was found in 75 (81%). However, histological inflammation was absent or minimal in 68 (73%). Conversely, biopsies from normal-looking mucosa revealed histological evidence of inflammation in 26 (27%). For patients with the endoscopic features of duodenitis the positive & negative predictive value for neutrophilic infiltrate was 39% and 98% respectively. Biopsies from erosions confirmed a breach in the mucosa in only 2 of 40 patients. Neutrophilic infiltrate occurred with NSAI ingestion and infection with H pylori. The endoscopic appearance of the duodenal mucosa is unreliable in determining the presence of histological inflammation. The endoscopic appearance of 'erosions' is not usually associated with a mucosal breach.
十二指肠炎症的内镜表现是因上腹部疼痛接受内镜检查的患者中的常见发现。然而，视觉检查结果与组织学之间的关系尚不清楚。我们着手确定十二指肠黏膜的内镜表现与组织学表现之间是否存在相关性。对因上腹部疼痛转诊进行诊断性胃十二指肠镜检查的连续患者进行了研究。两位内镜医师分别报告“十二指肠炎症”（红斑、糜烂和上皮下出血）的视觉表现。采集十二指肠活检样本并评估：中性粒细胞浸润、单核细胞浸润、胃化生、绒毛萎缩和黏膜破损情况。确定幽门螺杆菌感染状态。在93例有十二指肠炎症内镜特征的患者中，75例（81%）发现炎症组织学指标增加。然而，68例（73%）患者的组织学炎症不存在或很轻微。相反，外观正常的黏膜活检显示26例（27%）有炎症组织学证据。对于有十二指肠炎症内镜特征的患者，中性粒细胞浸润的阳性预测值和阴性预测值分别为39%和98%。40例糜烂患者的活检样本中，仅2例证实有黏膜破损。中性粒细胞浸润与服用非甾体抗炎药和幽门螺杆菌感染有关。十二指肠黏膜的内镜表现对于确定组织学炎症的存在并不可靠。“糜烂”的内镜表现通常与黏膜破损无关。
