Han Yeji, Jung Hye-Kyung, Chang Ji Young, Moon Chang Mo, Kim Seong-Eun, Shim Ki-Nam, Jung Sung-Ae, Kim Joo-Young, Bae Ji-Yun, Kim Sae-In, Lee Ji-Hyun, Park Sanghui
Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea.
Department of Pathology, Ewha Womans University School of Medicine, Seoul, Korea.
Korean J Intern Med. 2017 Sep;32(5):827-835. doi: 10.3904/kjim.2015.149. Epub 2017 Aug 21.
BACKGROUND/AIMS: Duodenitis is not infrequent finding in patient undergoing endoscopy. However, hospitalized patients have a higher incidence of secondary duodenal mucosal lesions that might be related with inflammatory bowel disease (IBD), cytomegalovirus (CMV) infection, tuberculosis, immunologic disorders, or other rare infections. We aimed to identify clinicopathologic features of duodenal mucosal lesions in hospitalized patients.
All hospitalized patients having duodenal mucosal lesions were identified by endoscopic registration data and pathologic data query from 2011 to 2014. The diagnostic index was designed to be sensitive; however, a detailed review of medical record and endoscopic findings was undertaken to improve specificity. Secondary duodenal lesion was defined as having specific reason to explain the duodenal lesion.
Among 6,334 hospitalized patients have undergone upper endoscopy, endoscopic duodenal mucosal lesions was detected in 475 patients. Secondary duodenal lesions was 21 patients (4.4%) and the most frequent secondary cause was IBD (n = 7). The mean age of secondary group was significantly lower than that in primary group (42.3 ± 18.9 years vs. 58.5 ± 16.8 years, = 0.00), and nonsteroidal anti-inflammatory drugs were less frequently used in secondary group, but there was no differences of gender or presence of . The involvement of distal part of duodenum including postbulbitis or panduodenitis was more frequently detected in secondary group than in primary group. By multivariate regression analysis, younger age of 29 years and the disease extent were significant predictors for the secondary mucosal lesions.
Secondary duodenal mucosal lesions with different pathophysiology, such as IBD or CMV infection, are rare. Disease extent and age seems the most distinctive feature of secondary duodenal mucosal lesions.
背景/目的：十二指肠炎症在接受内镜检查的患者中并不少见。然而，住院患者继发性十二指肠黏膜病变的发生率较高，这些病变可能与炎症性肠病（IBD）、巨细胞病毒（CMV）感染、结核病、免疫紊乱或其他罕见感染有关。我们旨在确定住院患者十二指肠黏膜病变的临床病理特征。
通过2011年至2014年的内镜登记数据和病理数据查询，确定所有有十二指肠黏膜病变的住院患者。诊断指标设计得较为敏感；然而，对病历和内镜检查结果进行了详细审查以提高特异性。继发性十二指肠病变被定义为有特定原因解释十二指肠病变。
在6334例接受上消化道内镜检查的住院患者中，475例患者检测到内镜下十二指肠黏膜病变。继发性十二指肠病变患者有21例（4.4%），最常见的继发性病因是IBD（n = 7）。继发性组的平均年龄显著低于原发性组（42.3±18.9岁对58.5±16.8岁，P = 0.00），继发性组较少使用非甾体抗炎药，但性别或幽门螺杆菌感染情况无差异。继发性组比原发性组更频繁地检测到十二指肠远端受累，包括球后炎或全十二指肠炎症。通过多因素回归分析，29岁的年轻年龄和疾病范围是继发性黏膜病变的重要预测因素。
具有不同病理生理学的继发性十二指肠黏膜病变，如IBD或CMV感染，较为罕见。疾病范围和年龄似乎是继发性十二指肠黏膜病变最显著的特征。
