Histopathological spectrum of duodenal biopsies: Experience at a tertiary care hospital
Abstract
Objective: Endoscopic duodenal biopsies constitute a significant load of specimens in the histopathological section of a tertiary care hospital. Most of these diseases comprise non-neoplastic lesions causing significant morbidity. The purpose of this study was to see the frequency of these diseases in our patient population and to compare and analyze our results with similar other studies.
Methods: In this retrospective study records of all duodenal biopsies reported from Feb 2017- Jan 2018 were retrieved. Both non neoplastic and neoplastic conditions along with biopsies with unremarkable findings were included. Various histological parameters like villous blunting, IEL count per 100 enterocytes, crypt hyperplasia, inflammation in lamina propria, and presence of microorganisms, any dysplasia or malignancy were studied. Data was statistically analyzed using SPSS v.23.
Results: A total of 159 duodenal biopsies were included in the study. Normal duodenal morphology was noted in 85 (53.45%) cases while 74 (46.83%) cases revealed abnormal duodenal pathology. There were 46 (28.93%) cases consistent with celiac disease. Twenty eight (17.61%) cases were of other duodenal pathologies of which non-specific duodenitis was most common. There were 22 (13.83%) cases of duodenitis and 2 (1.26%) cases were of duodenal ulcer. One case (0.62%) each was seen of Brunner gland hyperplasia, adenocarcinoma, signet ring carcinoma and one case was of metastatic adenocarcinoma.
Conclusion: In our study we found a significant percentage of 46.83% exhibiting abnormal duodenal pathology. Cases consistent with celiac disease were 28.93% while 13.83% of the cases had duodenitis. The percentage of malignant cases was minimal (1.88%).
Downloads
References
Akbulut UE, Fidan S, Emeksiz HC, Ors OP. Duodenal pathologies in children: a single-center experience. J de pediatria. 2018; 94(3):273-8.
DOI: https://doi.org/10.1016/j.jped.2017.06.018
Kakar S, Nehra V, Murray JA, Dayharsh GA, Burgart LJ. Significance of intraepithelial lymphocytosis in small bowel biopsy samples with normal mucosal architecture. Ame J Gastro. 2003; 98(9):2027-33.
DOI: https://doi.org/10.1016/S0002-9270(03)00542-2
Mahadeva S, Wyatt JI, Howdle PD. Is a raised intraepithelial lymphocyte count with normal duodenal villous architecture clinically relevant?. J Clin Path. 2002; 55(6):424-8.
DOI: https://doi.org/10.1136/jcp.55.6.424
Hammer ST, Greenson JK. The clinical significance of duodenal lymphocytosis with normal villus architecture. Arch Path & Laboratory Med. 2013; 137(9):1216-9.
DOI: https://doi.org/10.5858/arpa.2013-0261-RA
Fernández Bañares F, Mariné M, Rosinach M, Carrasco A, Esteve M. Type 1 Marsh celiac disease: diagnosis and response. OmniaScience Monographs. 2014.
DOI: https://doi.org/10.3926/oms.214
Yadav P, Das P, Mirdha BR, Gupta SD, Bhatnagar S, Pandey RM, et al. Current spectrum of malabsorption syndrome in adults in India. Indian Journal of Gastroenterology. 2011; 30(1):22-8.
DOI: 10.1007/s12664-011-0081-0
Ghoshal UC, Mehrotra M, Kumar S, Ghoshal U, Krishnani N, Misra A, Aggarwal R, Choudhuri G. Spectrum of malabsorption syndrome among adults & factors differentiating celiac disease & tropical malabsorption. Indian J Med Res. 2012; 136(3):451-59.
Balasubramanian P, Badhe BA, Ganesh RN, Panicker LC, Mohan P. Morphologic Spectrum of Duodenal Biopsies in Malabsorption: A Study from Southern India. J Cli Diagnostic Res. 2017; 11(7):EC17.
DOI: https://doi.org/10.7860/JCDR/2017/23871.10231
Wahab PJ, Crusius JB, Meijer JW, Mulder CJ. Gluten challenge in borderline gluten-sensitive enteropathy. American J Gastro. 2001; 96(5):1464-69.
DOI: https://doi.org/10.1111/j.1572-0241.2001.03812.x
Day DW, Jass JR, Price AB, Shepherd NA, James M, Sloan JM. Chronic ‘non specific’duodenitis. Morson and Dawson’s gastrointestinal pathology. 4th ed. Blackwell Publishing. 2003;308.
Madsen JE, Vetvik KÅ, Aase ST. Helicobacter‐associated duodenitis and gastric metaplasia in duodenal ulcer patients. APMIS. 1991; 99(7‐12):997-1000.
DOI: https://doi.org/10.1111/j.1699-0463.1991.tb01291.x
Wyatt JI, Rathbone BJ, Sobala GM, Shallcross T, Heatley RV, Axon AT, et al. Gastric epithelium in the duodenum: its association with Helicobacter pylori and inflammation. J Cli Path. 1990; 3(12):981-6.
DOI: https://doi.org/10.1136/jcp.43.12.981
Chu KM, Kwok KF, Law S, Wong KH. Patients with Helicobacter pylori positive and negative duodenal ulcers have distinct clinical characteristics. World J Gastroenterology: 2005; 11(23):3518-22.
DOI: https://doi.org/10.3748/wjg.v11.i23.3518
Cook GC. Aetiology and pathogenesis of postinfective tropical malabsorption (tropical sprue). The Lancet. 1984; 323(8379):721-3.
DOI: https://doi.org/10.1016/S0140-6736(84)92231-1
Brown IS, Bettington A, Bettington M, Rosty C. Tropical sprue: revisiting an underrecognized disease. Am J Sur Path. 2014; 38(5):666-72.
DOI: https://doi.org/10.1097/PAS.0000000000000153
Mirakian R, Richardson A, Milla PJ, Walker-Smith JA, Unsworth J, Savage MO, et al. Protracted diarrhoea of infancy: evidence in support of an autoimmune variant. Br Med J. 1986; 293(6555):1132-6.
DOI: https://doi.org/10.1136/bmj.293.6555.1132
Karegar MM, Kothari K, Mirjolkar AS. Duodenal biopsy in malabsorption-A clinicopathological study. Ind J Pathol Oncol. 2016; 3(2):197-201.
Sarfraz T, Rehman MM, Tariq H, Khan SA, Tariq H, Waqar S, et al. Histological outcome of duodenal biopsies in patients with clinically suspected celiac disease-a study of 100 cases. Pak Armed Forces Med J. 2018; 28;68(1):08-12.
Dutta AK, Balekuduru A, Chacko A. Spectrum of malabsorption in India-tropical sprue is still the leader. J Assoc Physicians India. 2011; 59(59):420-2.
Lillemoe K, Inbembo AL, Malignant neoplasms of the duodenum. Surg Gynecol Obstet. 1980; 150:822-826.
Cunningham JD, Alaeli R, Aleili M, Brower ST. Malignant bowel neoplasms. Histopathological determinants of recurrence and survival. Ann Surg. 1997; 225:300-6.
Copyright (c) 2019 Journal of Shifa Tameer-e-Millat University
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Journal of Shifa Tameer-e-Millat University (JSTMU) is the owner of all copyright to any work published in the journal. Any material printed in JSTMU may not be reproduced without the permission of the editors or publisher. The Journal accepts only original material for publication with the understanding that except for abstracts, no part of the data has been published or will be submitted for publication elsewhere before appearing and/or decision in this journal. The Editorial Board makes every effort to ensure the accuracy and authenticity of material printed in the journal. However, conclusions and statements expressed are views of the authors and do not necessarily reflect the opinions of the Editorial Board or JSTMU.
Content of this journal is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.