Histopathological spectrum of duodenal biopsies: Experience at a tertiary care hospital

  • Zafar Ali Shifa International Hospitals Ltd., Islamabad, Pakistan
  • Ghazala Mudassir Shifa College of Medicine, Shifa Tameer-e-Millat University, Islamabad, Pakistan
  • Imran Nazir Shifa International Hospitals Ltd., Islamabad, Pakistan
  • Nadira Mamoon Shifa International Hospitals Ltd., Islamabad, Pakistan
Keywords: Duodenal biopasy, celiac disease, duodenitis

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%).

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Author Biographies

Zafar Ali, Shifa International Hospitals Ltd., Islamabad, Pakistan

Associate Consultant, Pathology Laboratory

Ghazala Mudassir, Shifa College of Medicine, Shifa Tameer-e-Millat University, Islamabad, Pakistan

Assistant Professor, Department of Pathology

Imran Nazir, Shifa International Hospitals Ltd., Islamabad, Pakistan

Lab Director, Pathology Laboratory

Nadira Mamoon, Shifa International Hospitals Ltd., Islamabad, Pakistan

Section Head Histopathology, Pathology Laboratory

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.

DOI: https://doi.org/10.1097/00000658-199703000-00010

Published
2019-12-19
How to Cite
1.
Ali Z, Mudassir G, Nazir I, Mamoon N. Histopathological spectrum of duodenal biopsies: Experience at a tertiary care hospital. JSTMU [Internet]. 19Dec.2019 [cited 1Dec.2020];2(2):58-1. Available from: https://j.stmu.edu.pk/ojs/index.php/jstmu/article/view/63