This article will help you read and understand your pathology report for peptic duodenitis.
by Jason Wasserman MD PhD FRCPC, reviewed by our Patient Partners on September 16, 2020
The small bowel is a part of the digestive system. Another name for the small bowel is the small intestine. The small bowel is a long tube that starts at the stomach and ends at the colon. It is divided into three parts: duodenum, jejunum, and ileum. The duodenum is the shortest part of the small bowel. It connects to the stomach on the right side of the body just below the ribs.
Food that we eat enters the stomach where it is mixed and broken down by strong acids made by cells inside the stomach. When this is complete, the digested food moves into the small bowel. The purpose of the small bowel is to absorb nutrients from the food and transport those nutrients into the body.
The inside of the duodenum is lined by epithelial cells that are specially designed to absorb nutrients from the food we eat. These specialized cells form a barrier called an epithelium. Below the epithelium is a thin layer of tissue called the lamina propria. This tissue contains many small blood vessels which support the epithelial cells.
Mucosa is a word pathologists use to describe the epithelium and lamina propria together. The mucosa in the small bowel grows in a way that creates long finger-like projections of tissue called villi. These villi allow the small bowel to have a large surface area in a relatively small space.
Below the mucosa are specialized cells that connect to form round structures called Brunner’s glands. These glands produce substances which protect the epithelial cells from the strong acid coming from the stomach.
Peptic duodenitis is a non-cancerous change that happens in the duodenum. It is caused by increased acid production in the stomach. The extra acid spills into the duodenum where it damages the cells in the mucosa. The damage causes abdominal pain which is worse when the stomach is empty and better after a meal. If left untreated, peptic duodenitis can lead to ulcers and bleeding in the duodenum.
The most common cause of increased acid production is infection of the stomach by a bacteria called Helicobacter. Other common causes of increased acid production are prolonged use of non-steroidal anti-inflammatory drugs (NSAIDS), smoking, and chronic kidney disease.
The diagnosis of peptic duodenitis is made after a pathologist examines a tissue sample from the inside of the duodenum under the microscope. The tissue sample is removed in a procedure called a biopsy. A tissue sample should also be taken from inside of the stomach to look for Helicobacter. The biopsy is usually performed after the patient is sedated and a camera called an endoscope is inserted into the small bowel.
Pathologists look for the following features to make this diagnosis: