Lymphonodular hyperplasia on the duodenal bulb indicates food allergy in children

Recently, lymphonodular hyperplasia (LNH) of the duodenal mucosa has been described in association with gastrointestinal food allergy. This study was designed to assess the significance of LNH and other mucosal lesions of the foregut in diagnosing food allergy and distinguishing it from other clinical pathological states.

During a one-year period, 136 diagnostic esophagogastroduodenoscopies were conducted in children, 34 of whom had been diagnosed as having food allergy using an oral challenge test. The endoscopic findings were analyzed in the final diagnostic groups.

LNH of the duodenal bulb with a normal villous pattern was the main endoscopic finding in 22 of the 34 children with food allergy (65 %). On the other hand, it was seen in none of the 18 patients with celiac disease, who had an atrophic duodenal mucosa. All 11 patients with Helicobacter pylori infection had lymphonodular gastritis, but no LNH beyond the pylorus. Esophagitis (six patients) and gastritis (eight patients) were also common endoscopic findings associated with food allergy.

LNH in the duodenal bulb was associated mainly with food allergy in children. An endoscopic examination can be used as a new method of assessing gastrointestinal food allergy and differentiating it from celiac disease and other distinct types of gastrointestinal pathology.