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Lymphocytic duodenosis: aetiology and long-term response to specific treatment
Mercé Rosinach1, Maria Esteve, Clarisa González
1Department of Gastroenterology, Hospital Universitari Mutua Terrassa, University of Barcelona, Plaza Dr. Robert 5, Terrassa, Catalonia, Spain.
Insights
Lymphocytic duodenosis often has multiple causes, with gluten-sensitive enteropathy and Helicobacter pylori infection being common. Clinical symptoms can guide initial treatment for this condition.
Area of Science:
- Gastroenterology
- Internal Medicine
- Pathology
Background:
- The clinical significance of lymphocytic duodenosis is not well-established.
- Understanding the causes of lymphocytic duodenosis is crucial for effective patient management.
Purpose of the Study:
- To prospectively investigate the causes of lymphocytic duodenosis.
- To identify patterns in clinical presentation associated with different aetiologies.
Main Methods:
- Prospective study of 90 patients with lymphocytic duodenosis and coeliac disease spectrum symptoms.
- Inclusion of serological testing, HLA genotyping, H. pylori assessment, parasite examination, and NSAID intake recording.
- Aetiology determined by long-term response to specific therapies.
Main Results:
- Multiple potential aetiologies were identified in 44% of patients.
- Gluten-sensitive enteropathy (GSE) alone or with H. pylori was diagnosed in 43.3%.
- H. pylori infection without GSE occurred in 24.4%; NSAIDs (5.5%), autoimmune disease (3.3%), and parasites (2.2%) were less common. Chronic diarrhoea correlated with GSE, while chronic dyspepsia correlated with H. pylori.
Conclusions:
- Lymphocytic duodenosis frequently involves multiple underlying causes.
- Clinical presentation is valuable for guiding initial therapeutic strategies in patients with lymphocytic duodenosis.
Background:
The clinical significance of lymphocytic duodenosis remains unclear.
Aim:
To prospectively assess the aetiology of lymphocytic duodenosis and the patterns of clinical presentation.
Methods:
Ninety consecutive patients with lymphocytic duodenosis and clinical symptoms of the coeliac disease spectrum were prospectively included. All subjects underwent serological testing and HLA genotyping for coeliac disease, assessment of Helicobacter pylori infection, and parasite stool examination. Intake of non-steroidal anti-inflammatory drugs was also recorded. The final aetiology of lymphocytic duodenosis was evaluated on the basis of the long-term response to specific therapy.
Results:
More than one initial potential aetiology was observed in 44% of patients. The final diagnosis was gluten-sensitive enteropathy alone or associated with Helicobacter pylori infection in 43.3%, Helicobacter pylori infection (without gluten-sensitive enteropathy) in 24.4%, non-steroidal anti-inflammatory drugs intake in 5.5%, autoimmune disease in 3.3%, and parasitic infection in 2.2%. Among first degree relatives and patients with chronic diarrhoea, the most common final diagnosis was gluten-sensitive enteropathy. In contrast, in the group presenting with chronic dyspepsia the most common diagnosis was Helicobacter pylori infection ('Diarrhoea' vs 'Dyspepsia' groups, p=0.008).
Conclusions:
Lymphocytic duodenosis is often associated with more than one potential initial aetiology. Clinical presentation may be useful to decide the initial therapeutic approach with these patients.
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