Related Experiment Video
Updated: Aug 28, 2025
Robotic D3 Partial Duodenal Resection with Primary Side-to-Side Anastomosis
Published on: December 15, 2023
Differential diagnosis and long-term outcomes of non-atrophic duodenal changes in children
Sofia Kröger1,2, Marleena Repo1,2, Pauliina Hiltunen1
1Department of Pediatrics, Tampere Center for Child, Adolescent and Maternal Health Research, Tampere University Hospital, Tampere University, Tampere, Finland.
Insights
Non-atrophic duodenal changes are common in children undergoing endoscopy and linked to anemia and blood in stools. Most cases, excluding celiac disease, have a good long-term outlook without a specific diagnosis.
Area of Science:
- Pediatric Gastroenterology
- Gastrointestinal Pathology
Background:
- Gastrointestinal endoscopy is crucial for investigating pediatric abdominal complaints.
- While atrophic duodenal changes are often linked to celiac disease, non-atrophic changes require further investigation regarding their prevalence and clinical significance.
Purpose of the Study:
- To determine the prevalence and clinical significance of non-atrophic duodenal changes in a large pediatric endoscopic cohort.
- To compare clinical features, diagnostic findings, and long-term outcomes between children with non-atrophic duodenal changes and those with normal histology.
Main Methods:
- A retrospective analysis of 1,170 children undergoing upper gastrointestinal endoscopy with duodenal sampling.
- Comparison of variables between groups with non-atrophic changes versus normal histology, and between diagnosed and undiagnosed non-atrophic cases.
Main Results:
- Non-atrophic duodenal changes were found in 4.4% of children, with non-specific inflammation and intraepithelial lymphocytosis being most common.
- Patients with non-atrophic changes showed higher rates of blood in stools, anemia, and positive celiac serology compared to controls.
- Of those with non-atrophic changes, 44% received a diagnosis (e.g., IBD, H. pylori, food allergy); undiagnosed cases, excluding celiac disease, had a favorable long-term prognosis, with few developing celiac disease or ulcerative colitis upon follow-up.
Conclusions:
- Non-atrophic duodenal changes are relatively common in pediatric endoscopy and associated with specific clinical indicators.
- These findings underscore the importance of evaluating non-atrophic duodenal histology beyond celiac disease.
- Excluding celiac disease, children with non-atrophic duodenal changes without an initial diagnosis demonstrate a favorable long-term prognosis.
Objectives And Study:
Gastrointestinal endoscopy is often performed when investigating abdominal complaints in children. While atrophic changes of the duodenal mucosa are usually caused by celiac disease, the prevalence and clinical significance of non-atrophic duodenal changes are less clear. We studied these issues in a large pediatric endoscopic cohort.
Methods:
Comprehensive data on clinical features, diagnostic findings and long-term outcomes of children who had undergone upper gastrointestinal endoscopy with systematic duodenal sampling were collected. Study variables were compared between children with non-atrophic changes and normal histology, and between those with non-atrophic changes who did and did not receive a diagnosis.
Results:
The study comprised 1,170 consecutive children, of whom 51 (4.4%) had non-atrophic and 315 (26.9%) atrophic duodenal changes and 804 (68.7%) normal histology. The most common non-atrophic findings were non-specific inflammation (n = 19) and intraepithelial lymphocytosis (n = 14). Patients with non-atrophic changes presented more often with blood in stools (23.5 vs. 11.3%; p = 0.009), anemia (43.2 vs. 36.5%; p = 0.028) and positive celiac serology (34.3 vs. 12.9%; p < 0.001) than those with a normal duodenum. Twenty-four (44%) of those with non-atrophic changes received an initial diagnosis, the most common of which were inflammatory bowel disease (IBD) (n = 8), Helicobacter pylori infection (n = 3) and food allergy (n = 3). The prevalence of the diagnoses did not differ from those with a normal duodenum. Those who received a diagnosis had more often blood in stools (37.5 vs. 11.1%; p = 0.027), anemia (70.6 vs. 20.0%; p = 0.002) and negative celiac serology (50.0 vs. 7.7%; p = 0.013) than those without diagnosis. During a follow-up of 6.1-13.3 years, five of the 12 initially undiagnosed seropositive patients developed celiac disease, and one patient also developed ulcerative colitis.
Conclusion:
Non-atrophic duodenal changes are relatively common and associated with anemia, blood in stools, and positive celiac disease serology. Excluding potential celiac disease, those without an initial diagnosis have a favorable long-term prognosis.
More Related Videos
Related Concept Videos
01:28Peptic Ulcer Disease III: Clinical Manifestations and Diagnostic Studies
Few clinical manifestations differentiate gastric ulcers from duodenal ulcers. Distinctions in the location, timing, and pain relief are crucial for healthcare providers in differentiating between gastric and duodenal ulcers during clinical assessments.
01:30Inflammatory Bowel Disease III: Diagnostic Studies and Management I-Nutritional Therapy
Diagnostic studies
A colonoscopy is the definitive screening test, distinguishing ulcerative colitis from other colon diseases with similar symptoms. During a colonoscopy test, inflamed mucosa with exudate ulcerations can be observed, and biopsies are taken to determine the histologic characteristics of the...
01:29Gastroesophageal Reflux Disease II: Clinical Features and Management
Clinical Manifestations
GERD presents itself in a multitude of ways, with symptoms varying from person to person. The hallmark symptoms are...
01:26Esophageal Strictures-II: Clinical Features and Management
Healthcare providers should gather a comprehensive medical history and conduct a physical examination for diagnosis. If esophageal stricture is...
01:21Barrett Esophagus-II: Clinical Manifestations and Management
To diagnose Barrett's esophagus, healthcare providers often recommend an endoscopy for those showing symptoms of acid reflux. The procedure...
01:25Peptic Ulcer Disease V: Surgical Management and Nursing Care
Surgical Interventions for Peptic Ulcer Disease