"Bubbly" duodenal bulb in celiac disease: radiologic-pathologic correlation

Area of Science:

• Gastroenterology
• Internal Medicine

Background:

• Celiac disease is an autoimmune disorder triggered by gluten.
• Some patients with celiac disease exhibit atypical symptoms and poor response to gluten-free diets.
• Peptic duodenitis can cause duodenal bulb abnormalities.

Observation:

• Three patients with refractory celiac disease presented with small hexagonal filling defects in the duodenal bulb on imaging.
• Biopsies confirmed celiac disease and peptic duodenitis in all patients.
• Elevated acid output, indicative of peptic ulcer disease, was noted in two patients.

Findings:

• Cimetidine treatment improved nutrient absorption in all three patients.
• One patient showed resolution of duodenal nodularity and peptic duodenitis after treatment.
• These findings suggest that peptic duodenitis can contribute to duodenal bulb nodularity and treatment resistance in celiac disease.

Implications:

• The presence of duodenal nodules in malabsorption cases warrants consideration of celiac disease co-existing with peptic duodenitis.
• Peptic duodenitis may be a reversible aggravating factor in some celiac disease patients.
• This highlights the importance of considering and managing peptic disease in refractory celiac disease cases.