Frequency and extent of bulbar duodenitis in duodenal ulcer, endoscopic and histological study

The present prospective investigation was aimed at ascertaining the true incidence of duodenitis in the presence of duodenal ulcer, and the extent of bulbar involvement. In 54 consecutive patients 3 biopsy specimens were collected from preestablished sites during endoscopy. Endoscopic findings were defined as the presence or absence of definite inflammation. Biopsy specimens were evaluated blind, and the degree of duodenitis was classified from 0 to 3 in accordance with the criteria proposed by Whitehead; grade 1 was further classified into 1a (within the range of normal mucosa) and 1b (mild duodenitis). Only grades 1b, 2 and 3 were regarded as duodenitis. Reliable histologic evaluation of all 3 biopsies was possible in only 36 out of the 54 patients. Results show that endoscopic and histologic findings are in agreement in 82% of the patients, but endoscopic judgement of inflammation was false in 17 out of 54 (35%) observations of histologically normal mucosa. Histological duodenitis is more frequent and more severe close to the ulcer than in the mid-bulbar area, and the mucosa of the mid-bulbar area appears to be significantly more affected by the inflammatory process than the apex. Duodenitis is present predominantly in the areas of the duodenal bulb in which ulcers usually develop, and therefore it might not be merely a phenomenon induced by the presence of the ulcer.