Duodenitis: A Clinical, Endoscopic and Histopathologic Study

SUMMARY In 219 subjects who presented with dyspepsia the findings of serial endoscopies and mucosal biopsies ranged over periods from three to 12 months (48.9 per cent) and three to 36 months (51.1 per cent) were studied. The minimum number of endoscopies per subject was four. One hundred and sixty-three subjects had one or more periods of treatment with cimetidine. One hundred and thirty-five had a pentagastrin-stimulated maximal acid output measurement. At the initial endoscopy 78 subjects had either non-erosive or erosive duodenitis but no ulcer: 48 per cent of these ultimately developed an ulcer. By the final endoscopy three to 36 months after the initial one, 81.8 percent of the 219 had shown an ulcer crater at one or more endoscopy examinations. Erosive duodenitis on 276 occasions, was more common than non-erosive duodenitis on 187 occasions. Erosive duodenitis is significantly associated with a raised acid secretory capacity. Serial endoscopies reveal a permutation of association between the different degrees of duodenitis and the presence of one or more ulcer crater. The commonest permutations are non-erosive duodenitis or erosive duodenitis or ulcer (30.1 per cent) and erosive duodenitis or ulcer (23.7 per cent). Ulcer without duodenitis at any time was only seen in 8.2 per cent and duodenitis without an ulcer at any time in 18.3 per cent. Treatment with cimetidine resulted in healing of ulcer craters in 68.5 per cent but resolution of the duodenitis was observed in only 28.1 per cent. Only 10 subjects with non-erosive duodenitis alone or with ulcer came to surgery (23 per cent) compared with 62 (47 per cent) with erosive duodenitis alone or with ulcer. The persistence or recurrence of ulcers was the final arbiter for operation in most instances (50.5 per cent). Duodenitis, both non-erosive and erosive, is in 80 per cent of individuals a stage in the life-cycle and natural history of duodenal ulcer and is relatively resistant to treatment.