Diffuse duodenal nodular lymphoid hyperplasia: a large cohort of patients etiologically related to Helicobacter pyloriinfection

BMC Gastroenterology

Research Article

Mohammad S Khuroo¹  Naira S Khuroo²  Mehnaaz S Khuroo³ 

[1] Consultant Gastroenterology, Digestive Diseases Centre, Srinagar, Kashmir, India;Consultant Radiology, Digestive Diseases Centre, Srinagar, Kashmir, India;Lecturer, Department of Pathology, Government Medical college, Srinagar, Kashmir, India;

关键词: Pylorus Infection;    Pantoprazole;    Nodular Lesion;    Small Intestine Bacterial Overgrowth;    Duodenal Biopsy;   

DOI  :  10.1186/1471-230X-11-36

 received in 2010-11-05, accepted in 2011-04-11,  发布年份 2011

来源: Springer

【 摘 要 】

BackgroundNodular lymphoid hyperplasia of gastrointestinal tract is a rare disorder, often associated with immunodeficiency syndromes. There are no published reports of its association with Helicobacter pylori infection.MethodsFrom March 2005 till February 2010, we prospectively followed all patients with diffuse duodenal nodular lymphoid hyperplasia (DDNLH). Patients underwent esophagogastroduodenoscopy with targeted biopsies, colonoscopy, and small bowel video capsule endoscopy. Duodenal nodular lesions were graded from 0 to 4 based on their size and density. Patients were screened for celiac sprue (IgA endomysial antibody), immunoglobulin abnormalities (immunoglobulin levels & serum protein electrophoresis), small intestine bacterial overgrowth (lactulose hydrogen breath test), and Helicobacter pylori infection (rapid urease test, and histological examination of gastric biopsies). Patients infected with Helicobacter pylori received sequential antibiotic therapy and eradication of infection was evaluated by 14C urea breath test. Follow up duodenoscopies with biopsies were performed to ascertain resolution of nodular lesions.ResultsForty patients (Males 23, females 17; mean age ± 1SD 35.6 ± 14.6 years) with DDNLH were studied. Patients presented with epigastric pain, vomiting, and weight loss. Esophagogastroduodenoscopy showed diffuse nodular lesions (size varying from 2 to 5 mm or more) of varying grades (mean score ± 1SD 2.70 ± 0.84) involving postbulbar duodenum. Video capsule endoscopies revealed nodular disease exclusively limited to duodenum. None of the patients had immunoglobulin deficiency or small intestine bacterial overgrowth or positive IgA endomysial antibodies. All patients were infected with Helicobacter pylori infection. Sequential antibiotic therapy eradicated Helicobacter pylori infection in 26 patients. Follow up duodenoscopies in these patients showed significant reduction of duodenal nodular lesions score (2.69 ± 0.79 to 1.50 ± 1.10; p < 0.001). Nodular lesions showed complete resolution in 5 patients and significant resolution in remaining 21 patients. Patients with resistant Helicobacter pylori infection showed no significant reduction of nodular lesions score (2.71 ± 0.96 to 2.64 ± 1.15; p = 0.58). Nodules partially regressed in score in 2 patients, showed no interval change in 10 patients and progressed in 2 patients.ConclusionsWe report on a large cohort of patients with DDNLH, etiologically related to Helicobacter pylori infection.

【 授权许可】

CC BY   
© Khuroo et al; licensee BioMed Central Ltd. 2011