Endoscopic signs of duodenal erosion

Erosion is a small limited superficial defect of the mucous membrane, reaching its own plate and not penetrating to the muscularis mucosa. The shape is linear or round. The borders, unlike ulcers, are blurred. In addition, erosion can be lifted with biopsy forceps together with the surrounding mucous membrane, while the base of the ulcer is firmly fixed. Healing of erosions occurs within a few hours or days without scar formation.

Endoscopic characteristics of erosions and ulcers

	Erosion	Ulcer
Damage	Defect within the mucous membrane	The defect can affect the entire wall.
Form	Round or linear	Round, linear or irregular
Size	Small: only a few millimeters	Usually larger than a few millimeters
Depth	The defect is flat (slightly sunken)	The defect is deep and can penetrate through all layers of the wall.
Quantity	Usually multiple	As a rule, single
Reason for defect	Blood, hematin or fibrinous exudate	Blood, clots, hematin, fibrin, pus or necrotic masses
Edges	Flat, often blurry	Sharply demarcated, smoothed or raised, continuous or discontinuous
Mobility	Movable together with the mucous membrane	Has a fixed base
Flow	Typically acute (chronic erosions are called papules)	Usually subacute or chronic
Healing	Through re-epithelialization (without scar)	Through scar formation

According to etiology, there are 3 groups of erosions:

1. Idiopathic erosions with a tendency to periodic exacerbation.
2. Erosions resulting from a stressful situation.
3. Erosions resulting from the use of drugs and alcohol.

Classification.

1. Hemorrhagic erosions.
2. Incomplete erosions.
3. Complete erosions.

Hemorrhagic erosions. These are multiple small-point defects of the mucous membrane up to 0.1 cm in diameter, dark cherry in color. They can be nested, forming spots. There is no inflammation of the mucous membrane around. They can cause profuse bleeding. They are classified as acute erosions, and exist from several hours to 10 days. They are localized in the bulb and the initial part of the postbulbar sections, rarely - only in the postbulbar sections.

Incomplete erosions. They have a rounded shape and smooth edges. The size is 0.2-0.4 cm in diameter. The bottom is usually clean, but can be covered with a thin whitish fibrin coating. There is a rim of hyperemia around the erosion. Usually, erosions are multiple, located locally, due to which the affected areas have a peculiar appearance like "pepper and salt" (according to the definition of Japanese authors) due to the contrasting mosaic combination of white and bright red colors. Merging, erosions can form large erosive surfaces of irregular shape. When erosions heal, the coating disappears, the surface becomes pink. In acute and subacute cases, they epithelialize within 5-10 days (they can epithelialize within a few hours).

Complete erosions. Rare. Localized only in the bulb. Polypoid formations of a hemispherical shape with a slight depression at the top or without it. During an exacerbation, a thin fibrin coating appears at the top. During remission, it disappears. Dimensions 0.3-0.5 cm at the base. These erosions are chronic and can exist for years.

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