Endoscopic signs of duodenitis

Duodenitis is an inflammatory-dystrophic change in the mucous membrane of the duodenum. Most often, the pathological process is localized in the bulb.

According to the nature of distribution, the following are distinguished:

1. Total duodenitis.
2. Limited duodenitis:
   1. distal,
   2. proximal.

The etiology and pathogenesis are different: total duodenitis occurs as a result of diffuse diseases of the mucous membrane of the small intestine, proximal (bulbitis) - as a result of ulcer disease, except for follicular; distal, including papillitis, accompanies diseases of the pancreas and biliary system.

Forms of duodenitis.

1. Superficial (moderately expressed).
2. Expressed.
3. Sharply expressed.
4. Atrophic duodenitis.

Follicular duodenitis is considered separately.

Superficial duodenitis. The mucous membrane is unevenly edematous, areas of inflamed mucous alternate with areas that are outwardly unchanged. In areas of pronounced edema, sharp hyperemia is visible in the form of individual spots (motley appearance). The diameter of the areas of spotted hyperemia usually does not exceed 0.2-0.3 cm, they protrude slightly above the rest of the edematous mucous membrane. There is a slight thickening of the folds of the mucous membrane.

In severe duodenitis, the mucous membrane of the duodenum is diffusely edematous, there are more areas of spotted hyperemia, they often merge into fields with a diameter of 1.5-2.0 cm. In areas of spotted hyperemia, there are small-point hemorrhages. There is a lot of mucus, in addition, a transparent light-yellow opalescent liquid appears in the lumen of the intestine. When manipulating with an endoscope, the mucous membrane of the duodenum bleeds easily.

The endoscopic picture of severe duodenitis is the same as with severe duodenitis, but more pronounced. Areas of spotted hyperemia merge into fields of 2.0-4.0 cm or diffuse damage, there are small-point hemorrhages, the mucosa is easily vulnerable, bleeding. Erosions appear in some areas. In addition, in areas of the most pronounced edema, multiple whitish grains are detected, sharply different in color from the surrounding edematous-hyperemic mucous membrane of the duodenum and protruding above its surface, the diameter of which is 0.5-0.8 mm. Such an endoscopic picture is described as the "semolina" phenomenon. In the lumen of the duodenum, an accumulation of a large amount of liquid contents with a significant admixture of bile and mucus is determined.

Atrophic duodenitis. Along with edema and hyperemia, more or less wide areas of thinned, pale mucous membrane are revealed. The membrane has a translucent network of numerous small vascular branches. The mucous membrane is often clean, without mucus accumulations.

Follicular duodenitis. Against the background of a pale pink mucous membrane, numerous, less often single, pale, small rounded protrusions of 0.2-0.3 cm on a wide base of a whitish color are often visible. They are often multiple: they can be located in a cluster, or at a distance. Usually localized in the bulb. Often occur with parasitic invasion: lamblia, helminths.

Papillitis.

1. Moderately expressed.
2. Expressed.

There are 2 normal variants of the major duodenal papilla (MDP):

1. The BDS does not differ in color from the surrounding mucous membrane.
2. Part of the BDS is covered with ductal epithelium of a whitish, shiny, “radiant” appearance.

Moderate papillitis. The mucous membrane in the nipple area is edematous, the nipple is pale, there is no shine, there may be foci of hyperemia, the villi may be whitish.

Severe papillitis. Severe hyperemia, edema, radiant pattern disappears, surface is uneven, bumpy, nipple size can increase to 1.5-2.0 cm.

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