Gastric metaplasia of the duodenal mucosa in Crohn’s disease: novel histological and endoscopic findings

Abstract

Background and study aims Upper gastrointestinal endoscopy and biopsy are useful for differential diagnosis of Crohn’s disease (CD) of the large intestine and ulcerative colitis (UC). We aimed to identify novel histopathological and endoscopic findings in the upper gastrointestinal tract in patients with CD who did not have Helicobacter pylori infection. Patients and methods Upper gastrointestinal endoscopy was performed on patients with CD and UC. Mucosal lesions detected were subsequently observed using magnifying endoscopy with narrow-band imaging (M-NBI), following which biopsy was performed. When no mucosal lesion was detected on conventional endoscopy, M-NBI and biopsy were performed on four sites: the gastric body, gastric antrum, duodenal bulb, and second portion of the duodenum. Results The prevalences of gastric metaplasia (GM) were 48 % (24/50) and 16 % (8/50) in the CD and UC groups, showing a significant difference (P = 0.001). In 23 of 24 patients with histologically proven GM in the CD group, mucosal lesions were detected using conventional white-light imaging (C-WLI). In 22 of 24 patients with histologically proven GM in the CD group, disappearance of normal villous structure and the presence of curved marginal crypt epithelium were noted using magnifying endoscopic findings characteristic of GM (M-GM). A combination of C-WLI and M-NBI yielded a significantly increased specificity (P = 0.004) and accuracy (P = 0.039). Conclusions The prevalence of GM in the duodenal mucosa was significantly higher in patients with CD than in controls. The identified endoscopic findings may be useful as novel indicators for the histological diagnosis of GM in the duodenum.

Upper Gastrointestinal Tract Involvement in Inflammatory Bowel Diseases: Histologic Clues and Pitfalls

“… 87 , 91 Foveolar metaplasia may also develop, albeit less frequently compared with duodenal CD. 80 On the basis of the series of Lin et al, 87 diffuse chronic duodenitis is the only unique UGI inflammatory pattern that occurred only in UC patients and not in controls. Increased IEL may also be detected, especially in pediatric patients, and it is significantly more common in UC-associated duodenitis compared with CD-related cases.…”

“… 79 In many cases, foveolar metaplasia is also detected. 80 Foveolar metaplasia has long been documented in various forms of duodenitis, including peptic injury, while pseudopyloric metaplasia is used as a sign of chronic ileitis. However, recently it was recognized that foveolar metaplasia is not specific to the UGI tract, and both forms of gastric metaplasia may develop in ileal Crohn’s disease.…”

“…In contrast to the decrescendo pattern of celiac disease, the intraepithelial T cells are usually evenly distributed from the top of the villi to the base of the crypts 79. In many cases, foveolar metaplasia is also detected 80. Foveolar metaplasia has long been documented in various forms of duodenitis, including peptic injury, while pseudopyloric metaplasia is used as a sign of chronic ileitis.…”

“…4). 87,91 Foveolar metaplasia may also develop, albeit less frequently compared with duodenal CD 80. On the basis of the series of Lin et al,87 diffuse chronic duodenitis is the only unique UGI inflammatory pattern that occurred only in UC patients and not in controls.…”

Alterations in p53, Microsatellite Stability and Lack of MUC5AC Expression as Molecular Features of Colorectal Carcinoma Associated with Inflammatory Bowel Disease

“…In CD the presence of metaplastic changes such as pyloric gland metaplasia or gastric foveolar metaplasia have been described in the small bowel mucosa or in pouchitis in long-standing disease [17][18][19][20][21][22]. Recently, gastric metaplasia (GM) has been identified as a substrate for the initiation of the serrated pathway of CRC, due to the continuous lesion of the colonic epithelium of the right colon [23].…”