A 58-year-old man underwent upper gastrointestinal surveillance endoscopy for Barrett's oesophagus. This showed a possible gastric ulcer, although histological examination was normal. Follow-up endoscopy showed white ridges in the distal duodenum and these were subjected to biopsy. Histological examination of the biopsy specimens showed polypoid duodenal mucosa showing features similar to those of a hyperplastic polyp of the colon. In addition, the mucosal surface was focally of gastric surface type. The features were interpreted overall as most likely to represent an unusual form of regenerative change in the setting of previous chronic inflammatory mucosal damage. The case is presented as an unusual histological phenomenon at this site; it would be important not to overdiagnose neoplasia in this situation.A 58-year-old man with a 2-year history of Barrett's oesophagus underwent routine upper gastrointestinal surveillance endoscopy for this condition. This showed an endoscopic mucosal abnormality thought clinically most likely to represent a gastric antral ulcer, but gastric biopsy showed normal gastric mucosa with no evidence of Helicobacter-like organisms. He was treated with a protonpump inhibitor. A CLOtest was not carried out but was negative at follow-up endoscopy 3 months later, which showed endoscopically normal gastric mucosa. However, at this time the distal duodenum showed an unusual appearance, with white ridges on the tops of the mucosal folds ( fig 1A). Further biopsy specimens were taken from the gastric antrum and from the distal duodenum.
PathologyThe repeat gastric antral biopsy specimens showed normal appearances; no Helicobacter-like organisms were identified. The duodenal biopsy specimens showed an unusual appearance, with one polypoid fragment showing an area of elongated crypts and villi with serrated profiles (fig 1B,C). The appearances were similar to those of a hyperplastic polyp of the colon. The duodenal mucosa in this area was also focally covered by gastric-type surface epithelium-apical diastase-periodic acid-Schiff-positive mucin glands were present ( fig 1D)