Preliminary Evaluation of "Duodenitis" by Endoscopy and Biopsy

Abstract

may well be fortuitous or related to the increasing use of this procedure, or may be related to the initial reason for advising sterilization. All three of our patients had psychological reasons for seeking sterilization and, in addition, one had already established hypertension on the basis of chronic pyelonephritis. The possibility exists that the relation between the use of oral contraceptives and the disease could be due to the contraception itself rather than to its methods of achievement. This might be worth looking into before concluding that oral contraceptives are a risk factor in acute myocardial infarction and before recommending sterilization as a preferable method of contraception.It is now well established that the risks of developing ischaemic heart disease prematurely are increased in association with excess cigarette smoking (Doll and Hill, 1964) , 1971). Obviously all these factors are interrelated and must be taken into account in interpreting the role of oral contraceptives in myocardial infarction.The available evidence suggests that it would be wise to identify those risk factors commonly associated with ischaemic heart disease in young women about to start oral contraceptive therapy. It is easy to screen for hypertension and to monitor blood pressure subsequently. In those with a family history of precocious ischaemic heart disease a case can be made for screening for abnormalities in blood lipid concentrations and also for giving advice against cigarette smoking. In those with identifiable risk factors alternative contraceptive measures should be advised or, if personal circumstances demand, the duration of oral contraceptive use should be limited.

Focus on Duodenitis

“…Some authors believe that duodenitis is part of the spectrum of peptic ulcer [8,11,27,28], representing either the early devel opment or the later stage in the healing pro cess of duodenal ulceration [10,11]. As a matter of fact duodenitis was found to be associated with duodenal ulcer only in 39-40% of cases or less [13,29,30], Moreover, the inflammatory process is usually re stricted to the periulcer site, suggesting that duodenitis in this case is merely a perifocal lesion [5,9,31], On the other hand, when duodenitis is detected in areas far from the ulcer [16,17,32] , the concomitant presence of duodenal ulcer and duodenitis should be considered as fortuitous (table II).…”

“…Contact bleeding and, in severe cases, petechial hemorrhages and/or multiple mucosal erosions can be ob served. Various endoscopic classifications have been proposed [8][9][10], the most widely employed being that by Joffe [8] (table I).…”

“…The correlation between endoscopic and histological findings of duodenitis is consid ered to be good [ 16], fair [9,17], poor [ 18] or completely unsatisfactory [19] according to the various authors.…”

“…When the test was car ried out in patients with no endoscopic evi dence of mucosal abnormalities, even acid perfusion was ineffective in producing symptoms [8]. Whereas no agreement has yet been reached on the role of duodenitis as a cause of dyspepsia, it is widely recognized that X-ray diagnosis of duodenitis is totally unreliable, for want of specific radiological markers [8][9][10], Therefore, only endoscopy and/or histopathology provide acceptable diagnostic criteria.…”

The Pathophysiology of Duodenitis

“…Duodenitis was first described by Baudin [I] in 1837, but its existence as an entity distinct from duodenal ulcer disease has remained in doubt; a number of authors have considered that duodenitis is a precursor or variant of duodenal ulcer disease [2][3][4], If this hypothesis is correct, ulceration should be a common complication of duodeni tis and. furthermore, the gastric secretory status of pa tients with duodenitis should be similar to that of pa tients with duodenal ulceration and different from that of the normal population.…”