Quantitative histological study of duodenitis in biopsies.

In 48 patients, suffering from an endoscopically verified ulcerative or nonulcerative duodenitis, biopsies of the bulb and of the lower duodenum have been studied with quantitative histological methods. The evaluation of the data with simple and multivariate statistical methods revealed: In healthy duodenal mucosa the height of the villous epithelium significantly decreases with rising age, while the cellular infiltration of the stroma increases. Conclusive, sex dependent differences are not present. Many histological variables are significantly correlated to the endoscopical degree of inflammation, if the endoscopically normal mucosa of the lower duodenum is used as normal control. In contrast, the endoscopically normal bulb mucosa histologically showed inflammatory alterations in the majority of cases. As shown by a multivariate discriminant analysis, a correct histological diagnosis of duodenitis will be reached in nearly all patients, if a biopsy of the endoscopically normal lower duodenum of the same patients is used as matched control. As shown by a multiple stepwise regression analysis, the same procedure results in a good correspondence of the endoscopically estimated degree of inflammation and the values, calculated from histology. In some patients, the lower duodenum slightly takes part in the inflammation of the bulb. But no significant correlation was found between the calculated degree of inflammation of the bulb and of the lower duodenum, neither in ulcerative duodenitis nor in nonulcerative duodenitis. From a practical point of view, our findings elucidate, that the simultaneous histological examination of mucosa of the bulb and of endoscopically healthy mucosa of the lower duodenum will be an essential help in the diagnosis and grading of duodenitis and should be introduced as routine method.