Histologically, what findings suggest peptic duodenitis? Gastric foveolar metaplasia is seen in the villi (which may be focal or extensive), along with active lesions (i.e., cryptitis or crypt abscess) and increased chronic inflammation in the lamina propria. Rarely, Helicobacter organisms may be identified in cases with extensive foveolar metaplasia. The differential diagnosis includes gastric heterotopia.
What are the morphologic features of celiac disease? The normal duodenal mucosa has numerous fingerlike projections, or villi, whereas in celiac disease the normal villous architecture is lost (blunted villi and crypt hyperplasia) and intraepithelial lymphocytes (IELs) are increased. Increased IELs are seen more toward the tips of the villi. These are T lymphocytes that …
Complications of celiac sprue Collagenous sprue: Some cases of longstanding sprue, unresponsive to gluten-free diet, exhibit a thickened subepithelial collagen table greater than 10 μm along with marked villous blunting. Ulcerative jejunoileitis is characterized by multiple transverse ulcers in the small intestine, predominantly in the jejunum. Enteropathy-associated T-cell lymphoma is mostly seen in older adult patients with celiac …
What is the differential diagnosis of the biopsy showing villous blunting? Allergy to other proteins (e.g., cow’s milk in the pediatric population) Dermatitis herpetiformis Nonsteroidal antiinflammatory drugs (NSAIDs) Peptic duodenitis Giardiasis Tropical sprue Crohn’s disease Severe malnutrition Bacterial overgrowth Common variable immunodeficiency Autoimmune enteropathy Graft-versus-host disease (GVHD) Zollinger-Ellison syndrome Chemotherapy effect
How should foreign bodies be removed? Once identified, nearly all objects can be removed endoscopically. Other modalities have been used with variable success, although major complications have been reported. Prior to endoscopy, a rehearsal of what will be done using retrieval devices that would capture similar-shaped foreign objects is useful. Several endoscopic retrieval tools, such …
Which anatomic and functional defects of the GI tract contribute to foreign body obstruction? Anatomic and Functional Defects of the Gastrointestinal Tract That Contribute to Foreign Body Obstruction Intestinal Site Anatomic Defect Functional Defect Esophagus Stenosis, atresia, rings, webs, benign/malignant stricture, eosinophilic esophagitis, diverticula, vascular anomalies Scleroderma, achalasia, Chagas disease Stomach Pyloric stenosis (congenital, malignancy, …
Symptoms of a complication related to foreign body ingestion Respiratory symptoms suggest entrapment of the foreign body in the hypopharynx, trachea, pyriform sinus, or Zenker diverticulum. Sharp objects may penetrate, obstruct, or perforate the esophagus or intestine, presenting with chest, neck, or abdominal pain that varies from mild discomfort to symptoms and signs of acute …
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