Skip to main content
SpringerLink
Log in

Gastroduodenal inflammation in patients with nonulcer dyspepsia

A controlled endoscopic and morphometric study

  • Original Articles
  • Published:
Digestive Diseases and Sciences Aims and scope Submit manuscript

Abstract

Proper control and quantitation are important in the accurate evaluation of gastroduodenal inflammation in dyspeptic patients without ulcers or erosions as proved by endoscopy. The endoscopic findings and the gastroduodenal mucosal inflammatory cell count in 31 patients with nonulcer dyspepsia were compared with an age-matched group of 32 healthy controls. Endoscopy revealed similar mucosal changes and in similar frequency in both groups. Differential mucosal inflammatory cell count showed a statistically significant (P<0.001) increase in the neutrophil count in the gastric body, antrum, and duodenal cap of the dyspeptic group, as well as a slight but significant (P<0.05) increase in the round cell and eosinophil count of the duodenal mucosa alone. No correlation was found between the endoscopic changes and an increase in neutrophil count above a normal level determined by the healthy controls. However, an endoscopically normal mucosa was more likely to be associated with a normal neutrophil count. Active inflammation of the gastroduodenal mucosa likely accounts for the symptoms in patients with nonulcer dyspepsia.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Horrocks JC, De Dimbal FT: Clinical presentation of patients with ‘dyspepsia.’ Detailed symptomatic study of 360 patients. Gut 19:19–26, 1978

    PubMed  Google Scholar 

  2. Gear MWL, Barnes RJ: Endoscopic studies of dyspepsia in general practice. Br Med J 2:1136–1137, 1980

    Google Scholar 

  3. Greenlaw R, Sheahan DG, De Luca V, Miller D, Myerson D, Myerson P: Gastroduodenitis, a broader concept of peptic ulcer disease. Dig Dis Sci 25:660–672, 1980

    PubMed  Google Scholar 

  4. Sturdevent RAL, Walsh JH: Duodenal ulcer.In Gastrointestinal Disease. MH Sleisenger, JS Fordtran, (eds). Philadelphia, WB Saunders, 1978, pp 840–860

    Google Scholar 

  5. Tyagi KP, Mukhopadhyay AK, Agarwal HH, Naik SR, Malik GB, Gupta DN, Chuttani HK: Gastric mucosal morphology in tropics and influence of spices, tea and smoking. Nutr Metab 17:129–135, 1974

    PubMed  Google Scholar 

  6. Fung WP, Papadimitriou JM, Matz LR: Endoscopic, histological and ultrastructural correlations in chronic gastritis. Am J Gastroenterol 71:269–279, 1979

    PubMed  Google Scholar 

  7. Stahel E, Gyr K, Jallah E, Heitz P: Gastroduodenitis and peptic ulcer in a rural Liberian community. An endoscopic prospective study. Trop Geogr Med 33:155–160, 1981

    PubMed  Google Scholar 

  8. Beck IT, Kahn DS, Lacerte M, Solymar J, Callegarini U, Geokas MC: “Chronic duodenitis”: A clinical pathological entity? Gut 6:376–383, 1965

    PubMed  Google Scholar 

  9. Cotton PB, Price AB, Tighe JR, Beales JSM: Preliminary evaluation of “duodenitis” by endoscopy and biopsy. Br Med J 3:430–433, 1973

    PubMed  Google Scholar 

  10. Gelzayed EA, Biederman MA, Gelfand DW: Changing concepts of duodenitis. Am J Gastroenterol 64:213–216, 1975

    PubMed  Google Scholar 

  11. Joffe SN, Lee FD, Blumgart LH: Duodenitis. Clin Gastroenterol 7:635–650, 1978

    PubMed  Google Scholar 

  12. Shiner M, Doniach I: A study of x-ray-negative dyspepsia with reference to histologic changes in the gastric mucosa. Gastroenterology 3:313–324, 1957

    Google Scholar 

  13. Siurala M, Isokoski M, Varis K, Kekki M: Prevalence of gastritis in a rural population. Bioptic study of subjects selected at random. Scand J Gastroenterol 3:211–223, 1968

    PubMed  Google Scholar 

  14. Lambert R: Chronic gastritis: A critical study of the progressive atrophy of the gastric mucosa. Digestion 7:83–126, 1972

    PubMed  Google Scholar 

  15. Robert DM: Chronic gastritis, alcohol, and nonulcer dyspepsia: Gut 13:768–774, 1972

    PubMed  Google Scholar 

  16. Oddsson E, Vibeke Binder, Thorgeirsson T, Jonasson TA, Gunnlaugsson O, Marion Wulff, Jónasson K, Wulff HR, Bjarnason O, Riis P: A prospective comparative study of clinical and pathological characteristics in Icelandic and Danish patients with gastric ulcer, duodenal ulcer, and x-ray-negative dyspepsia. II. Histological results. Scand J Gastroenterol 13:489–495, 1978

    PubMed  Google Scholar 

  17. Holdstock GE, Smith CL, Isaacson P: Prevalence and significance of chronic gastritis in patients undergoing endoscopy. Gut 20:A901, 1979

    Google Scholar 

  18. Aronson AR, Norfleet RG: The duodenal mucosa in peptic ulcer disease. A clinical pathological correlation. Am J Dig Dis 7:506–514, 1962

    PubMed  Google Scholar 

  19. Kreuning J, Bosman FT, Kuiper G, v d Wal AM, Lindeman J: Gastric and duodenal mucosa in “healthy” individuals. An endoscopic and histopathological study of 50 volunteers. J Clin Pathol 3:69–77, 1978

    Google Scholar 

  20. Holdstock GE, Smith CL, Isaacson P: Prevalence and significance of duodenitis in patients undergoing endoscopy. Gut 20:A902, 1979

    Google Scholar 

  21. MacDonald WC, Rubin CE: Gastric biopsy—a critical evaluation. Gastroenterology 53:143–170, 1967

    PubMed  Google Scholar 

  22. Palmer ED: Gastritis: A re-evaluation. Medicine 33:199–290, 1954

    PubMed  Google Scholar 

  23. Joske RA, Finkh ES, Wood IJ: Gastric biopsy. A study of 1000 consecutive successful gastric biopsies. Q J Med 24:269–294, 1955

    PubMed  Google Scholar 

  24. Korn ER, Foroozan P: Endoscopic biopsies of normal duodenal mucosa. Gastrointest Endosc 21:51–54, 1974

    PubMed  Google Scholar 

  25. Villako K, Tamm A, Savisaar E, Ruttas M: Prevalence of antral and fundic gastritis in a randomly selected group of an Estonian rural population. Scand J Gastroenterol 11:817–822, 1976

    PubMed  Google Scholar 

  26. Ihamaki T, Saukkonen M, Siurala M: Long-term observation of subjects with normal mucosa and with superficial gastritis: Results of 23–27 years' follow-up examinations. Scand J Gastroenterol 13:771–775, 1978

    PubMed  Google Scholar 

  27. Myren J, Sereck-Hanssen A: Gastroscopic observation related to bioptical histology in healthy medical students. Scand J Gastroenterol 10:353–355, 1975

    PubMed  Google Scholar 

  28. Seaman WB: Gastritis. Radiology 113:485–486, 1974

    PubMed  Google Scholar 

  29. Cheli R, Simon L, Aste H, Figus IA, Nicolo G, Bajtai A, Puntoni R: Atrophic gastritis and intestinal metaplasia in asymptomatic Hungarian and Italian populations. Endoscopy 12:105–108, 1980

    PubMed  Google Scholar 

  30. Belber JP: Endoscopic examination of the duodenal bulb: A comparison with x-ray. Gastroenterology 61:55–61, 1971

    PubMed  Google Scholar 

  31. Thomson WO, Robertson AG, Imrie CW, Joffe SN, Lee FD, Blumgart LH: Is duodenitis a dyspeptic myth? Lancet 1:1197–1198, 1977

    PubMed  Google Scholar 

  32. Wenger J, Petty AM, Mendeloff J: Simultaneous gastroscopic, photographic and histologic study of common types of gastritis: A preliminary report. Gastrointest Endosc 16:234–236, 1970

    PubMed  Google Scholar 

  33. Myren J, Sereck-Hanssen A: The gastroscopic diagnosis of gastritis with particular reference to mucosal reddening and mucus covering. Scand J Gastroenterol 9:457–462, 1974

    PubMed  Google Scholar 

  34. Turner CJ, Lipitz LR, Pastore RA: Antral gastritis. Radiology 113:305–312, 1974

    PubMed  Google Scholar 

  35. Gregg JA, Garabedian M: Duodenitis. Am J Gastroenterol 61:177–184, 1974

    PubMed  Google Scholar 

  36. Whitehead R, Truelove SC, Gear MWL: The histological diagnosis of chronic gastritis. J Clin Pathol 25:1–11, 1972

    PubMed  Google Scholar 

  37. Whitehead R, Roca M, Meikle DD, Skinner J, Truelove SC: The histological classification of duodenitis in fibreoptic biopsy specimens. Digestion 13:129–136, 1975

    PubMed  Google Scholar 

  38. Wellbrock WLA: Duodenitis and duodenal ulcer. Ann Surg 9:533–539, 1930

    Google Scholar 

  39. Parl FF, Lev R, Thomas E, Pitchumoni CS: Histologic and morphometric study of chronic gastritis in alcoholic patients. Hum Pathol 10:45–56, 1979

    PubMed  Google Scholar 

  40. Fitzgibbon JH, Long GB: A gastroscopic study of healthy individuals: A preliminary report. Gastroenterology 1:67–71, 1943

    Google Scholar 

  41. Cronstedt JL, Simson IW: Correlation between gastroscopic and direct vision biopsy findings. Gastrointest Endosc 19:174–175, 1973

    PubMed  Google Scholar 

  42. Fontan AN, Rapaport M, Celener D, Piskorz E, Peralta CG, Rubio HH: Chronic nonspecific duodenitis (bulbitis). Endoscopy 10:94–98, 1978

    PubMed  Google Scholar 

  43. McCallum RW, Sing D, Wollman J: Endoscopic and histological correlations of the duodenal bulb. Arch Pathol Lab Med 103:169–172, 1979

    Google Scholar 

  44. Goldberg SJ, Smith CL, Connell AM: Emotion related gastritis. Am J Gastroenterol 65:41–45, 1976

    PubMed  Google Scholar 

  45. Ostrow JD, Resnick RH: Hyperchlorhydria, duodenitis and duodenal ulcer: A clinical study of their interrelationships. Ann Intern Med 51:1303–1328, 1959

    PubMed  Google Scholar 

  46. Rhodes J, Evans KT, Lawrie JH, Forrest APM: Course mucosal folds in the duodenum. Q J Med 37:151–169, 1968

    PubMed  Google Scholar 

  47. Hodgkin GKH, Freedman R, Fuller I, Whewell J: Duodenal ulcer and recurrent dyspepsia. Br Med J 3:368–371, 1970

    PubMed  Google Scholar 

  48. DeLuca VA, Winnan GG, Sheahan DG, Sanders FJ Jr, Greenlaw R, Marignani P, Gorelick FS, Bhalotra R, Goldblatt RS: Is gastroduodenitis part of the spectrum of peptic ulcer disease? J Clin Gastroenterol 3:17–22, 1981

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Gastroenterology Unit, Department of Medicine, Jordan University Hospital, Jordan University, P.O. Box 13046, Amman, Jordan

    Ala U. Toukan FRCP(C), M. Faisal Kamal PhD, Samir S. Amr MD, Mohammed A. Arnaout MB, BS & Adel S. Abu-Romiyeh BSc(Biol)

  2. Department of Pathology, Faculty of Medicine, Jordan University, P.O. Box 13046, Amman, Jordan

    Ala U. Toukan FRCP(C), M. Faisal Kamal PhD, Samir S. Amr MD, Mohammed A. Arnaout MB, BS & Adel S. Abu-Romiyeh BSc(Biol)

Authors
  1. Ala U. Toukan FRCP(C)
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M. Faisal Kamal PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Samir S. Amr MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Mohammed A. Arnaout MB, BS
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Adel S. Abu-Romiyeh BSc(Biol)
    View author publications

    You can also search for this author in PubMed Google Scholar

Additional information

This work was kindly supported by funds from Jordan University, Amman, and by technical assistance from the Arab Pharmaceutical Manufacturing Company, Salt, Jordan.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Toukan, A.U., Kamal, M.F., Amr, S.S. et al. Gastroduodenal inflammation in patients with nonulcer dyspepsia. Digest Dis Sci 30, 313–320 (1985). https://doi.org/10.1007/BF01403839

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF01403839

Keywords

Search

Navigation