Portal hypertensive jejunopathy: a case control study

BACKGROUND

Small bowel mucosa is a recognized potential source of bleeding in portal hypertension. However, the frequency of its involvement is not known.

AIMS

To document the nature, severity and frequency of endoscopic and histologic changes in the jejunum in patients with portal hypertension.

METHODS

Forty consecutive patients with portal hypertension and 43 patients with non-ulcer dyspepsia (controls) underwent push enteroscopy and jejunal, duodenal and gastric biopsies. Biopsies were randomized and examined by a blinded pathologist for inflammation and vascular dilatation, which was quantified by morphometry.

RESULTS

Endoscopic jejunopathy was observed in 6 patients and none of the control subjects. All patients with jejunopathy had portal hypertensive gastropathy (PHG) and 5 had duodenopathy. Vascular dilatation was observed in 15 patients and 25 control subjects (p = ns). The degree of vascular dilatation was similar in both groups. Inflammatory changes were observed in 24 patients and 25 control subjects (p = 0.05).

CONCLUSIONS

Endoscopic jejunopathy was present in 15% of patients with portal hypertension. These changes were mild in 83% of them. All patients with jejunopathy also had PHG. Histologic changes were similar in patients and control subjects.

Helicobacter pylori and intestinal metaplasia of gastric mucosa

BACKGROUND

The role of Helicobacter pylori in stomach carcinogenesis is currently under study. H pylori-related chronic gastritis leading to dysplasia or intestinal metaplasia (IM) especially of the colonic type is postulated as one of the mechanisms.

METHODS

We studied 120 patients with or without H pylori infection to determine the frequency of occurrence of IM in the stomach.

RESULTS

IM was found in 16.6% of patients; most cases had the small intestinal type, which is not known to have a malignant potential. There was no relation between H pylori infection and development of IM.

CONCLUSION

H pylori infection leading to IM does not appear to be a factor in the genesis of carcinoma stomach in our population.

Prepyloric diaphragm detected following foreign body ingestion

Prepyloric diaphragms are unusual and are usually detected in adulthood. We report a five-year-old boy who presented with history of ingestion of a coin and was found to have a prepyloric diaphragms on laparotomy.