duodenal white spot syndrome
Introduction
Introduction to duodenal white spot syndrome Duodenal White Spot Syndrome (DWSS) is a new syndrome concept proposed by Japanese scholars in recent years based on endoscopy. It refers to the duodenal mucosa that is different from duodenal ulcer and scattered in the miliary White or white spots of the same size. Because duodenal inflammation exists in biopsy pathological examination, most scholars in China believe that it should not be classified as an independent syndrome. Its essence is a special manifestation of duodenitis, called "white." Point-type duodenitis is more appropriate, and the name has recently been applied in the domestic literature. basic knowledge The proportion of sickness: 0.002%-0.003% Susceptible people: no special people Mode of infection: non-infectious Complications: duodenal ulcer gastric ulcer atrophic gastritis
Cause
The cause of duodenal white spot syndrome
Some people think that upper gastrointestinal inflammation, especially atrophic gastritis, reduces gastric acid secretion, reduces pancreatic juice secretion, and lacks pancreatic lipase in pancreatic juice, aggravating fat digestion, absorption, and transport dysfunction, allowing lipids to be stored in absorbed epithelial cells or Mucosal lamina propria and white lesions, clinical manifestations of steatorrhea, but the Chinese atrophic gastritis lesions are mostly in the sinus, there is no acid secretion cells in this area, so the clinical appearance of atrophic gastritis gastric acid secretion function is quite normal More, plus the duodenal white spot biopsy pathological histology has inflammation, it is considered that this disease is a special duodenitis.
Light microscopy showed chronic inflammation of the duodenal mucosa at the white spot, mainly manifested by lymphocytes, plasma cells, monocytes and eosinophils, lymphatic and vasodilatation in the villus interstitial, duodenum The glandular cavity is enlarged, and the end of the villus is in the form of focal translucent vacuoles. Under normal electron microscope, the normal duodenal villi are finger-like or lobulated, and the crypt is enlarged. The characteristic change is that the intestinal mucosa absorbs a large amount of lipid storage in the epithelial cells. As the disease worsens, the nucleus and organelles may be squeezed, the submicrostructure of the organelles will degenerate, the electron density will decrease, the mitochondria will degenerate, increase, and densely distributed around the nucleus, and the rough endoplasmic reticulum expands into a sac or spherical shape. The smooth endoplasmic reticulum is more compensatory, and individual chromatin has agglutination.
Prevention
Duodenal white spot syndrome prevention
Take care to prevent upper gastrointestinal inflammation.
Complication
Duodenal white spot syndrome complications Complications duodenal ulcer gastric ulcer atrophic gastritis
With duodenal ulcer, gastric ulcer, superficial or atrophic gastritis.
Symptom
Symptoms of duodenal white spot syndrome Common symptoms Hemorrhagic diarrhea, loss of appetite, indigestion, nausea and anorexia
The disease is more male than female, more common in young and middle-aged, clinical manifestations of irregular upper abdominal pain or discomfort, nausea, anorexia, belching, loss of appetite and other dyspepsia symptoms, some typical steatorrhea: feces A large amount, no shape, brown or slightly gray, stench, greasy luster on the surface, microscopic examination of a large number of fat globules, some may be associated with chronic superficial gastritis, atrophic gastritis, peptic ulcer, chronic cholecystitis, Pancreatitis, cholelithiasis, etc., make the clinical symptoms more specific, making it difficult to estimate the presence of DWSS before endoscopy.
Examine
Examination of duodenal white spot syndrome
1. In the laboratory examination, except for elderly patients, blood lipids may increase, and there are no obvious abnormalities.
2. Endoscopy: Endoscopic duodenal mucosa white spots are mostly located in the ball, especially the anterior wall and the large curved side, and the posterior wall is less, which may be related to the direction of blood vessels and lymphatic vessels, and some are located in the upper corner. In the part and the descending part, the white spots are sparsely scattered or densely clustered, round or elliptical, about 1 to 3 mm in diameter, mostly flat, and some of the light depressions are umbilical or microscopically plaque-like, with a milky white surface or Grayish white, which is localized in fat, and is diffused by lymphatic vessels. It is sometimes stained yellow by bile. It is usually covered with no secretions, and the boundary is clear. The edge gradually transitions from light yellow to normal duodenal mucosa. The surface of white or white spots is smooth. The texture is slightly hard, the reflection is enhanced, and it is white fluffy in close observation. There is no change after washing with water. The duodenal mucosa around the lesion may have variegated or congested, rough and uneven, and lose normal fluffy appearance.
Diagnosis
Diagnosis and diagnosis of duodenal white spot syndrome
diagnosis
Therefore, endoscopy should not only be satisfied with the discovery of a lesion, and should be carefully observed to not miss the accompanying lesions, to make a complete diagnosis.
Differential diagnosis
The diseases that must be distinguished by endoscopy include duodenal inflammatory polyps, duodenal brucellosis, duodenal frost-like ulcers, etc., duodenal inflammatory polyps are mostly flat. Wide-based bulge, superficial congestion, peripheral duodenal mucosa with varying degrees of inflammation, duodenal brucella gland hyperplasia with nodular multiple micro-augmentation, normal surface color, duodenal frost-like ulcer It is flaky and smashed in multiple places, and it is distributed in multiple scattered areas. The mucous membrane is congested and edematous. The appearance seems to drop the box. Generally, there is no depression. It is generally not difficult to make a differential diagnosis.
