Chronic duodenitis in patients with ulcerative colitis

Introduction: Ulcerative colitis (UC) is a chronic inflammatory disease of the colon of unknown etiology. UC characteristically affects the large bowel in a continuous manner, the upper gastrointestinal tract is not generally considered as a target of the disease. Several recent publications have served to challenge the traditional views regarding the anatomic distribution of UC. Case reports described patients with UC associated with upper small intestinal involvement.

Aims: The purpose of this study was to analyze gastro-duodenal lesions in patients with well documented UC.

Patients and methods: Fifteen patients (age: 18–56 years, mean age: 36.9 years) with UC underwent upper gastrointestinal endoscopy. Histology was also performed. Age, gender, alcohol and tobacco use, H. pylori infection, therapy, extension and activity of the colitis were evaluated.

Results: No patient had any visible lesion in the small intestine during endoscopy. Mild chronic duodenitis was seen in the biopsy specimens of 8 (53.3%) patients. Duodenitis was more common in males than in females (71.4% vs. 37.5%) and it appeared more commonly during an active flare of UC. We found no significant correlation between the extension of colitis and the frequency of duodenitis. The frequency of histologically proven chronic gastritis was extremely high in UC patients (90.9%). The frequency of possible risk factors (H. pylori infection, alcohol and tobacco use) was low, no correlation was found between these conditions and the presence of gastro-duodenal disorders.

Conclusion: Inflammation of the gastro-duodenal mucosa was commonly seen in our study. However, these alterations were mild and non-specific. Further studies are needed to better understand and characterize the issue of upper gastrointestinal inflammation in UC.