A nodular duodenal cap...
This was found in the duodenal cap of a patient undergoing gastroscopy because of dyspepsia.
APART FROM TAKING SAMPLES, WHAT ELSE SHOULD BE DONE?
a) take a CLO test
b) take gastric biopsies
Will show a Hp associated gastritis
c) take samples from D2
That's a no from me...
d) request an EUS
Never seem to be the right answer!?
e) request a CT
Perhaps if bx against all odds with suggest lymphoma but that would be a long shot
You first guesses when you find funny bumps in the duodenal cap should be gastric metaplasia and gastric heterotopia. Brunner's gland hyperplasia is also common but are never multiple (at least I have never seen a case with more than one nodule from Brunner's gland hyperplasia).
This is a case of foveolar gastric metaplasia in the duodenal cap. Basically, the mucosa in the duodenal cap has become more 'stomach-like' with crypts lined by mucus secreting cells (foveolar cells) which are different to goblet cells found elsewhere in the GI tract.
Gastric metaplasia is common in patients with a history of peptic ulcer disease and is thought to be a defence response or adaption to the presence of excess acid in the duodenum. It's thought that Helicobacter are able to colonise the foveolar gastric metaplasia in the duodenum and this contributes to duodenitis and duodenal ulceration.
So, what should you do next? Do a CLO test for Helicobacters of course!