Dispeptik hastalarda Helicobacter pylori ile duodenumun dağınık beyaz noktasal lezyonları arasındaki ilişkinin değerlendirilmesi

Öz

Giriş ve Amaç: Rutin endoskopik değerlendirmede genellikle karşılaştığımız ve intestinal lenfanjiektazi olarak değerlendirdiğimiz duodenumun dağınık beyaz noktasal lezyonlarının çoğunlukla belirgin bir nedeni veya klinik karşılığı bilinmemektedir. Çalışmamızda dağınık beyaz noktasal lezyonların sıklığını, patolojik karşılığını ve Helicobacter pylori ile olan ilişkisini değerlendirmeyi amaçladık. Gereç ve Yöntem: İç Hastalıkları ve Gastroenteroloji Bilim Dalımız polikliniklerine başvuran ve aynı endoskopist tarafından dispeptik yakınma şikayeti ile gastroskopileri uygulanan toplam 445 hastanın endoskopi bulguları retrospektif olarak değerlendirildi. Endoskopik bulgularında dağınık beyaz noktasal lezyonlar saptanan hastaların antrum ve duodenal biyopsileri alınarak histolojik olarak incelendi. Bulgular: Tüm hastaların %60’ı kadın (n = 245) ve yaşları ortalaması 47.1 yıl idi. İncelenen endoskopik raporlarda 39 (%8.8) hastada dağınık beyaz noktasal lezyonların olduğu saptandı. Dağınık beyaz noktasal lezyonlar saptanan hastaların biyopsilerinde 10 hastada (%26.3) intestinal lenfanjiektazi, 21 hastada (%55.2) kronik nonspesifik duodenit ve 7 hastada (%18.5) Giardia enfeksiyonu saptandı. Dağınık beyaz noktasal lezyonların saptandığı hastaların yarısında (n = 19) Helicobacter pylori pozitif olarak saptandı (p = 0.695). Helicobacter pylori sıklığı patolojik olarak intestinal lenfanjiektazi saptanmış grupta da istatiksel olarak farklı bulunmadı. Sonuç: Dispeptik yakınmalar ile gelen hastaların gastroskopilerinde dağınık beyaz noktasal lezyonların sıklığı %8.8 olarak bulundu. Bu hastaların ancak dörtte birinde patoloji ile konfirme intestinal lenfanjiektazi görülmektedir. Dağınık beyaz noktasal lezyonlar ve intestinal lenfanjiektazi saptanması ile Helicobacter pylori pozitifliği arasında bir ilişki saptanmamıştır. Dispepsi, duodenal dağınık beyaz noktasal lezyonlar, Helicobacter pylori

Anahtar Kelimeler

• Dispepsi
• duodenal dağınık beyaz noktasal lezyonlar
• Helicobacter pylori

Evaluation of the relationship between Helicobacter pylori and duodenal scattered white spots lesions in dyspeptic patients

Öz

Background and Aims: Duodenal scattered white spot lesions, which we usually encounter and evaluate as intestinal lymphangiectasia in routine endoscopic evaluation, are mostly unknown for a cause or clinical equivalent. In our study, we aimed to evaluate the frequency of duodenal scattered white spot lesions, their pathological findings and their relationship with Helicobacter pylori. Materials and Methods: A total of 445 patients admitted to Department of Internal Medicine and Gastroenterology and underwent gastroscopy by the same endoscopist who have dyspeptic complaints. The endoscopy findings of all patients were evaluated retrospectively. Antrum and duodenal biopsies were taken of patients with endoscopic findings of duodenal scattered white spot lesions and histologically examined. Results: Two-thirds of the patients were female (60%) and the mean age was 47.1 years. The examined endoscopic reports revealed that 39 (8.8%) patients had duodenal scattered white spot lesions. The biopsies of the patients with duodenal scattered white spot lesions revealed intestinal lymphangiectasia in 10 patients (26.3%), chronic nonspecific duodenitis in 21 patients (55.2%), and Giardia infection in 7 patients (18.5%). There were 19 (n = 19) patients with Helicobacter pylori was found to be positive (p = 0.695). The frequency of Helicobacter pylori was also not found to be statistically different in the pathologically intestinal lymphangiectasia group. Conclusion: The frequency of duodenal scattered white spot lesions in gastroscopies of patients with dyspeptic complaints was found to be 8.8%. However, the confirmation of intestinal lymphangiectasia with pathology is observed in only a quarter of these patients. The detection of duodenal scattered white spot lesions and intestinal lymphangiectasia, there is no correlation between Helicobacter pylori positivity. Dyspepsia, duodenal scattered white spots lesions, Helicobacter pylori

Anahtar Kelimeler

• Dyspepsia
• duodenal scattered white spots lesions
• Helicobacter pylori

Kaynakça

1. 1. Veldhuyzen van Zanten SJ, Bartelsman JF, Tytgat GN. Endoscopic diagnosis of primary intestinal lymphangiectasia using a high-fat meal. Endoscopy 1986;18:108-10.
2. 2. Kori M, Gladish V, Ziv-Sokolovskaya N, et al. The significance of routine duodenal biopsies in pediatric patients undergoing upper intestinal endoscopy. J Clin Gastroenterol 2003;37:39-41.
3. 3. Hopper AD, Cross SS, McAlindon ME, Sanders DS. Symptomatic giardiasis without diarrhea: further evidence to support the routine duodenal biopsy? Gastrointest Endosc 2003;58:120-2.
4. 4. García-Sancho M, Sainz Á, Villaescusa A, Rodríguez A, Rodríguez-Franco F. White spots on the mucosal surface of the duodenum in dogs with lymphocytic plasmacytic enteritis. J Vet Sci 2011;12:165-9.
5. 5. Bataga SM, Toma F, Mocan S, Bataga T. Giardia lamblia and duodenal involvement. Bacteriol Virusol Parazitol Epidemiol 2004;49:145-50.
6. 6. Desai AP, Guvenc BH, Carachi R. Evidence for medium chain triglycerides in the treatment of primary intestinal lymphangiectasia. Eur J Pediatr Surg 2009;19:241-5.
7. 7. Kim JH, Bak YT, Kim JS, et al. Clinical significance of duodenal lymphangiectasia incidentally found during routine upper gastrointestinal endoscopy. Endoscopy 2009;41:510-5.
8. 8. Biyikoğlu I, Babali A, Cakal B, et al. Do scattered white spots in the duodenum mark a specific gastrointestinal pathology? J Dig Dis 2009;10:300-4.

9. 9. Taş A, Koklu S, Beyazit Y, et al. The endoscopic course of scattered white spots in the descending duodenum: a prospective study. Gastroenterol Hepatol 2012;35:57-64.
10. 10. Kurtkulagi O, Yonem O, Terzi H, Altinkaya E, Kurtkulagi O. What do the white spots in the second part of duodenum tell us? Nat J Health Sci [Internet] 2022;5:109-13.
11. 11. Nishiyama N, Kobara H, Ayaki M, et al. White spot, a novel endoscopic finding, may be associated with acid-suppressing agents and hypergastrinemia. J Clin Med 2021;10:2625.