Gastroduodenal Disease - Causes, Diagnosis, Treatment, and Complications

Introduction:

The gastroduodenal disease comes under the inflammatory bowel disease (IBD) category, which has only two subtypes. One is this disease, and the other one is ulcerative colitis. It is a type of disease that can be present lifelong. Gastroduodenal Crohn's disease is a rare condition that accounts for only four percent of all Crohn's disease cases. It has no cure as of now but treating the symptoms will reduce the severity. The duodenum is the first part of the intestine, which is present immediately after the stomach. The jejunum is the second part of the intestine.

What Could Be Causing This Rare Disease?

The exact cause remains a mystery, but scientists are stating that genetics could be a factor since 200 variants have been identified as possible outcomes for developing this disease. Nonsteroidal anti-inflammatory drugs or oral contraceptives could also play a vital role in its etiology, but this is not yet confirmed. The other factors that could be playing a role in causing this are as follows.

• Sedentary lifestyle.

• Diet.

• Smoking.

• Improper hygiene practices.

How Can This Disease Be Identified?

• The most common symptom is upper abdominal pain, which does not radiate to other parts of the body, often presents itself after eating, and can usually be relieved by antacids.

• Nausea and vomiting, along with constant pain in the abdomen, cause gastric outlet obstruction due to the formation of strictures, which is an abnormal narrowing of a passage in the gastroduodenal region.

• Loss of blood can appear in the form of chronic anemia.

• Anorexia (fear of gaining weight).

• Weight loss.

• Loss of appetite.

• Pain in the upper abdomen.

• Upper gastrointestinal abnormalities.

How Can This Disease Be Diagnosed?

The diagnosis of this disease needs more attention since it can easily be confused with lower gastrointestinal tract disease. Hence, good imaging and endoscopic techniques should be used to diagnose properly. With the help of biopsy, endoscopy is most widely used in diagnosing this disease.

Endoscopic Findings:

• Accumulated blood in the dilating blood vessels leads to an abnormal redness of the skin or mucous membrane, which is otherwise called erythematous patches.

• The mucosa (the inner lining of an organ like the stomach) becomes weak and bleeds easily, leading to mucosal friability.

• The nodular appearance of the mucosa in the gastroduodenal region.

• The earliest sign of Crohn's disease is an aphthous ulcer, a small sore occurring in the mouth or base of the gums.

Radiographic Findings:

• Mucosal nodules (a lump or growth that can be cancerous).

• Cobblestone thickened folds.

• Ulcerations.

• Diffused inflammation.

• An end-to-end anastomosis pattern can be noticed between the antrum and proximal duodenum in radiographs.

• Deformity of diseased antrum can show a funnel-shaped appearance in radiographs called Ram's horn sign, as the stomach resembles the horn of a ram (male sheep).

• Advanced stages of the disease can be evaluated by using radiographs.

• Non-caseating granulomatous inflammation of the stomach or the duodenum.

• Contagious gastroduodenal involvement is the most common, with patients having diseased antrum, pylorus, and proximal duodenum.

Pathological Features:

• Swelling is due to excess fluid in the mucosal region, called mucosal edema.

• Acute or chronic inflammation.

• Inflammatory cells accumulate in the crypts of the gastrointestinal tract, which is called crypt abscess.

• Connective tissue thickening, which is termed fibrosis, extends into the muscularis mucosa.

• Helicobacter pylori is the most common type of microorganism found in the disease.

How Can This Disease Be Treated?

• Acid suppression should be the primary goal since it tends to cause inflammation.

• Proton pump inhibitors can be a good option.

• Corticosteroids like six Mercaptopurine and Azathioprine can be combined early in the disease with proton pump inhibitors to maintain corticosteroid-induced remission.

• Narrowing a passage in the gastrointestinal region called strictures can sometimes become complicated.

• If the duodenal strictures are short, endoscopic balloon dilation with a rigid-flex balloon (8 mm) or microwave balloon (10 mm) can be used with a perforation risk of 1 to 2 mm.

• Some patients may require surgery, especially when they have a duodenal obstruction or refractory ulcer-type abdominal pain.

• To analyze the extent of the spread of the disease and what mode of treatment shall be given.

• Upper gastrointestinal tract endoscopy.

• Small bowel radiotherapy.

• Colonoscopy.

What Are Various Surgical Interventions?

• Bypass surgery by creating a connection between the stomach and the jejunum, called gastrojejunostomy, is performed to bypass the duodenal stricture.

• Gastroduodenostomy (connecting the stomach and the duodenum by surgery).

• Duodenojejunostomy (surgically connecting duodenum and jejunum).

• Stricturoplasty (a surgical procedure to correct the narrowing of the bowel).

What Could Be the Possible Postoperative Complications?

The complications include:

• Collection of gasses inside the abdomen.

• An anastomotic leak occurs when the connection that was made surgically fails to connect or heal properly.

• The enterocutaneous fistula is a connection between the stomach or intestinal tract and the skin.

• Stomal ulcerations are the development of ulcers in the gastrointestinal region after surgery.

• There might be diarrhea and ulcers after bypass surgery. Thus, performing gastrojejunostomy with highly selective vagotomy would preserve the autonomic innervation to the small bowel.

• Emptying of gasses may be delayed postoperatively after bypass surgery and even after a stricturoplasty.

• Patients undergoing stricturoplasty had higher rates of repeated surgery.

What Are Some Complications After Getting This Disease?

• Narrowing the stomach and the duodenum due to strictures can obstruct the gastric outlet, the most common complication of gastroduodenal Crohn's disease.

• Fistulas are abnormal connections between two body parts, like an organ, blood vessel, and another structure.

• Gastrocolic fistula, formed between the distal transverse colon and stomach, is the most common fistula encountered, which causes diarrhea, feculent vomiting, and weight loss.

• Pancreatitis can occur due to the reflux of contents from the duodenum into the pancreatic duct. This is a rare complication.

When to See the Doctor?

The person should see the doctor if they experience signs and symptoms of this condition such as

• Bloody stools.

• Diarrhea which persists for a week.

• Continuous stomach pain.

• Sudden weight loss.

• Slow growth in children.

Can Gastroduodenal Crogn’s Condition Be Prevented?

There are no ways to prevent this condition. However, the symptoms can be managed by following a proper Crohn’s diet, reducing stress, and avoiding smoking.

Conclusion:

Gastroduodenal involvement in Crohn's disease is a rare condition that is characterized by inflammation of the duodenum, but the symptoms can be treated with the right diagnosis. Though many other diagnostic methods have come, endoscopy remains the gold standard for diagnosing this rare disease. This condition is usually treated with the help of medications and surgery.