Multiple mucosal lesions in the duodenum: Exploring the potential clinicalbackgrounds and concurrent diseases

Background/Aims: Multiple mucosal lesions of the duodenum (MMLD), presentin g with multiple mucosal redness-and ulcers with or without blood clots in t he proximal duodenum, may be occasionally discovered during gastroduodenal endoscopy. This study was undertaken to investigate the clinical implicatio ns of MMLD. Methodology: Endoscopic pictures and charts of patients with MMLD were retr ospectively reviewed. The endoscopic features of MMLD were recorded for bot h location and severity. The endoscopic severity of MMLD was defined as-fol lows: Grade I: multiple mucosal redness; Grade IT: multiple ulcers with cle ar base; Grade m: multiple ulcers with reddish base or fresh blood clot coa ting. Results: A total of 229 (1.08%) MMLD events in 207 patients were identified out of a total of 21,223 upper gastrointestinal endoscopies. Common backgr ounds of patients with MMLD included diabetes, hypertension, and some chemi cal exposure, such as cigarettes, alcohol,nonsteroidal anti-inflammatory dr ugs and anti-Helicobatcer pyloric regimens. Common concurrent diseases incl uded peptic disease, sepsis, malignancy, renal insufficiency, and portal hy pertension. MMLD associated with sepsis usually involved only the second po rtion of the duodenum, but when associated with nonsteroidal anti-inflammat ory drugs was less often only involved with the second portion, MMLD with r enal insufficiency was less prone to involve the bulb alone. Diabetes-relat ed MMLD tended to present with mild severity as defined by Grade I, H. pylo ri infection with Grade II, and renal insufficiency and portal hypertension with higher severity such as Grade III. Nine patients had fatal outcomes d ue to uncontrolled concurrent diseases, other than MMLD. Conclusions: MMLD, an uncommon occurrence in endoscopy, can develop from se veral clinical settings. When encountering MMLD while performing endoscopy, the best policy is to search and correct the concurrent diseases as early as possible.