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What Does Duodenitis In Biopsy Report Indicate?

Posted on Tue, 18 Mar 2014

Question: Hi. I was diagnosed with duodenal ulcer disease that was H.Pylori negative in1994 and treated with a proton pump inhibitor that still left me with symptoms that I was told were "functional". I also got a second opinion from another excellent gastroenterologist. I'd also had increasing fatigue for years and had been on antidepressants since 1990 that didn't seem to be of much help. I continued to get much sicker until an alternative practitioner recommended i get tested for CD. My ttg was off the charts and my biopsy showed severe villous atrophy. I looked at my biopsy report from 1994 and it described a "duodenitis" which I've read can occur with CD. I've continued to have problems with an increasingly treatment-resistant depression, anxiety and fatigue. I'd been working as a "GP Psychotherapist" part-time which was the only thing i was able to do and after a severe depressive episode last year i found i was left with cognitive deficits and personality changes that made it impossible to do my job. (I'm a 55 yo female with a partner but no kids). I am really angry and think that I should have been diagnosed with CD in 1994. Do you think that is reasonable? I feel i no longer have a reason to live and despite being on a strict GFD since 2003 the only improvements have been GI and I'm no longer as weak. Everything else is worse. Thank you for your opinion. Best, XXXX

Answered by Dr. Dr.Raju.A.T (28 hours later)

Brief Answer: Get your CD staged Detailed Answer: Hi, Thanks for your query. Sorry for the delay in my response. I am medical doctor, an associate in Department of Gastroenterology, working with an experienced Gastroenterologist. I answer on his behalf. Back in 1994 the duodenitis in biopsy report could be an indication for initial stage CD. Unfortunately without detail work up or other considerable factors a diagnosis of CD may not be reasonable at that time. According to " Marsh Staging of CD " Duodenitis is considered as stage 1 disease. I would now stage you as Marsh stage 3 based on the current biopsy report. Kindly consider this is not the end. Management can be easy and successful even in this stage of the disease. Please do not loose hopes on yourself. I would recommend a full scale investigation into the condition with tests like thyroid function tests, serum calcium, serum iron, complete blood count, Vit B12 and folic acid levels etc to understand the disease better. The more you understand about the condition the more confident you get about the management. This would surely help you to know the prognosis and avoid unnecessary thoughts and anxiety over the issue. Hope, I answered your query. Please get back to if there are any concerns. regards,

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr.Raju.A.T (2 hours later)

It seems I wasn't clear enough. I said I've been on a GF diet since 2003. That's when my tissue transglutaminase was off the charts and my duodenal biopsy showed severe CD. All of what you suggested has been done and I take appropriate supplements. As I said I am a physician and I also have with a background in nutrition and biochemistry. My Dr discovered I had a mild normocytic, normochromic anemia back in 1971 which persisted throughout my life until I was on a GFD for several mos. I also had chronically low iron stores and constantly took iron supplements. In 1982 I developed fatigue and started to self medicate with caffeine. It continued to worsen to 2003. I have been struggling with a treatment-resistant depression since 2004. I began to work part-time as a "GP Psychotherapist" in 2005 and loved my work and was constantly learning. Now I can't even do that. Please refer back to my initial note.

Answered by Dr. Dr.Raju.A.T (34 minutes later)

Brief Answer: Psychiatrist consultation could help Detailed Answer: Hi, Thanks for the information. Based on the information you provided now, I consider that all possible management modes for the existing CD has been employed by you. I believe your major concern now is the treatment-resistant depression you are going through since 2004. The depression you are going through though related to the CD and its secondary effects you are suffering from, has to be considered as an separate entity and be dealt by a Specialist in Psychiatry. Myself being a doctor with experience in gastroenterology have no much to do.Do consult a Psychiatrist who can guide you how to overcome the problem you are facing. I also believe you wold understand his/her opinion better and apply the same to yourself. Wish you good health. regards,

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr.Raju.A.T (19 minutes later)

I have been treated for depression with psychotherapy and medications since 1990, I have the best care possible, that is not the issue. The issue is that I believe I had active undiagnosed CD for more than 30 years, based on the history I gave you, and think that I should have been diagnosed in 1994. I realize it's a "judgement call" but it's something I need to know. I realize now it was foolish of me to try to get an answer here.

Answered by Dr. Dr.Raju.A.T (2 hours later)

Brief Answer: yes, you are right Detailed Answer: Hi, I did try to convey it in my initial post that what which was declared as duodenitis could be the first stage CD only. I agree that the condition diagnosis would have been made in 1994 if detailed work up had been done at that time. regards,

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar