title: Multiple mucosal lesions in the duodenum: exploring the potential clinical backgrounds and concurrent diseases.
abstract: OBJECTIVE
  Multiple mucosal lesions of the duodenum (MMLD), presenting with multiple mucosal redness and ulcers with or without blood clots in the proximal duodenum, may be occasionally discovered during gastroduodenal endoscopy. This study was undertaken to investigate the clinical implications of MMLD.
  
  
  METHODS
  Endoscopic pictures and charts of patients with MMLD were retrospectively reviewed. The endoscopic features of MMLD were recorded for both location and severity. The endoscopic severity of MMLD was defined as follows: Grade I: multiple mucosal redness; Grade II: multiple ulcers with clear base; Grade III: multiple ulcers with reddish base or fresh blood clot coating.
  
  
  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 backgrounds of patients with MMLD included diabetes, hypertension, and some chemical exposure, such as cigarettes, alcohol, nonsteroidal anti-inflammatory drugs and anti-Helicobacter pyloric regimens. Common concurrent diseases included peptic disease, sepsis, malignancy, renal insufficiency, and portal hypertension. MMLD associated with sepsis usually involved only the second portion of the duodenum, but when associated with nonsteroidal anti-inflammatory drugs was less often only involved with the second portion. MMLD with renal insufficiency was less prone to involve the bulb alone. Diabetes-related MMLD tended to present with mild severity as defined by Grade I, H. pylori infection with Grade II, and renal insufficiency and portal hypertension with higher severity such as Grade III. Nine patients had fatal outcomes due to uncontrolled concurrent diseases, other than MMLD.
  
  
  CONCLUSIONS
  MMLD, an uncommon occurrence in endoscopy, can develop from several clinical settings. When encountering MMLD while performing endoscopy, the best policy is to search and correct the concurrent diseases as early as possible.
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, National Cheng Kung University Hospital, 138 Sheng Li Road, Tainan 70428, Taiwan.
authors.forename: C M
authors.initials: CM
authors.lastname: Jen
authors.forename: B S
authors.initials: BS
authors.lastname: Sheu
authors.forename: X Z
authors.initials: XZ
authors.lastname: Lin
mesh_terms: D000328:Adult; D000368:Aged; D003937:Diagnosis, Differential; D004381:Duodenal Ulcer / Q000175:diagnosis / Q000209:etiology* / Q000473:pathology; D004384:Duodenoscopy; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis / Q000209:etiology / Q000473:pathology; D016481:Helicobacter Infections / Q000175:diagnosis / Q000473:pathology; D016480:Helicobacter pylori; D006801:Humans; D007413:Intestinal Mucosa / Q000473:pathology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies