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Introduction: Duodenal eosinophilia has been implicated in the pathophysiology of functional dyspepsia. In a retrospective observational study, we previously reported that duodenal eosinophilia (as defined by a mucosal count of greater than 15 eosinophils per 5 high power fields), was associated with symptomatic erosive gastroesophageal reflux disease (GERD), concomitant co-morbidities and Chinese ethnicity but not functional dyspepsia among 289 multiracial subjects undergoing diagnostic endoscopy in 2019 before the COVID-19 pandemic. We tested the reproducibility of those findings on a larger sample that included the original cohort and another 221 subjects who underwent endoscopy in 2022 after the easing of pandemic restrictions., Materials and Methods: Archived duodenal histology slides were assessed by a pathologist blind to demographic and clinical data gleamed retrospectively from clinical chart review. Logistic regression analysis was used to explore associations between duodenal eosinophilia and the variables age, gender, ethnicity, year of sampling (2019 vs 2022), concomitant co-morbidities, functional dyspepsia, symptomatic erosive GERD (Los Angeles Grades A to D), endoscopic oesophagitis, gallstone disease, Helicobacter pylori infection, irritable bowel syndrome and NSAID consumption. Three different thresholds for defining duodenal eosinophilia (>15, >22 and >30 eosinophils per 5 high power fields) were tested., Results: Year of sampling (2019, pre-pandemic) strongly predicted duodenal eosinophilia across all thresholds (OR 11.76, 13.11 and 21.41 respectively; p = 0.000). The presence of concomitant co-morbidities was a modest predictor across all thresholds whereas Chinese ethnicity only predicted at the lowest threshold. Absolute duodenal eosinophil counts predicted symptomatic erosive GERD (OR 1.03; p = 0.015) but not functional dyspepsia (OR 1.00; p = 0.896) after adjusting for age, gender, ethnicity, concomitant comorbidities and year of endoscopy. None of the subjects reached the threshold for the diagnosis of eosinophilic duodenitis., Conclusion: The cumulative impact of environmental exposures on duodenal eosinophil counts may be much greater than of putative factors linked to functional dyspepsia. A signal linking duodenal eosinophil counts and symptomatic erosive GERD was detected.

We present a case involving a 67-year-old patient with a medical history of gastric bypass who was recently diagnosed with a 6-centimeter duodenal mass causing biliary duct stenosis. Despite our best efforts, we were unable to access this tumor endoscopically, necessitating surgical intervention. During the surgical exploration, we discovered a duodenal diverticulum filled with stones, leading to the obstruction of the biliary ductâ?"a manifestation of Lemmel syndrome. This rare condition is characterized by obstructive jaundice in the absence of choledocholithiasis or tumors and is secondary to dilatation of peri-ampullary diverticula. While it is typically managed through endoscopy, our diagnostic and therapeutic approach was complicated by the patient's history of bariatric surgery (gastric bypass), making endoscopic access impossible despite our multiple attempts. This case report sheds light on the challenges posed by the concurrence of a rare pathology and surgically modified anatomy, which is increasingly encountered in daily surgical practice. In such situations, exploratory surgery continues to play a significant role., (Celsius.)

Pseudomelanosis duodeni is characterized by endoscopic findings of black or black-brown speckled pigmentation in the duodenal mucosa, usually diagnosed via biopsy. This report presents a case of a 75-year-old male presented with left lower abdominal pain, change in bowel habits, and decreased appetite. Gastroduodenoscopy and biopsies of the duodenum and antrum lead to the diagnosis of pseudomelanosis duodeni., Competing Interests: Declaration of competing interests The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Pan-Arab Association of Gastroenterology. Published by Elsevier B.V. All rights reserved.)

Aspergillosis mostly involves the lung and sinuses in severely immunocompromised patients like those with hematological malignancies, postorgan transplants, acquired immunodeficiency syndrome (AIDS), and secondary to chemotherapeutic agents. Duodenal aspergillosis is very rare and mostly occurs as a part of disseminated disease or in classical immunosuppressive conditions. We report a middle-aged female with uncontrolled diabetes who presented to us with epigastric pain and was finally diagnosed as a case of primary duodenal aspergillosis. Diabetes mellitus should also be kept as one of the predisposing conditions for it, and a high index of suspicion should be kept for it to reduce morbidity and mortality., (© Journal of the Association of Physicians of India 2024.)

Primary aortoduodenal fistula is a rare condition caused mainly by a bulging infra-renal aortic aneurysm with subsequent erosion of the duodenum and formation of a fistula. We present a patient who suffered from a herald upper gastrointestinal bleeding followed by circulo-respiratory collapse only hours after, due to bleeding from the fistula. The mortality is reported to be 100 %, requiring emergency EVAR or open aortic graft repair to control any further bleeding.

The most common site of the congenital duodenal web is the second part. Web distal to the second part of the duodenum is rare. It mimics the windsock deformity. Diagnosis may be missed if accompanying malrotation is present. We hereby report two cases of distal duodenal webs associated with malrotation and challenges in their diagnosis and management., Competing Interests: Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.