The Prevalence of Duodenitis in Children

To the Editor

Alper et al ⁽¹⁾ compared clinical symptoms and mucosal pathology of endoscopic biopsies, reporting duodenitis in 352 (12.7%) patients mostly associated with celiac disease (32%), inflammatory bowel disease (16%), and Helicobacter pylori infection (6%). We previously published a review of 728 first diagnostic gastroscopies that showed similar rates of duodenitis ⁽²⁾. We found gastritis in 56%, esophagitis in 37%, and duodenitis in 11% of biopsies. Eosinophilic esophagitis was found in 10%, and H pylori gastritis was found in only 2%. All procedures included biopsies from all anatomical locations. It was encouraging to see that the rates of duodenitis in Alper et al's report were similar to ours (12.7% vs 11%), but the esophagitis rate was much lower (21% vs 37%). That difference may be attributed to the different patient population and/or endoscopic reports (first vs repeated gastroscopy). The authors compared duodenitis with various symptoms but did not include all mucosal pathologies in 1 table (see Tables 1, 2 in Alper et al). In our study, none of the clinical symptoms had adequate sensitivity or positive predictive value to predict mucosal pathology. Accordingly, we believe that the association between symptoms and duodenitis is uncertain unless all anatomical locations are analyzed together. Thus, we were delighted to have confirmation of our data by a larger study from a different state. The low rate of duodenitis in children (approximately 10%) should raise the question whether duodenal biopsies should be obtained in every diagnostic gastroscopy or should be limited to certain clinical indications ⁽³⁾? Alper et al's study is another step toward answering this query.