Duodenal white spot syndrome

　　Some believe that upper gastrointestinal inflammation, especially atrophic gastritis, leads to decreased gastric acid secretion and reduced pancreatic juice secretion. Insufficient pancreatic lipase in the pancreatic juice exacerbates the dysfunction of fat digestion, absorption, and transport, causing lipid retention in the absorption epithelial cells or the固有membrane layer of the mucosa, resulting in white lesions and clinical manifestations such as steatorrhea. However, the lesions of atrophic gastritis in most Chinese patients are located in the antrum, an area without acid-secreting cells, so there are many cases with normal gastric acid secretion function in clinical atrophic gastritis. Moreover, pathological examination of the biopsy at the duodenal white spot shows inflammation, so some believe that this disease is a special form of duodenitis.

　　The duodenal mucosa at the white spot shows chronic inflammatory changes under light microscopy. The main manifestations include infiltration of lymphocytes, plasma cells, monocytes, and eosinophils. The lymph and blood vessels in the inter villous stroma are dilated, the duodenal gland ducts are expanded, and the villous ends show focal translucent vesicular distribution. Under electron microscopy, normal duodenal villi appear finger-like or lobulated, and crypts are dilated. Characteristic changes include a large amount of lipid retention in the intestinal mucosal absorption epithelial cells. With the progression of the disease, there may be compression phenomena in the nuclei and organelles. The submicroscopic structure of the organelles shows degenerative changes, and the electron density decreases. Mitochondria show changes, increase in number, and are densely distributed around the nucleus. The rough endoplasmic reticulum expands into cystic or spherical shapes, and the smooth endoplasmic reticulum compensatorily increases. There may be condensation phenomena in some chromatin.

　　Accompanied by duodenal ulcer, gastric ulcer, superficial or atrophic gastritis, etc.

　　1. Duodenal ulcer:Duodenal ulcer is one of the common chronic diseases. Duodenal ulcer is the most common type of peptic ulcer, occurring in the duodenum, which is the first ten centimeters of the small intestine connecting the stomach. It is caused by defects in the mucosal and muscular layers of the duodenum due to various factors.

　　The cause of duodenal ulcer is related to gastric acid factors: when the defense mechanism of the stomach and duodenum is destroyed by gastric acid, such as changes in the amount of mucus produced, ulcers will form.

　　2. Gastric ulcer:Gastric ulcer, which is a chronic ulcer located between the cardia and pylorus, is one type of peptic ulcer. Peptic ulcers (peptic ulcer) can occur in the stomach, duodenum, lower end of the esophagus, near the gastrojejunal anastomosis, and on the ectopic gastric mucosa in the Meckel diverticulum. The formation of these ulcers is related to the digestive action of gastric acid and pepsin, hence the name 'peptic ulcer'. The vast majority of cases (98% to 99%) are located in the stomach and duodenum. About 10% of the population may suffer from this disease at some point in their lives.

　　3. Superficial or atrophic gastritis:Chronic atrophic gastritis, abbreviated as (CAG), also known as atrophic gastritis, is a common disease. The World Health Organization lists it as a precancerous state of gastric cancer, especially in those with intestinal metaplasia or atypical hyperplasia, where the possibility of canceration is greater. The onset is slow, the disease is lingering, and it is difficult to heal. Treatment is difficult. There is no name for atrophic gastritis in the literature of traditional Chinese medicine, which belongs to the category of 'gastric epigastralgia' and 'abdominal distension' in traditional Chinese medicine. Because chronic atrophic gastritis is often characterized by epigastric pain due to spleen fullness, or spleen fullness without pain, and a few patients have no obvious symptoms, the Third Academic Conference on Spleen and Stomach of the National Association of Traditional Chinese Medicine believes that the differentiation of chronic atrophic gastritis can be attributed to the 'gastric mass' syndrome, in terms of atrophic gastritis.

　　This disease is more common in men than in women, and is more common in young and middle-aged people. Clinically, it often manifests as irregular upper abdominal pain or discomfort, nausea, anorexia, belching, loss of appetite, and other symptoms of dyspepsia. Some may have typical steatorrhea: large fecal volume, non-formed, brown or slightly gray, foul smell, with greasy luster on the surface, and a large number of fat globules under the microscope. Some may be accompanied by chronic superficial gastritis, atrophic gastritis, peptic ulcer, chronic cholecystitis, pancreatitis, cholelithiasis, and other conditions, making the clinical symptoms more non-specific, and most cases are difficult to estimate the presence of DWSS before endoscopy.

　　Prevent upper gastrointestinal inflammation.

　　Upper gastrointestinal inflammation refers to bleeding from the esophagus, stomach, duodenum, and biliary tract, etc., which are pathological sites above the Treitz ligament (also known as the Treitz ligament, located at the root of the transverse mesocolon and on the left side of the second lumbar vertebra). Normally, the upper and lower gastrointestinal tracts are demarcated by the duodenojejunal flexure. In normal circumstances, the upper and lower gastrointestinal tracts are demarcated by the duodenojejunal flexure as the boundary line.

　　1. Laboratory examination:Except for elderly patients with increased blood lipids, there are usually no obvious abnormalities.

　　2. Endoscopic examination:Duodenal white spots are located in the bulb, especially the anterior wall and the greater curvature, fewer on the posterior wall, which may be related to the direction of blood vessels and lymphatic vessels, and some are located in the upper corner and descending part, white spots are sparsely scattered or clustered, round or elliptical, about 1-3mm in diameter, most are flat, some are slightly concave,呈脐状 or slightly raised呈 plaque-like, surface milk white spots or gray white, due to local storage of fat, expansion of lymphatic vessels, sometimes stained yellow by bile, usually without secretions covering, clear boundaries, edges gradually transition from light yellow to normal duodenal mucosa, white spots or white spots are smooth, slightly hard, reflective enhanced, close to observation呈 white feather-like, washed with water without change, the duodenal mucosa around the lesion may have speckled or congestion, rough and uneven, losing the normal feather-like appearance, etc.

　　1. Eat easily digestible foods:Such as congee, noodles, steamed buns, bun, wonton, soft cake, soft rice, etc., chew slowly, easy to digest and absorb fully. Eat less legumes, onions, potatoes, sweet potatoes, etc. that are easy to produce acid and gas, avoid cold and greasy, spicy, alcohol, avoid adverse factors stimulate ulcers.

　　2. Special recommendation for nourishing the stomach and spleen:Yam lotus and lily porridge, peanut red bean millet porridge, can add eggs, minced meat, chicken puree, fish puree, minced vegetables, fruit granules, milk, etc. for seasoning, and increase nutrition.

　　For those with high stomach acid and abdominal pain, H2-receptor blockers (cimetidine, ranitidine, famotidine, etc.) or proton pump inhibitors (omeprazole or lansoprazole) may be administered; alkaline drugs such as Gastrostop, aluminum hydroxide gel, etc., are effective in alleviating symptoms. Since the role of Helicobacter pylori in the onset of the disease is not yet clear, the application of antibiotics and bismuth preparations has no definite indication, but some have observed that 13 of 16 DWSS patients had white spots disappear within 3 months after treatment with cimetidine and anti-Helicobacter pylori drugs, with 2 cases reduced. Further research is needed.