Hyperplasia of duodenal bicarbonate-secreting glands, called Brunner's glands, is seen in peptic ulcer disease.
Brunner's glands are found only in the duodenal submucosa. These tubular glands secrete alkaline mucus and neutralize acidic chyme from the stomach as it moves into the small intestine. Hyperplasia of Brunner's glands is occasionally seen with peptic ulcer disease (PUD). Brunner's glands should not be confused with Peyer's patches, which are lymphoid aggregates located in the ileum.
Ramakrishnan and Salinas describe the etiologies, diagnosis, and management of peptic ulcer disease. Ulcers are usually seen in the proximal duodenum or distal stomach and occur most commonly secondary to NSAID use, H. pylori infection, or steroid use. Ulcers secondary to high stress or gastrin-secreting tumors (Zollinger-Ellison syndrome) are less common. Symptoms are managed with histamine receptor antagonists and proton pump inhibitors, as well as treatment of H. pylori if infection is suspected. Ulcers that do not respond to therapy warrant further evaluation as with endoscopy and may necessitate surgical intervention.
Fuse et al. studied the structural changes that occur in Brunner's glands in patients with duodenal ulcer disease. The thickness of Brunner's glands, determined from samples taken with endoscopic biopsy, differed significantly between patients with duodenal ulcer disease and controls. Mean thickness in controls was 1.54 mm, while mean thickness in the duodenal ulcer group was 3.0 mm. In addition, Brunner's glands were found to be thicker the closer they were to the center of an ulcer, and to be thinner at the centers of healed ulcers.
Illustration A shows duodenal tissue under light microscopy. A submucosal Brunner's gland is indicated with the arrow.
Answer 1: The crypts of Lieberkühn are secretory glands present throughout the mucosa of both the small and large intestines.
Answer 2: K cells are present in the duodenum and jejunum. GIP is released in response to the presence of glucose, fatty acids, or amino acids, and is not related to PUD.
Answer 4: Peyer's patches are specific to the ileum.
Answer 5: While secretin-releasing S cells are present in the duodenum and stimulate pancreatic HCO3 secretion in response to the presence of gastric acid, proliferation of these cells is not a characteristic of PUD.
Fuse Y, Tsuchihashi Y, Takamasu M, Kodama T, Fujita S, Kashima K. Thickness of Brunner's glands and its clinical significance in duodenal ulcer disease. Scand J Gastroenterol. 1990 Feb;25(2):165-72. PubMed PMID: 2305213.
PMID:2305213 (Link to Abstract)
Ramakrishnan K, Salinas RC. Peptic ulcer disease. Am Fam Physician. 2007 Oct 1;76(7):1005-12. Review. PubMed PMID: 17956071
PMID:17956071 (Link to Abstract)