Brunner gland hyperplasia (BGH) is a non-cancerous condition affecting the duodenum, the first part of the small intestine. It involves an overgrowth of normal glands in this area. BGH is a benign lesion, meaning it is not malignant and does not spread like cancer.
Understanding Brunner Gland Hyperplasia
Brunner glands are small exocrine glands located in the submucosal layer of the duodenum. Their primary function involves secreting an alkaline-rich mucus, which protects the duodenal lining against acidic stomach contents. Hyperplasia refers to an increase in the number of normal cells within a tissue or organ, meaning BGH is an excessive, yet benign, proliferation of these mucus-producing Brunner glands.
The exact cause of Brunner gland hyperplasia is not fully understood, but several theories exist. Chronic inflammation, often triggered by excessive gastric acid secretion or bile reflux into the duodenum, is thought to contribute to its development. It is also believed that an increased activity of exocrine modulating factors, such as hormones or the vagus nerve, might play a role in stimulating this glandular overgrowth.
Recognizing Symptoms and Diagnosis
Brunner gland hyperplasia is often asymptomatic, meaning it does not cause any noticeable symptoms. It is frequently discovered incidentally during endoscopic examinations performed for other reasons. When symptoms do occur, they are generally non-specific and depend on the size or location of the hyperplastic growth. These symptoms can include abdominal pain, nausea, bloating, or dyspepsia.
In some cases, larger lesions can lead to complications such as gastrointestinal bleeding, which may manifest as melena (dark, tarry stools) or hematochezia (bright red blood in stool). Rarely, a large hyperplastic mass can cause partial or transient bowel obstruction. The primary method for diagnosing BGH involves an upper gastrointestinal endoscopy. During this procedure, a biopsy is typically performed to obtain tissue samples, which are then examined under a microscope.
A biopsy confirms the diagnosis of Brunner gland hyperplasia and differentiates it from other conditions like malignancies or duodenal tumors. While imaging tests like CT scans or MRI may be part of a broader workup, endoscopy with biopsy provides the definitive diagnosis by showing benign proliferation of Brunner glands without signs of cellular atypia or malignancy.
Treatment and Long-Term Outlook
Since BGH is benign and often asymptomatic, specific treatment may not be necessary. Observation is common for asymptomatic cases. For symptomatic individuals, management focuses on addressing underlying factors like excessive stomach acid. Acid-suppressing medications, such as proton pump inhibitors, may be prescribed to reduce acid exposure.
If the hyperplastic lesion is large and causes significant symptoms like obstruction or bleeding, endoscopic removal may be considered. Techniques such as endoscopic polypectomy can effectively remove the growth. The prognosis for Brunner gland hyperplasia is excellent, as it does not progress to cancer. Recurrence after endoscopic removal is uncommon, and patients typically have good long-term outcomes. Regular follow-up with a doctor is advisable, especially if symptoms persist or recur, to ensure appropriate management.