Brunner’s gland hyperplasia refers to an abnormal increase in the number of cells within the Brunner’s glands, which are small glands located in the submucosa of the duodenum, the first part of the small intestine. While benign, this proliferation can sometimes form a noticeable mass or polyp within the duodenal lining.
Understanding Brunner’s Gland Hyperplasia and Its Diagnosis
Brunner’s glands protect the duodenal lining by secreting an alkaline fluid rich in mucin, which neutralizes acidic chyme from the stomach. They also produce epidermal growth factor, inhibiting acid and digestive enzyme secretion. The exact cause of Brunner’s gland hyperplasia is not fully understood, but it is often linked to chronic irritation or inflammation, such as excessive gastric acid secretion or Helicobacter pylori infection. Some theories suggest that overactivity of exocrine modulating factors, like hormones or the vagus nerve, may also contribute to this overgrowth.
Symptoms are often non-specific and include upper abdominal discomfort, bloating, or indigestion. Larger hyperplastic lesions can cause issues such as gastrointestinal bleeding, abdominal pain, or blockages in the duodenum. Diagnosis typically involves an upper endoscopy, where a thin, flexible tube with a camera visualizes the upper digestive tract. During endoscopy, a biopsy of the abnormal tissue is often taken to confirm diagnosis and rule out other conditions, including malignancy. Imaging techniques like computed tomography (CT) scans can also assess larger lesions’ size and location.
Non-Surgical Treatment Options
Initial treatment for Brunner’s gland hyperplasia focuses on managing underlying conditions. If excessive stomach acid is suspected, medications such as proton pump inhibitors (PPIs) are commonly prescribed. PPIs work by reducing stomach acid production, decreasing the acidic environment that might stimulate Brunner’s gland overgrowth.
If Helicobacter pylori infection is identified through testing, a course of antibiotics is typically initiated. This often involves “triple” or “quadruple therapy,” combining a PPI with two or more antibiotics (e.g., clarithromycin, amoxicillin, metronidazole, or tetracycline) for 10 to 14 days. Eradicating H. pylori can reduce duodenal inflammation, alleviating symptoms and potentially reducing hyperplasia size. While medical treatments aim to control symptoms and address contributing factors, complete regression of the hyperplastic tissue is uncommon with these methods alone.
Endoscopic and Surgical Procedures
When non-surgical treatments fail to control symptoms or if complications like significant bleeding, obstruction, or suspected malignancy arise, interventional procedures become necessary. Endoscopic procedures are often the preferred approach for removing hyperplastic tissue, especially for smaller or pedunculated (stalk-like) lesions. Endoscopic polypectomy, using a snare through the endoscope, is a common technique. Endoscopic mucosal resection (EMR) is another method used for larger or sessile (flat) lesions, where the tissue is lifted and then resected. These minimally invasive techniques allow direct visualization and removal of affected tissue.
In rare instances, especially for very large lesions (exceeding 5 cm), those causing severe obstruction, or when malignancy cannot be definitively ruled out through biopsies, surgical resection may be required. Surgical options range from localized duodenal polypectomy or wedge resection to more extensive procedures like partial gastrectomy or duodenocephalopancreatectomy in complex cases involving pancreatic invasion or difficult differentiation from malignancy. The choice of procedure depends on the size, location, and characteristics of the hyperplasia, as well as the patient’s overall health.
Life After Treatment and Monitoring
Following treatment for Brunner’s gland hyperplasia, ongoing monitoring is generally recommended to assess the effectiveness of the intervention and to detect any recurrence. This often involves follow-up endoscopies at intervals determined by the treating physician, to ensure complete resolution of the hyperplasia and to monitor for any new growths or changes in the duodenal lining. While Brunner’s gland hyperplasia is benign, a small percentage of cases (around 2.1%) have shown dysplastic changes, suggesting a low potential for malignant transformation, which underscores the importance of continued surveillance.
Lifestyle adjustments, such as dietary modifications to reduce gastric acid production, might be suggested to support recovery and potentially prevent recurrence of associated conditions like peptic ulcers. The overall outlook for individuals with Brunner’s gland hyperplasia after appropriate treatment is generally favorable. However, close collaboration with a gastroenterologist is advisable for personalized management and long-term care, especially if symptoms persist or new concerns arise.