Brunner’s gland hyperplasia (BGH) is a rare, non-cancerous overgrowth of specialized cells found in the upper small intestine. This proliferation of glands can lead to noticeable symptoms and complications. Understanding this benign growth is the first step in exploring treatment options, which range from non-invasive observation to surgical removal.
Defining Brunner’s Gland Hyperplasia
Brunner’s glands are mucus-secreting glands located primarily in the submucosa of the duodenum, the first segment of the small intestine. Their principal function is to produce an alkaline fluid rich in mucin and bicarbonate, which acts as a protective barrier shielding the duodenal lining from the highly acidic contents that empty from the stomach. Hyperplasia describes a benign increase in the number of these mucus-secreting cells. This cellular overgrowth results in the formation of a mass, often described as a polyp or nodule, typically found in the duodenal bulb.
The exact cause of this overgrowth is unknown, but it is often linked to chronic irritation or excessive stimulation. Chronic exposure to high levels of stomach acid may stimulate the glands to proliferate, attempting to produce more protective alkaline mucus. The lesions are typically small, often less than one centimeter in diameter.
How the Condition is Diagnosed
BGH is often small and asymptomatic, discovered incidentally during unrelated medical procedures. However, it can present with symptoms such as vague abdominal pain, nausea, or a feeling of fullness. Larger lesions can cause more serious issues like gastrointestinal bleeding or partial blockage of the small intestine.
The primary diagnostic tool is an upper endoscopy, where a flexible tube with a camera is passed into the stomach and duodenum. During the procedure, the growth typically appears as a polyp or mass, often with a pedunculated (stalk-like) or sessile (flat) configuration. The visual appearance can sometimes mimic a malignant tumor or other submucosal lesions.
Confirmation requires a biopsy, where a small tissue sample is taken for microscopic examination. Endoscopic biopsies can sometimes be inconclusive because the lesion is covered by normal duodenal lining, preventing the forceps from reaching the deeper tissue. The pathologist must confirm the presence of benign Brunner’s glands to rule out concerning possibilities like malignancy.
Medical and Endoscopic Management
Treatment is guided by the patient’s symptoms and the size of the lesion. For small, asymptomatic lesions, periodic endoscopic surveillance is recommended to monitor for changes. Since hyperacidity is thought to be a contributing factor, initial medical management for symptomatic patients involves controlling stomach acid secretion.
Medications like Proton Pump Inhibitors (PPIs) or H2 blockers reduce the amount of acid produced by the stomach. Suppressing gastric acid may help alleviate symptoms and lessen the chronic stimulation of the glands. However, medical therapy rarely causes complete regression, so excision remains the definitive treatment for symptomatic or complicated cases.
Endoscopic removal is the preferred, minimally invasive method for symptomatic or large lesions, or those whose benign nature cannot be confirmed by biopsy. Endoscopic polypectomy is a common technique for pedunculated or smaller lesions, where a wire loop is used to remove the polyp. This procedure is highly effective and is a less invasive alternative to surgery.
For larger, flatter, or more broadly based lesions, Endoscopic Mucosal Resection (EMR) may be employed. EMR involves injecting a fluid underneath the lesion to lift it away from the deeper muscle layer before excision. This technique helps ensure complete removal and reduces the risk of perforation. The goal is to remove the growth completely to resolve symptoms and provide a large tissue sample for diagnosis.
Surgical Intervention and Long-Term Monitoring
Surgical intervention is reserved for cases where endoscopic removal is not feasible or safe. This includes extremely large lesions, typically exceeding five centimeters, or those difficult to resect endoscopically due to a high risk of perforation. Surgery is also necessary if the lesion causes complete intestinal obstruction or has extended beyond the inner lining of the duodenum.
The type of surgery depends on the size and location of the growth, but generally involves localized excision. Procedures range from a simple surgical polypectomy or a wedge resection of the duodenal wall. In extremely rare instances, such as when a giant lesion mimics a malignancy and involves the head of the pancreas, a partial duodenectomy may be required.
Given the benign nature of BGH, the long-term outlook following successful removal is excellent. Follow-up monitoring is important, especially for patients with large or complex lesions. This typically involves repeat upper endoscopy examinations at predetermined intervals to check for recurrence, which is uncommon, and to confirm the duodenal lining remains healthy.