Nonceliac diaphragm disease of the duodenum
In 1988, Bjarnason et al and Lang et al described the clinical and pathological features associated with small intestinal strictures in patients who had received non- steroidal anti-inflammatory drugs. These small intestinal strictures were very distinctive and unique to the known forms of small intestinal pathology associated with nonster- oidal anti-inflammatory drugs. Investigators used the term ‘diaphragm disease’ to describe the pathological changes. The observations were later confirmed by others detailing solitary or multiple diaphragm-like strictures, particularly in the distal small intestine and colon. In a subsequent report, a duodenal diaphragm-like stricture was reported in a Belgian man after consumption of an over-the-counter preparation that contained acetylsalicylic acid (ASA) and sodium bicarbonate.
Many other conditions have been associated with duodenal stricture formation and include congenital forms of duodenal stenosis, other disease-induced strictures including those related to intrinsic small bowel disorders, medication-induced strictures (ie, potassium chloride), abdominal trauma and infections such as tuberculosis. The present report documents a middle- aged adult with obstructive symptoms and endoscopically detected membranous stenosis of the descending duodenum. Although there was no history of medication use, the changes were typical of duodenal diaphragm disease.
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