Variations in the morphology of villous epithelial cells within 8 mm of untreated duodenal ulcers

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Abstract
In order to investigate the bio‐mechanics of duodenal ulcerogenesis and compare the ‘quality’ of drug mediated mucosal healing, it is necessary to define the morphological appearance of ulcerative mucosae. This report describes the morphological appearance of pre‐therapy, juxta‐duodenal ulcer (DU) villous epithelia. Biopsies made at endoscopy from the first part of the duodenum in four healthy volunteers and 3–8 mm from the edge of the DU in 97 patients were examined by light and electron microscopy. Irrespective of whether biopsies were made from the normal or juxta‐DU mucosa, the villous epithelium was populated by one, or more, of six, morphologically identifiable cell types. Control epithelia were populated with normal goblet and absorptive cells. Based on the fine‐structural characteristics of the predominant cell type, pathological specimens were divided into two groups: metaplastic (Group 1) and non‐metaplastic (Group 2). Group 1 specimens were either exclusively populated with fully differentiated metaplastic gastric surface mucus secreting cells (GMC) (Group 1A), or GMC in various phases of metaplastic differentiation together with abnormal goblet cells (Group 1B). Group 2 specimens were populated with ‘pathological’ absorptive and normal goblet cells. It is postulated that the group variations in pre‐therapy juxta‐DU morphology represent various phases in the natural history of duodenal ulcerogenesis and healing.