Brunner’s glands are glands that secrete mucus. These glands are located in the deep mucous membrane (the mucous membrane is the membrane lining the various body cavities and covering the surface of the internal organs) and the submucosa of the duodenum, which flows into the intestinal glands. The primary physiological function of Brunner’s gland is to secrete alkaline mucus, which protects the duodenal mucosa from acid secreted in the stomach.
Brunner’s gland hyperplasia is a type of proliferative disease of the duodenum, which is a very rare case. Brunner’s gland hyperplasia is usually asymptomatic, which means that it may show no symptoms or some symptoms such as abdominal pain, upper gastrointestinal bleeding, and may be associated with chronic pancreatitis.
What is Brunner’s gland Hyperplasia?
Brunner’s gland hyperplasia may be a very rare lesion of the duodenum that is usually asymptomatic and is diagnosed incidentally during upper gastrointestinal endoscopy. It can cause gastrointestinal bleeding, but the hemorrhagic shock may be a rare clinical manifestation of Brunner’s gland hyperplasia.
Brunner’s gland Hyperplasia Symptoms
Brunner’s gland was first described by Brunner in 1688. it’s a gland present within the mucosa and submucosa of the duodenum and performs the most physiological function of secreting alkaline mucus to shield the duodenal mucosa from acid secreted within the stomach. Brunner’s gland hyperplasia is the reason behind up to 10.6% of duodenal tumors and barely manifests itself with many symptoms, that is, asymptomatic. The primary cause of Brunner’s gland hyperplasia was diagnosed in 1835 in an exceedingly patient with fatal duodenal intussusception. It is usually found unintentionally because it is small and asymptomatic. However, Brunner’s gland hyperplasia can result in severe symptoms, including gastrointestinal bleeding, abdominal pain, and ileus. Brunner’s gland hyperplasia is sometimes polypoid within the configuration. A case of the diffuse nodular variety of Brunner’s gland hyperplasia was reported once with symptoms of intermittent upper abdominal pain, nausea, and vomiting, which were difficult to differentiate from malignancy.
Brunner’s gland Hyperplasia Causes
Patients with duodenal Brunner’s gland hyperplasia often suffer from chronic pancreatitis, peptic ulceration, and chronic erosive gastritis. It is believed that the reason for Brunner’s gland hyperplasia is chronic inflammation, a chronic irritant because of excessive secretion of gastric acid, or a decrease in exocrine pancreatic function. However, recently, it’s believed that hyperactivity of the exocrine modulating factor (hormone, pneumogastric, and intestinal mucosa factor) is the primary explanation for Brunner’s gland hyperplasia.
Clinical manifestations of Brunner’s gland hyperplasia are non-specific, like epigastric discomfort, bloating, dyspepsia, etc. Sometimes, it can result in bleeding, accelerated peristalsis, diarrhea, transient or partial bowel obstruction, and the duodenum’s intussusception because of the formation.
Brunner’s gland Hyperplasia Cancer
Brunner’s gland hyperplasia is a rare benign proliferative disease of the duodenum. Large masses can cause symptoms of obstruction and compression, which can depend on the location of the tumor. Due to their rarity, these lesions can be mistaken for malignancy on radiographic and endoscopic examinations.
Symptomatic hyperplasia of Brunner’s gland associated with pancreatitis is very rare, and the literature is limited to a few clinical cases. Endoscopic ultrasound can be useful in obtaining a correct diagnosis.
Brunner’s gland Hyperplasia Treatment
There is no consensus on the therapeutic principles of Brunner’s gland hyperplasia because follow-up research is insufficient since the disease is asymptomatic. Medical treatment serves to regulate gastric hyperacidity, which is one amongst the causes of Brunner’s gland hyperplasia. Thus, removal is the preferred method. We must completely remove the lesion by endoscopic resection or surgical resection when Brunner’s hyperplasia results in symptoms and complications, or when a definitive diagnosis is required.
There are various other methods of resection of Brunner’s gland hyperplasia. For instance, endoscopic polypectomy should be performed if the lesions are but 1 cm in diameter, if the scale is simply too large, or if the tumor could be a sessile tumor. Surgical polypectomy, wedge resection of the duodenum, or partial gastrectomy with extension to the duodenal bulb should then be performed. However, in one case of Brunner’s gland hyperplasia, there’s a relationship involving the second duodenal portion of the duodenum with pancreatic invasion. A 67-year-old patient reported massive stenosis induced by Brunner’s gland hyperplasia of the second duodenal portion and canal dilation on an abdominal CT finding.
Even though the frozen biopsy showed no signs of malignancy, they decided to continue the operation because they might not rule out the chance of malignancy.
However, it’s advised to consult a specialist if any of the above symptoms are seen.