ABSTRACT
Discussion The most frequent cause of thickened duodenal folds is peptic ulcer disease. The folds may be enlarged as a result of edema, or Brunner gland hyperplasia (case 3.34) may simulate fold thickening. Usually, multiple enlarged, discrete nodules that form a cobblestone appearance are present in patients with Brunner gland hyperplasia. Most cases of duodenitis are caused by Helicobacter pylori infection. Treatment is with antibiotics and acid blockers. Patients with Crohn disease (cases 3.15, 3.16, and 3.17), giardiasis (case 4.48), sprue (case 3.18), Whipple disease (case 4.49), and lymphoma (case 4.55) also can present with thickened duodenal folds.
