Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jul 28, 2021; 27(28): 4484-4492
Published online Jul 28, 2021. doi: 10.3748/wjg.v27.i28.4484
Asymptomatic small intestinal ulcerative lesions: Obesity and Helicobacter pylori are likely to be risk factors
Shunji Fujimori
Shunji Fujimori, Department of Gastroenterology, Chiba Hokusoh Hospital, Nippon Medical School, Chiba 270-1694, Japan
Author contributions: Fujimori S contributed to the writing this paper.
Conflict-of-interest statement: The author declares no conflict of interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Shunji Fujimori, AGAF, MD, PhD, Director, Department of Gastroenterology, Chiba Hokusoh Hospital, Nippon Medical School, 1715 Kamagari, Inzai-City, Chiba 270-1694, Japan. s-fujimori@nms.ac.jp
Received: January 31, 2021
Peer-review started: January 31, 2021
First decision: March 29, 2021
Revised: April 9, 2021
Accepted: July 12, 2021
Article in press: July 12, 2021
Published online: July 28, 2021

It is often difficult to explain why ulcerative lesions are found in the small intestine because there are no obvious aggressors such as gastric acid. In particular, the treatment of small intestinal ulcerative lesions in asymptomatic patients with no symptoms, normal physical examinations, and normal blood test findings is not well documented. According to a summary of capsule endoscopy studies in healthy subjects, approximately 10% of subjects have small intestinal mucosal breaks. The number of mucosal breaks in these instances is approximately 1-3. We examined small intestinal mucosal breaks in healthy subjects recruited from our past two studies. Mucosal breaks were observed in approximately 10% of subjects, and the average number was 0.24 ± 1.21. The number of mucosal breaks in the small intestine was correlated with body mass index and was significantly higher in Helicobacter pylori-infected subjects and higher in males. These results indicate that 1-2 small ulcerative lesions, such as erosions in the small intestine, can be considered to be in the normal range, and close examination is not required. It is assumed that a follow-up medical examination is required for such asymptomatic persons. The presence of many small ulcerative lesions or an unequivocal ulcer indicates an abnormality for which close examination is desired. However, in many cases, it is sufficient to scrutinize after detecting anemia, but it is difficult to make a judgment due to insufficient reports, and future studies are required.

Keywords: Small intestine, Mucosal break, Ulcer, Asymptomatic, Obesity, Helicobacter pylori

Core Tip: Approximately 10% of asymptomatic subjects with normal blood tests have small intestinal mucosal breaks. A reanalysis of our previous studies showed that small intestinal mucosal breaks were strongly correlated with body mass index, were significantly more prevalent in Helicobacter pylori-infected individuals and were more prevalent in men. These may be risk factors for small intestinal mucosal breaks. Overall, 1-2 small ulcerative lesions in asymptomatic patients are considered to be in the normal range and do not require close examination, and it is assumed that a follow-up medical examination is required.