Brunner's glands

Brunner's glands
Section of duodenum. (Duodenal glands in submucosa are labeled at right, fourth from the top.)
Details
System	Digestive system
Location	Duodenum
Identifiers
Latin	glandulae duodenales
MeSH	D002011
TA98	A05.6.02.017
TA2	2957
FMA	71622
Anatomical terms of microanatomy [ edit on Wikidata]

Brunner's glands (or duodenal glands) are compound tubuloalveolar submucosal glands found in that portion of the duodenum proximal to the hepatopancreatic sphincter (i.e sphincter of Oddi).^{[ citation needed ]}

For decades, it was believed that the main function of the glands is to secrete alkaline (bicarbonate-containing) mucus in order to:^{[ citation needed ]}

• protect the duodenum from the acidic content of chyme (which enters the duodenum from the stomach),
• provide an alkaline environment which promotes the activity of intestinal enzymes,
• lubricate the intestinal walls.

However, more recent studies have demonstrated that Brunner’s glands actually act as major modulators of the gut microbiome and systemic immunity.

They are the distinguishing feature of the duodenum, and are named for the Swiss physician who first described them, Johann Conrad Brunner.^{[ citation needed ]}

Human Brunner's gland

Structure

Duodenal glands are situated within the mucosa and submucosa of the duodenum. They are most abundant near the pylorus, growing shorter and more sparse distally towards the terminal portion of the duodenum. ^[1]

The duodenum can be distinguished from the jejunum and ileum by the presence of Brunner's glands in the submucosa.^{[ citation needed ]}

Histology

Their excretory cannals are tortuous, opening at the bases of the villi. ^[1]

Two forms of duodenal glands are distinguished: the external group (which are more voluminous and extend into the duodenal submucosa), and the internal group (which are smaller and are situated within the duodenal mucosa). ^[1]

Function

They also secrete epidermal growth factor, which inhibits parietal and chief cells of the stomach from secreting acid and their digestive enzymes. ^{[2] [ citation needed ]} This is another form of protection for the duodenum.^{[ citation needed ]}

The Brunner glands, which empty into the intestinal glands, secrete an alkaline fluid composed of mucin, which exerts a physiologic anti-acid function by coating the duodenal epithelium, therefore protecting it from the acid chyme of the stomach. Furthermore, in response to the presence of acid in the duodenum, these glands secrete pepsinogen and urogastrone, which inhibit gastric acid secretion.^{[ citation needed ]}

More recent studies have demonstrated that Brunner’s glands are major modulators of the gut microbiome and systemic immunity. Studies conducted by Ivan De Araujo’s laboratory revealed that Brunner’s gland secretions promote the proliferation of probiotics and protect the host against foreign pathogens. ^[3]

Clinical significance

Hyperplasia of Brunner glands with a lesion greater than 1 cm was initially described as a Brunner gland adenoma. ^[4] Several features of these lesions favor their designation as hamartomas, including the lack of encapsulation; the mixture of acini, smooth muscles, adipose tissue, Paneth cells, and mucosal glands; and the lack of any cell atypia. These hamartomas are rare, with approximately 150 cases described in the literature. It is estimated that they represent approximately 5–10% of benign duodenal tumors. They are variable in size, typically 1–3 cm, with only a few reported cases of lesions larger than 5 cm. ^[5]

Most patients with Brunner gland hamartomas are asymptomatic or have nonspecific complaints such as nausea, bloating, or vague abdominal pain. ^[6]

Most reports in the literature describe local surgical resection of Brunner gland hamartoma via duodenotomy. Increasingly, successful endoscopic resection has been reported and is primarily used for pedunculated Brunner gland hamartomas. The endoscopic approach in selective cases appears to be safe, less invasive, and less costly. ^[7]

Consistent with the more recent idea that Brunner’s glands influence systemic immunity via the microbiome, patients who had the duodenal bulb removed (where the glands are mostly located) showed greater alterations in immune factors compared to patients having  more distal parts of the duodenum removed. ^[3]

See also

• Peutz–Jeghers syndrome
• List of distinct cell types in the adult human body

References

1. "Dictionnaire médical de l'Académie de Médecine". www.academie-medecine.fr. Retrieved 2023-11-10.
2. Gregory, H.; Preston, B. M. (1977-01-01). "The primary structure of human urogastrone". International Journal of Peptide and Protein Research. 9 (2): 107–118. doi:10.1111/j.1399-3011.1977.tb03470.x. ISSN   0367-8377. PMID   300079.
3. Chang H, Perkins MH, Novaes LS, Qian F, Zhang T, Neckel PH, Scherer S, Ley RE, Han W, de Araujo I; et al. (2024). "Stress-sensitive neural circuits change the gut microbiome via duodenal glands". Cell. 187 (19): 5393–5412.e30. doi:10.1016/j.cell.2024.07.019. PMC  11425084. PMID   39121857.
4. Abbass, Rami; Al-Kawas, Firas H. (July 2008). "Brunner gland hamartoma". Gastroenterology & Hepatology. 4 (7): 473–475. ISSN   1554-7914. PMC   3096129 . PMID   21960922.
5. Zhu, Menghua; Li, Hongyu; Wu, Yanyan; An, Yang; Wang, Yuye; Ye, Chun; Zhang, Dan; Ma, Rui; Wang, Xuehan; Shao, Xiaodong; Guo, Xiaozhong; Qi, Xingshun (June 2021). "Brunner's Gland Hamartoma of the Duodenum: A Literature Review". Advances in Therapy. 38 (6): 2779–2794. doi:10.1007/s12325-021-01750-6. ISSN   1865-8652. PMC   8189944 . PMID   33914269.
6. Barbeiro, Sandra; Martins, Catarina Atalaia; Marcos, Pedro; Gonçalves, Cláudia (2015-11-01). "Brunner's Gland Hamartoma – A Rare Cause of Upper Gastrointestinal Bleeding". GE - Portuguese Journal of Gastroenterology. 22 (6): 283–285. doi:10.1016/j.jpge.2015.06.005. ISSN   2341-4545.
7. Keihanian, Tara; England, Jonathan S.; Amin, Sunil (October 2020). "Endoscopic resection of a duodenal Brunner gland hamartoma presenting with GI bleeding". VideoGIE: An Official Video Journal of the American Society for Gastrointestinal Endoscopy. 5 (10): 486–487. doi:10.1016/j.vgie.2020.05.019. ISSN   2468-4481. PMC   7570429 . PMID   33103005.

External links

• Histology image: 11504loa  – Histology Learning System at Boston University - "Digestive System: Alimentary Canal: pyloro/duodenal junction, duodenum"
• Histology image: 11513loa  – Histology Learning System at Boston University - "Digestive System: Alimentary Canal: pyloro/duodenal junction"
• Histology image: 11609loa  – Histology Learning System at Boston University - "Digestive System: Alimentary Canal: duodenum, plicae circularis"