The endoscopic picture of melanosis in the duodenum.

CASE REPORT A 57-year-old black woman was treated for hypertension for 12 years. Her present medications for hypertension included propranolol and hydrochlorothiazide. The gastroenterology service was consulted because the patient had upper abdominal pain which increased after meals but was relieved by "ENO," a nonprescription drug that contains sodium tartrate and sodium citrate. The patient often had constipation which was also relieved by "ENO." She vehemently denied havil'lg taken any other laxatives. The physical examination was unremarkable except for moderate obesity. Upper gastrointestinal radiography revealed a normal esophagus and duodenum; the stomach appeared normal except for a questionable filling defect in the midantrum. On endoscopic examination, 2 polyps were found in the gastric antrum. One of these was removed with the electrical snare. Biopsy specimens were taken from the second polyp which was small and sessile. Histologically, these tissue fragments were composed of varying sized glands lined by uniformly tall, columnar, mucus secreting epithelium. There were scattered chronic inflammatory cells. There was no evidence of malignancy. The duodenal mucosa, on endoscopy, showed diffusely scattered black dots, each about 1 mm, extending all over the first and proximal second portions of the duodenum,