Diffuse Duodenal Nodular Lymphoid Hyperplasia. Duodenal composite images. Progression of disease. 40 year women presented with epigastric pain, vomiting, weight loss and recurrent diarrhoea. IgA levels were elevated [IgG 1400 mg/dl (normal 700-1600 mg/dl); IgM. 220 mg/dl (normal = 40-230 mg/dl); IgA 540 mg/dl (normal = 70-400 mg/dl)]. Patient had H. pylori related erythematous antral gastritis. Patient received H. pylori eradication sequential therapy followed by Levofloxacin/Doxycycline based second line eradication therapy and 14C UBT showed resistant H. pylori infection. Top 2 images. Duodenal mucosa showed diffuse infiltration with nodules of 3 to 5 mm size, scored as grade 3 nodular disease. Bottom 2 images at 2 years follow up. There was significant increase in size (>5 mm) and density of the nodular lesions. Kerckring's folds showed infiltration and focal thickening by nodular disease, scored as grade 4 nodular disease. Biopsies showed nodular lymphoid follicles and infiltrate showed polyclonality of the lymphocytes.