This article explains duodenitis and its causes, symptoms, and treatments.
Duodenitis is inflammation of the upper small intestine. This section connects to the stomach. Stomach conditions and diseases can also affect the duodenum.
The most common cause of duodenitis is a stomach infection with the bacteria Helicobacter pylori (H. pylori). This bacteria also causes inflammation of the stomach, or gastritis. Thus, gastritis is closely related to duodenitis. They share many of the same causes, symptoms, and treatments.
If you have duodenitis, your disease course may vary from other people’s. The signs and symptoms can be constant or may come and go. Some people with duodenitis have no symptoms at all. Others may have burning pain or nausea with or without vomiting.
See your doctor if you have symptoms of duodenitis. Seek immediate medical care (call 911) for serious symptoms such as severe abdominal pain, bloody or black tarry stools, or bloody or black vomit.
The most common cause of both gastritis and duodenitis is infection with H. pylori. H. pylori disrupts the mucus barrier that normally protects the delicate duodenal lining.
Loss of this barrier allows acidic stomach contents to irritate the lining. This puts a person at risk of chronic inflammation and duodenal ulcer. Nonsteroidal anti-inflammatory drugs (NSAIDs) have a similar effect.
Many people get an H. pylori infection at a young age. However, symptoms commonly do not appear until adulthood. If H. pylori is the cause of duodenitis, symptoms will continue until you treat the infection.
Other less common causes of duodenitis include:
- Autoimmune diseases: These include autoimmune enteropathy and Celiac disease, which attack the lining of the intestines.
- Cancer treatments: Chemotherapy and radiation therapy can cause duodenitis.
- Critical illness: A critical illness can decrease blood flow to the digestive system, causing stress and disruption of the lining.
- Crohn’s disease: This is a form of inflammatory bowel disease that can affect the small intestine.
- Food allergies: Allergies to milk and soy, among others, can cause duodenitis.
- Graft versus host disease: This is a condition that can develop after a donor transplant.
- Malabsorption diseases: These include tropical sprue, a chronic diarrheal disease.
- Medications: NSAIDs such as ibuprofen (Advil, Motrin), naproxen (Aleve), and aspirin can cause duodenitis.
- Peptic duodenitis: This is a condition in which there is excess stomach acid production.
- Substance use: Substances such as alcohol and tobacco in prolonged or excessive use can cause duodenitis.
Duodenitis may result in a number of symptoms. The intensity of symptoms can vary among individuals.
Common symptoms of duodenitis
You may get duodenitis symptoms daily or just once in a while. At times, any of these symptoms can be severe, including:
- abdominal pain
- bloating or fullness
- gas
- indigestion
- loss of appetite
- nausea with or without vomiting
Treatment for duodenitis begins with diagnosing it. To find out whether you have duodenitis, your doctor may order blood, urine, and stool samples for laboratory tests.
Imaging exams, such as an upper endoscopy to look at the lining of duodenum, may be necessary.
During an endoscopy, doctors can take small mucosal biopsies. Biopsies can confirm whether you have an H. pylori infection.
A complete diagnosis will guide your treatment, which may include antibiotics and medicine to reduce stomach acid.
Antibiotics
When duodenitis is due to an H. pylori infection, triple therapy is standard treatment. This consists of two antibiotics and a proton pump inhibitor (PPI). The most common antibiotics for H. pylori include:
- amoxicillin
- clarithromycin (Biaxin)
- metronidazole (Flagyl)
- tetracycline
Treatment with triple therapy lasts for 14–21 days. It is important to follow your antibiotic treatment plan precisely to avoid reinfection or recurrence.
Proton pump inhibitors
PPIs decrease stomach acid production. They are part of triple therapy for H. pylori. They may also be effective for other causes of duodenitis. PPIs include:
- esomeprazole (Nexium)
- lansoprazole (Prevacid)
- omeprazole (Prilosec)
- pantoprazole (Protonix)
- rabeprazole (Aciphex)
Histamine H2-receptor antagonists
Histamine H2-receptor antagonists also decrease the amount of acid in the stomach. These drugs include:
- cimetidine (Tagamet)
- famotidine (Pepcid)
- nizatidine (Axid)
If you have diarrhea or vomiting from duodenitis, fluid and electrolyte replacement is also a component of successful treatment.
You may help reduce your risk of H. pylori infection with certain hygiene practices. This includes washing your hands with soap and water. Hand washing is especially important when you are preparing food.
Increasing your intake of cruciferous vegetables may also help prevent infection. These vegetables include broccoli, cabbage, and cauliflower.
Limiting alcohol intake, tobacco use, and use of NSAIDs can also reduce your risk of duodenitis. It may also help to avoid foods that can irritate the lining of the digestive tract, such as spicy foods.
Potential complications of duodenitis include:
- cancer
- a duodenal ulcer, which can perforate the intestinal wall
- gastrointestinal bleeding
- an intestinal obstruction
- nutritional deficiencies
- recurrent symptoms and ulcers
You can help reduce the risk of serious complications by following your treatment plan.
Duodenitis is inflammation of the first part of the small intestine. It is closely related to gastritis, which is inflammation of the stomach. The two conditions are most commonly the result of an H. pylori infection.
You can have this infection for years and not know about it until it causes problems. Treating it involves triple therapy with two antibiotics and a PPI. Treatment often helps symptoms, but recurrences are common.
