Duodenitis

What is duodenitis?

Duodenitis is inflammation occurring in the duodenum, the beginning of the small intestine. Inflammation in the lining of the duodenum may result in abdominal pain, bleeding, and other gastrointestinal symptoms. The most common cause of duodenitis is a stomach infection associated with a type of bacteria called Helicobacter pylori (H pylori). This organism disrupts the mucus barrier that normally protects the delicate duodenal lining from acidic stomach contents. Loss of this barrier predisposes a person to chronic inflammation and duodenal ulcer.

Many people become infected with H pylori at a young age, but symptoms most commonly do not appear until adulthood. In some people, H pylori infection causes duodenitis, which, if untreated, may lead to an ulcer (open sore) in the duodenum. Severe illness and prolonged use of medications such as nonsteroidal anti-inflammatory drugs (NSAIDs), alcohol, or tobacco may also lead to duodenitis. Less commonly, Crohn’s disease can cause duodenitis.

The signs and symptoms of duodenitis can be constant or sporadic, and the disease course varies among individuals. If H pylori is the cause, your symptoms will remain as long as the infection is untreated. Some people with duodenitis have no symptoms at all, while others may have burning pain or nausea with or without vomiting.

In the case of H pylori-related duodenitis, the infection can be treated successfully with antibiotics. For duodenitis not related to H pylori, medications that reduce stomach acid can be an effective treatment. You can reduce your risk of H pylori infection by following commonsense hygiene practices such as washing your hands with soap and water. Lifestyle changes, such as limiting alcohol consumption and limiting your use of nonsteroidal anti-inflammatory drugs (NSAIDs) can reduce your risk of duodenitis that is not related to H pylori.

Seek immediate medical care (call 911) for serious symptoms such as severe abdominal pain, bloody or black tarry stools, or bloody or black vomit.

Seek prompt medical care if you are being treated for duodenitis but mild symptoms recur or are persistent.

What are the symptoms of duodenitis?

Duodenitis causes inflammation of the stomach lining that may result in a number of symptoms. The symptoms can vary in intensity among individuals.

Common symptoms of duodenitis

You may experience duodenitis symptoms daily or just once in a while. At times any of these abdominal symptoms can be severe:

Abdominal bloating
Abdominal pain
Gas
Loss of appetite
Nausea with or without vomiting

Serious symptoms that might indicate a life-threatening condition

In some cases, duodenitis can be life threatening. Seek immediate medical care (call 911) if you, or someone you are with, have any of these life-threatening symptoms including:

Bloody stool (blood may be red, black, or tarry in texture)
Severe abdominal pain
Vomiting blood

What causes duodenitis?

The most common cause of duodenitis is H pylori infection. Other causes of duodenitis include prolonged use of medications such as nonsteroidal anti-inflammatory drugs (NSAIDs), which can cause inflammation of the lining of the duodenum. Severe illness, radiation therapy, and Crohn’s disease are also associated with duodenitis.

What are the risk factors for duodenitis?

A number of factors increase the risk of developing duodenitis. Not all people with risk factors will get duodenitis. Risk factors for duodenitis include:

Alcohol abuse
Crohn’s disease (inflammatory bowel disease that can affect any part of the intestine)
H pylori infection
History of radiation therapy
Prolonged use of nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin), naproxen (Aleve), or aspirin
Stress or severe illness
Tobacco use

How is duodenitis treated?

Treatment for duodenitis begins with seeking medical care from your health care provider. To determine if you have duodenitis, your health care provider may ask you to provide blood, urine, and stool samples for laboratory tests. Upper endoscopy permits visualization of the duodenum and the collection of small mucosal biopsies. Biopsies are studied under the microscope to confirm H pylori infection.

Antibiotic treatments for duodenal ulcer

If your duodenitis is caused by H pylori infection, antibiotic therapy is the mainstay of treatment. It is important to follow your antibiotic regimen precisely to avoid re-infection or recurrence. Most commonly, two antibiotics are given for 14 days. Examples of antibiotic treatments include:

Amoxicillin
Clarithromycin (Biaxin)
Metronidazole (Flagyl)
Tetracycline

Other medications to treat duodenitis

Medications such as proton pump inhibitors and histamine H2-receptor antagonists, which decrease the amount of acid in the stomach, can also be an effective treatment for duodenitis.

Proton pump inhibitors that may be effective in the treatment of duodenitis include:

Esomeprazole (Nexium)
Lansoprazole (Prevacid)
Omeprazole (Prilosec)
Pantoprazole (Protonix)
Rabeprazole (Aciphex)

Histamine H2-receptor antagonists that may be effective in the treatment of duodenitis include:

Cimetidine (Tagamet)
Famotidine (Pepcid)
Nizatidine (Axid)
Ranitidine (Zantac)

If you have diarrhea and vomiting, fluid and electrolyte replenishment is also a component of successful treatment.

What are the potential complications of duodenitis?

You can help minimize your risk of serious complications by following the treatment plan you and your health care professional design specifically for you. Complications of duodenitis include: