Diagnosis
In addition to X-ray and ultrasound, duodenoscopy of the duodenum and other sections of the intestine is also a suitable examination method. In duodenoscopy, as in gastroscopy, a thin tube containing a camera is inserted through the esophagus and stomach into the duodenum, through which the mucous membrane can then be examined projected onto a screen. Using a small instrument attached to the tube, samples can be taken from the intestinal wall during a duodenoscopy, should the examiner discover suspicious areas on the surface mucosa (= biopsy).
If a patient suffers from the disease, this is impressively indicated by a swelling of the mucosa of the uppermost layer of the intestinal wall or the presence of gastric mucosa cells in the duodenum. Particularly severe forms of inflammation can be recognized by a thinning (= atrophy) of the mucous membrane. A peptic ulcer can be recognized as a sharply defined inflammation.
In combination with a thin ultrasound device, the intestinal wall can then also be examined by ultrasound. If desired, the complete examination can be performed while the patient is awake or under superficial anaesthesia. The therapy of an inflammation of the duodenum consists primarily of treating the underlying cause.
In case of inflammation in the course of painkiller treatment, these should be replaced immediately by alternative preparations that do not irritate the mucous membrane. If the cause is an infection with Helicobacter pylori, the inflammation will not disappear without treatment. In this case, the therapy consists of the indirect treatment of the inflammation by stopping the colonization with Helicobacter pylori.
This therapy is called eradication and usually takes about 7-10 days. During this time a gastric acid blocker (usually a so-called proton pump inhibitor) must be taken together with a combination of 2 antibiotics (usually amoxicillin, clarithromycin or metronidazole). After this time the germ is in most cases successfully fought and the mucous membrane of the stomach and duodenum can recover from the inflammation.
For all other inflammations it can often be helpful to reduce the production of gastric acid, because the hydrochloric acid produced in the stomach can also cause enormous damage to the sensitive mucous membrane of the duodenum. Less hydrochloric acid from the stomach therefore causes less damage in the duodenum. The reduction of gastric acid production is sufficiently possible in mild cases through a healthy lifestyle with easily digestible, low-fat, mild whole foods.
Foods that are difficult to digest and high in fat remain in the stomach for a very long time and lead to much more stomach acid production than light products that can be digested quickly in the rest of the digestive tract. It is recommended to eat several small rather than a few large meals. If these measures are not enough, there are also medicines that chemically regulate the production of gastric acid.
Apart from lighter preparations such as the so-called antacids (= “against acid”), the above-mentioned proton pump inhibitors play a prominent role here as the most effective stomach acid-reducing drugs. There is also support from the field of natural remedies for treating inflammation in the duodenum. Mustard seed grains, as well as broad plantain juice mixed with honey or also mixtures of aloe with sugar water and white wine are suitable here.
As already described above, colonization with the bacterium Helicobacter pylori is often responsible for duodenitis. If this is the case, it often requires a drug therapy to eliminate the bacterium.One speaks of an eradication therapy. Here, a combination of three active ingredients is usually used.
These are the acid pump inhibitor omeprazole and two antibiotics. These are either Clarithromycin and Metronidazol or Clarithromycin and Amoxicillin. Painkillers from the group of non-steroidal anti-inflammatory drugs should be avoided in the presence of duodenitis.
They are often the trigger of the disease and often lead to a worsening of an already existing inflammation. Ibuprofen and Diclofenac belong to this group of drugs. Diclofenac in the form of an ointment (e.g. Voltaren®) is not affected, as the substance is not absorbed into the body.
In the case of duodenitis, the main symptom relief measures are a diet that is easy on the stomach and avoiding the consumption of alcohol, nicotine and coffee. Warm, gentle types of tea such as chamomile tea or peppermint tea can provide relief. There are no specific home remedies for the treatment of duodenitis.
In the case of inflammation of the mucous membrane of the duodenum, the same applies to the recommended diet as in the case of inflammation of the stomach mucous membrane (gastritis): digestible food should be eaten as much as possible. Avoid fatty and spicy dishes. Alcohol should also be avoided in the presence of duodenitis, as this can lead to additional irritation of the mucous membrane. The same applies to coffee and nicotine.
