Duodenitis is the medical term for an inflammation of the duodenal mucosa. It can take both an acute and a chronic course.
What is duodenitis?
Duodenitis is an inflammation of the lining of the duodenum. The name duodenum comes from the fact that this part of the body is about twelve fingers wide. The duodenum is part of the intestinal tube and is directly connected to the stomach portal. As a curve in the shape of a C, the duodenum represents the initial part of the small intestine. The duodenum has the task of neutralizing gastric hydrochloric acid, which is transported from the stomach to the intestine along with food.
Causes
Duodenitis can be caused by a variety of triggers. These primarily include infections of the intestinal tract caused by viruses, bacteria such as shigella or salmonella, and amoebae. One of the most common causes of duodenitis is the bacterium Helicobacter pylori, which often settles in the stomach in childhood and causes symptoms in around ten percent of all sufferers. The bacterium has the ability to produce ammonia. This can irritate the surface mucosa in the small intestine and ultimately cause inflammatory reactions. If the surface layer of the mucosa is penetrated, there is a risk of duodenal ulceration. However, harmful substances such as certain medications, which include non-steroidal anti-inflammatory drugs such as acetylsalicylic acid (ASA), diclofenac, naproxen as well as ibuprofen, can also have a damaging effect on the mucosa of the duodenum. This is especially true for long-term use. In rare cases, the inflammatory bowel disease Crohn’s disease is the originator of duodenitis. Other possible causes include diseases of the stomach, bile ducts or pancreas, disorders of the central nervous system, stress and exposure to alcoholic beverages.
Symptoms, complaints, and signs
Duodenitis becomes noticeable in a variety of ways. In many cases, it is even not noticed at all by those affected, so that a diagnosis is only made by chance. Typical symptoms of duodenitis include stabbing or pressing pain that occurs below the ribcage, loss of appetite, digestive problems, and nausea and vomiting. If duodenitis is present, the symptoms are particularly apparent between meals. However, they may also occur in a fasting state and improve after eating, causing the pain to subside following meals. In the case of chronic duodenitis or duodenal ulcer, it is not uncommon to experience black or bloody stools and intense abdominal pain. Because this may indicate intestinal bleeding, a physician should be consulted quickly in such cases.
Diagnosis and course
If the symptoms of duodenitis lead to a doctor, he usually first performs a sonography (ultrasound examination) or has X-rays taken. Furthermore, he has the option of performing a duodenoscopy, which, like gastroscopy, is a reflection with an endoscope. The endoscope is equipped with a thin tube and a camera. The doctor inserts this instrument into the duodenum via the esophagus and stomach. The camera is used to take pictures that can be played back on an attached monitor. With the help of a small instrument attached to the tube of the endoscope, the doctor can take samples from the wall of the duodenum, which is called a biopsy. A clear sign of duodenitis is swelling on the top lining of the intestinal wall. In addition, gastric mucosal cells can be found within the duodenum. The physician can recognize severe forms of duodenitis by atrophy (thinning). An ulcer can be identified as a clearly circumscribed inflammation. The patient can follow a duodenoscopy while awake. However, it is equally possible to give him a surface anesthesia. Normally, duodenitis takes a positive course and, with appropriate medical treatment, freedom from symptoms is achieved after only a few days. However, if the cause of the condition cannot be determined, the inflammation can always return.
Complications
Complications do not necessarily arise in every case of duodenitis. Often, the affected person does not even notice the inflammation unless it is discovered by chance during an examination. In other cases, the inflammation causes pain in the abdomen and a loss of appetite. Likewise, vomiting and nausea occur and can thus reduce the patient’s quality of life. The patient is particularly affected by the symptoms between meals. In some cases, intestinal bleeding also results in bloody stools. This can lead to a panic attack in many people. Duodenitis can be well treated and limited. If the inflammation occurs due to taking painkillers, they must be discontinued or replaced with another medication. In most cases, this results in rapid improvement without complications. The inflammation itself is fought with the help of antibiotics and usually passes without further complaints. However, the patient must adjust to a change in diet and is limited to the intake of some foods during the treatment. Life expectancy is not reduced by duodenitis.
When should you see a doctor?
In any case, a doctor must be consulted for duodenitis. There is no self-healing in this disease, so early treatment can prevent possible complications and other ailments. A doctor should be consulted if there is severe and especially chronic pain in the area of the intestine that is not due to a stomach flu. Digestive complaints or a loss of appetite may also be indicative of duodenitis and should definitely be investigated if they occur for a prolonged period of time. Likewise, if vomiting and nausea persist, it is also advisable to see a doctor. Especially between meals, there may be significant discomfort. An immediate visit to the doctor is necessary if the duodenitis has also caused bloody stools. In emergencies or in case of very severe pain, a hospital should be visited or the emergency doctor should be called directly. As a rule, duodenitis is treated by an internist and can also be diagnosed by him.
Treatment and therapy
Treatment of duodenitis focuses on addressing the triggering cause. If the inflammation of the duodenum was triggered by taking painkillers, it is advisable to replace these drugs with other medications. If, on the other hand, the bacterium Heliobacter pylori causes the disease, its colonization of the gastrointestinal tract must be stopped, which means that the therapy of the inflammation is carried out in an indirect way. Such treatment may take seven to ten days. The patient is administered a so-called proton pump inhibitor (stomach acid blocker). In addition, he receives a combination of two antibiotics such as metronidazole, clarithromycin or amoxicillin. In most cases, the duodenum recovers from the inflammation after this treatment. In some patients, a reduction in gastric acid production is already sufficient. Thus, the sensitive mucosa of the duodenum is not infrequently affected by the hydrochloric acid, the production of which takes place in the stomach. Stomach acid can be reduced by a gentle diet with low-fat, mild whole foods that are easy to digest. In contrast, high-fat foods have a stimulating effect on stomach acid production and strain the gastrointestinal tract. In addition, to support the duodenum, natural remedies such as mustard seed seeds, aloe with sugar water, or common plantain juice mixed with honey can be taken.
Outlook and prognosis
In most cases, duodenitis can be treated relatively well, so there are no particular complications for the affected person. Here, early diagnosis and treatment always has a positive effect on the further course of the disease. If duodenitis is not treated, those affected suffer from severe abdominal pain and bloody stools. The symptoms usually intensify and there is no self-healing. As the disease progresses, bleeding occurs in the intestine and an ulcer forms. The inflammation can also spread to the surrounding organs, so that immediate treatment is necessary.In most cases, treatment is carried out with the help of medication and can completely relieve the symptoms. The duodenum usually recovers after successful treatment, so there is no long-term damage. Likewise, a balanced and healthy diet can have a positive effect on the course of the disease. Only in severe cases are surgical interventions necessary to treat duodenitis. Therefore, life expectancy is usually not reduced in this disease.
Prevention
To prevent duodenitis, a healthy lifestyle consisting of easily digestible whole foods is recommended. It also makes sense to avoid alcohol, tobacco, and medications that can damage the gastrointestinal tract.
Aftercare
In most cases, the measures and options for aftercare in duodenitis are very limited. In this case, a comprehensive examination and diagnosis of the disease must first take place to prevent further complications or further discomfort in the affected person. The earlier duodenitis is detected and treated, the better the further course of the disease usually is. In most cases, those affected by duodenitis are dependent on taking medication to alleviate the symptoms. Care must be taken to ensure that the dosage is correct and that the medication is taken regularly. As a rule, the doctor’s instructions should be followed, although a doctor should also be contacted if there are any questions or if there is any doubt. Quite often, a healthy lifestyle with a balanced diet can also have a positive effect on the course of duodenitis and significantly alleviate the symptoms. The affected person should avoid fatty or very sweet foods in order to protect the intestines and the stomach. Whether duodenitis reduces the patient’s life expectancy cannot be predicted in general.
Here’s what you can do yourself
The course of the disease and the severity of duodenitis depend on the causative factors and the possibility of their elimination. Self-help measures and adjustment of behavior in everyday life can support a positive course of the disease in terms of severity and duration. In cases where duodenitis is caused by long-term use of painkillers and non-steroidal anti-inflammatory drugs such as diclofenac, ibuprofen or acetylsalicylic acid (aspirin), discontinuation of the drugs can lead to rapid improvement and regeneration of the intestinal mucosa of the duodenum. In some cases, a change in diet to a low-fat, light diet is already sufficient to reduce gastric acid production, which is greatly stimulated by high-fat diets and leads to inflammation in the intestinal mucosa of the duodenum. The change in diet can also be carried out as an accompanying measure parallel to treatment with so-called proton pump inhibitors. If the symptoms are caused by a bacterial or viral infection, which indicates a weakening of the immune system, the diet should be adjusted to strengthen the immune system to accompany drug therapy. The supply of vitamins, minerals and various enzymes has a positive effect, so that the pathogenic germs can be better fought by the immune system. Equally positive effect during the treatment of duodenitis the renunciation of any alcohol consumption or tobacco consumption.
