Duodenitis

Duodenitis is inflammation of the duodenum, the first portion of the small intestine just beyond the stomach. It can be acute or chronic and, in many cases, reflects irritation from gastric acid, infection, or medications, with underlying diseases contributing in some patients.

Common causes include Helicobacter pylori infection, nonsteroidal anti-inflammatory drugs (NSAIDs) and other medications such as aspirin, alcohol use, smoking, and stress-related mucosal disease in critically ill individuals. Less common causes include autoimmune processes, Crohn's disease, celiac disease, and exposure to radiation.

Symptoms are often nonspecific and may include upper abdominal pain or discomfort, nausea, vomiting, bloating, and reduced appetite. If there is significant bleeding, signs may include black stools or vomiting blood.

Diagnosis is typically based on clinical presentation and endoscopic findings. Endoscopy with biopsy can assess inflammation and allow testing for H. pylori. Noninvasive tests for H. pylori (urea breath test, stool antigen) may also be used. Additional tests can include complete blood count to detect anemia and imaging if complications are suspected.

Treatment aims to relieve inflammation, treat underlying causes, and prevent complications. This may involve eradication therapy for H. pylori, proton pump inhibitors or other acid-suppressing medications, and avoidance of NSAIDs. In patients with Crohn’s disease, autoimmune disease, or other contributing conditions, disease-specific therapies may be needed.

Prognosis is generally favorable with appropriate treatment, though symptoms may recur if risk factors persist. Potential complications include gastrointestinal bleeding and, rarely, perforation or obstruction. Duodenitis may coexist with duodenal ulcers.