What is the treatment for duodenitis (inflammation of the duodenum)?

From the Guidelines

Duodenitis treatment should prioritize addressing the underlying cause, such as Helicobacter pylori infection, and managing symptoms with proton pump inhibitors (PPIs) and lifestyle modifications. The treatment approach involves a combination of medication and lifestyle changes to reduce stomach acid production, neutralize existing acid, and eliminate bacterial infections that damage the duodenal lining. According to the consensus recommendations for managing patients with nonvariceal upper gastrointestinal bleeding 1, patients with upper GI bleeding should be tested for Helicobacter pylori and receive eradication therapy if infection is present.

Treatment Options

• Medication options include PPIs like omeprazole (20-40mg daily) or pantoprazole (40mg daily) for 4-8 weeks to reduce stomach acid.
• H2 blockers such as famotidine (20mg twice daily) may also help.
• If Helicobacter pylori infection is present, triple therapy is necessary, consisting of a PPI plus two antibiotics (typically amoxicillin 1g twice daily and clarithromycin 500mg twice daily) for 10-14 days.
• For NSAID-induced duodenitis, discontinuing the medication and using a PPI is recommended.
• Antacids can provide quick symptom relief between doses of other medications.

Lifestyle Modifications

• Avoiding spicy foods, alcohol, NSAIDs, and smoking is recommended for mild cases.
• Patients considered at low risk for rebleeding after endoscopy can be fed within 24 hours 1.
• Severe cases may require endoscopic evaluation and targeted treatment.

Outcome

Most patients respond well to treatment within 2-4 weeks, though complete healing may take longer. The goal of treatment is to reduce morbidity, mortality, and improve quality of life by addressing the underlying cause of duodenitis and managing symptoms effectively. As stated in the consensus recommendations 1, post-treatment H. pylori infection status has been shown to be an independent predictor of rebleeding, and eradication of H. pylori has been demonstrated to reduce the rate of ulcer recurrence and rebleeding in complicated ulcer disease.

From the FDA Drug Label

Lansoprazole delayed-release capsules are indicated in adults for short-term treatment (for four weeks ) for healing and symptom relief of active duodenal ulcer [see Clinical Studies ( 14.1]. Omeprazole 20 mg once daily was significantly higher with omeprazole 20 mg once daily than with placebo (p ≤ 0.01) in a multicenter, double-blind, placebo-controlled study of 147 patients with endoscopically documented duodenal ulcer. Sucralfate 1 g bid is effective as maintenance therapy following healing of duodenal ulcers.

Duodenitis treatment options include:

• Omeprazole 20 mg once daily for short-term treatment of active duodenal ulcer 2
• Lansoprazole delayed-release capsules for short-term treatment (for four weeks ) for healing and symptom relief of active duodenal ulcer 3
• Sucralfate 1 g bid as maintenance therapy following healing of duodenal ulcers 4 Key points to consider when treating duodenitis:
• The treatment should be based on the severity and cause of the duodenitis
• The treatment options may vary depending on the presence of H. pylori infection or other underlying conditions.

From the Research

Duodenitis Treatment

• The treatment of duodenitis is similar to that of peptic ulcer, with the withdrawal of any predisposing and precipitating factors such as aspirin, alcohol, and smoking 5.
• Antacids may relieve the symptoms of duodenitis 5.
• H2-receptor antagonists, such as cimetidine, may be effective in treating duodenitis, but double-blind clinical and endoscopic studies are required to confirm this 5.
• In patients with duodenal ulcer associated with Helicobacter pylori, treatment of the infection improves healing and prevents complications and recurrences 6.
• The drug regimen generally consists of a high-dose proton-pump inhibitor (PPI) such as omeprazole plus antibiotics 6.
• A 14-day course of lansoprazole-based triple therapy without additional acid suppression therapy is highly effective in the eradication of H. pylori and in preventing ulcer recurrence 7.

Helicobacter pylori Eradication

• Eradication of H. pylori reduces the risk of complications and recurrence in patients with gastric or duodenal ulcer associated with H. pylori 6.
• The first-choice empirical treatment consists of three antibiotics: amoxicillin, clarithromycin, and metronidazole, plus a PPI 6.
• Dual treatment with a sufficient dose of a proton pump inhibitor plus amoxicillin could cure H. pylori infection even after the failure to cure H. pylori infection by a usual proton pump inhibitor-based triple therapy in patients with the wt/wt homozygous extensive metabolizer genotype of CYP2C19 8.

Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)

• Omeprazole was superior to placebo for the prevention of ulcer recurrence in chronic NSAID users 9.
• Misoprostol was superior to omeprazole for the prevention of gastric ulcers among those patients with unequivocal NSAID ulcers 9.
• The combination of low-dose misoprostol plus an antisecretory drug (either an H(2)-receptor antagonist or a proton pump inhibitor) may provide superior results compared with either alone 9.