From the Guidelines
Acquired duodenal stenosis is most commonly caused by peptic ulcer disease, but can also result from other conditions, with the main causes including peptic ulcer disease, Crohn's disease, pancreatitis, malignancy, radiation therapy, surgical complications, corrosive ingestion, and eosinophilic gastroenteritis. The main causes of acquired duodenal stenosis include:
- Peptic ulcer disease: Chronic inflammation and scarring from duodenal ulcers can lead to narrowing of the duodenum.
- Crohn's disease: Inflammation and strictures in the small intestine can affect the duodenum, as noted in the British Society of Gastroenterology consensus guidelines on the management of inflammatory bowel disease in adults 1.
- Pancreatitis: Chronic inflammation of the pancreas can cause fibrosis and narrowing of the adjacent duodenum, with nutritional support often needed, as discussed in the ESPEN guidelines on enteral nutrition: pancreas 1.
- Malignancy: Tumors of the duodenum, pancreas, or surrounding structures can cause external compression or infiltration.
- Radiation therapy: Treatment for abdominal cancers can lead to fibrosis and stenosis of the duodenum.
- Surgical complications: Anastomotic strictures following gastroduodenal surgery.
- Corrosive ingestion: Accidental or intentional ingestion of caustic substances can cause scarring.
- Eosinophilic gastroenteritis: Rare condition causing eosinophilic infiltration and fibrosis. Treatment depends on the underlying cause and may include endoscopic dilation, surgical intervention, or medical management of the primary condition, with early diagnosis and treatment crucial to prevent complications such as malnutrition or gastric outlet obstruction, as highlighted in the ACR Appropriateness Criteria for nonvariceal upper gastrointestinal bleeding 1 and the AGA clinical practice update on endoscopic management of perforations in the gastrointestinal tract 1.
From the Research
Causes of Acquired Duodenal Stenosis
The causes of acquired duodenal stenosis can be intrinsic or extrinsic. Intrinsic causes include:
- Neoplasm 2
- Inflammatory stenosis, often associated with Crohn's disease 3, 4, 5, 6
- Fibrosing or neoplastic process 3
Extrinsic causes include:
Association with Crohn's Disease
Crohn's disease is a common cause of acquired duodenal stenosis, with stenosis being a typical complication of the disease 3, 4, 5, 6. The stenosis can be inflammatory or fibrostenotic in nature 4. In some cases, the stenosis may be the first evidence of Crohn's disease 6.
Other Causes
Other causes of acquired duodenal stenosis include adenomas with high-grade dysplasia 2. The treatment of duodenal stenosis depends on the underlying cause and may involve medical, endoscopic, or surgical approaches 3, 2, 5, 6.