From the Guidelines
Peptic duodenitis is primarily caused by Helicobacter pylori infection, and the most effective treatment is triple therapy consisting of a proton pump inhibitor (PPI) and two antibiotics, as recommended by the most recent guidelines 1. The causes of peptic duodenitis include:
- Helicobacter pylori infection
- NSAID use
- Excessive alcohol consumption
- Smoking
- Stress Treatment options for peptic duodenitis focus on addressing the underlying cause, with first-line therapy for H. pylori infection being triple therapy consisting of a PPI such as omeprazole 20mg twice daily plus two antibiotics (typically amoxicillin 1g twice daily and clarithromycin 500mg twice daily) for 10-14 days, as recommended by the WSES guidelines 1. For NSAID-induced duodenitis, discontinuing the offending medication and using a PPI like pantoprazole 40mg daily for 4-8 weeks is recommended. Lifestyle modifications are essential regardless of cause, including:
- Avoiding alcohol
- Quitting smoking
- Reducing stress
- Eliminating spicy foods and caffeine H2 blockers such as famotidine 20mg twice daily can be used for milder cases or as maintenance therapy. Sucralfate 1g four times daily may help protect the duodenal lining during healing. These treatments work by either eliminating the bacterial infection, reducing stomach acid production to allow healing, or creating a protective barrier over inflamed tissue. Symptoms typically improve within 1-2 weeks of treatment, but complete healing may take 4-8 weeks, and follow-up testing to confirm H. pylori eradication is recommended 4 weeks after completing therapy, as supported by recent studies 1.
From the FDA Drug Label
14.1 Active Duodenal Ulcer In a multicenter, double-blind, placebo-controlled study of 147 patients with endoscopically documented duodenal ulcer, the percentage of patients healed (per protocol) at 2 and 4 weeks was significantly higher with omeprazole 20 mg once daily than with placebo (p ≤ 0.01).
14.2 H. pylori Eradication in Patients with Duodenal Ulcer Disease Triple Therapy (omeprazole/clarithromycin/amoxicillin) Three U.S., randomized, double-blind clinical studies in patients with H. pylori infection and duodenal ulcer disease (n = 558) compared omeprazole plus clarithromycin plus amoxicillin with clarithromycin plus amoxicillin
The causes of peptic duodenitis are not directly stated in the provided drug label, but it can be inferred that H. pylori infection is a contributing factor to duodenal ulcer disease. The treatment options for peptic duodenitis include:
- Omeprazole 20 mg once daily for the healing of active duodenal ulcers
- Triple therapy: omeprazole plus clarithromycin plus amoxicillin for the eradication of H. pylori in patients with duodenal ulcer disease
- Dual therapy: omeprazole plus clarithromycin for the eradication of H. pylori in patients with active duodenal ulcer associated with H. pylori 2
From the Research
Causes of Peptic Duodenitis
- Helicobacter pylori infection is a major cause of peptic duodenitis, as well as duodenal and gastric ulcers 3, 4
- Use of nonsteroidal anti-inflammatory drugs (NSAIDs) can also contribute to the development of peptic duodenitis 3
Treatment Options for Peptic Duodenitis
- Proton pump inhibitors (PPIs) such as omeprazole, lansoprazole, pantoprazole, and rabeprazole are effective in treating peptic duodenitis by reducing gastric acid secretion 3, 5, 6, 7
- Combination therapy with a PPI and antibiotics can eradicate H. pylori infection and reduce ulcer recurrence 3, 4
- Treatment with PPIs for 2 to 4 weeks can heal duodenal ulcers, while treatment for 4 to 8 weeks may be necessary for gastric ulcers 3, 6
- Maintenance therapy with daily doses of a PPI can prevent relapse of gastroesophageal reflux disease (GERD) 7
Comparison of Treatment Options
- Different PPIs have similar efficacy in many cases, but may differ in their clinical pharmacology and potential for drug-drug interactions 7
- Lansoprazole has been shown to have a higher healing rate than omeprazole in some studies 6
- Rabeprazole has a more rapid onset of action than other PPIs and may be more effective in certain cases 7