From the Guidelines
Duodenitis is primarily caused by Helicobacter pylori infection, as well as other factors such as nonsteroidal anti-inflammatory drugs (NSAIDs), excessive alcohol consumption, smoking, and autoimmune conditions like Crohn's disease and celiac disease, with treatment depending on the underlying cause. The causes of duodenitis can be multifactorial, involving infectious agents, medications, lifestyle factors, and underlying diseases. According to the study by 1, duodenitis is listed as one of the etiologies of upper gastrointestinal bleeding, highlighting its significance in gastrointestinal pathology.
Causes of Duodenitis
- Helicobacter pylori infection: This bacterium is known to damage the protective mucus layer of the duodenum, leading to inflammation and duodenitis 1.
- Nonsteroidal anti-inflammatory drugs (NSAIDs): Regular use of NSAIDs like aspirin, ibuprofen, and naproxen can reduce protective prostaglandins in the digestive tract, increasing the risk of duodenitis.
- Excessive alcohol consumption: Alcohol can directly irritate the duodenal lining, leading to inflammation and duodenitis.
- Smoking: Smoking impairs mucosal defense mechanisms and increases acid production, contributing to the development of duodenitis.
- Autoimmune conditions: Conditions like Crohn's disease and celiac disease can trigger inflammation in the duodenum through immune system dysfunction.
- Bile reflux: Bile reflux from the gallbladder into the duodenum can cause duodenitis.
- Viral or bacterial infections: Certain viral or bacterial infections beyond H. pylori can also cause duodenitis.
- Severe physical stress: Severe physical stress, such as burns or trauma, can lead to duodenitis.
Treatment of Duodenitis
Treatment of duodenitis depends on the underlying cause and may include:
- Acid-reducing medications like proton pump inhibitors (e.g., omeprazole 20mg daily)
- Antibiotics for H. pylori infection (e.g., clarithromycin 500mg, amoxicillin 1g, and omeprazole 20mg, all twice daily for 14 days)
- Lifestyle modifications, such as avoiding NSAIDs and alcohol
- Addressing underlying conditions, such as Crohn's disease or celiac disease.
From the Research
Causes of Duodenitis
The causes of duodenitis, which is the inflammation of the duodenum, can be attributed to several factors. Some of the key causes include:
- Helicobacter pylori infection, which is a major cause of duodenitis and is often associated with gastric metaplasia in the duodenum 2
- Nonsteroidal anti-inflammatory drug (NSAID) use, which can lead to a decrease in pH, imbalance between apoptosis and proliferation, reduction in mucosal blood flow, and recruitment of polymorphonucleates in distinct compartments 3
- Other factors such as gastric acid secretion and mucosal defense mechanisms may also play a role in the development of duodenitis
Relationship between H. pylori and Duodenitis
There is a strong association between H. pylori infection and duodenitis. Studies have shown that H. pylori infection can cause acute gastritis and progress to chronic gastritis, and that duodenitis often occurs concurrently with H. pylori infection 2. The eradication of H. pylori has been shown to improve healing and prevent complications and recurrences of duodenal ulcers 4.
Role of NSAIDs in Duodenitis
NSAIDs can also contribute to the development of duodenitis by causing a decrease in pH, imbalance between apoptosis and proliferation, reduction in mucosal blood flow, and recruitment of polymorphonucleates in distinct compartments 3. The concurrent use of NSAIDs in patients with H. pylori-induced gastritis may modify the subsequent inflammatory response 2.
Treatment and Prevention
Treatment of H. pylori infection and discontinuation of NSAID use can help to prevent and treat duodenitis. Proton pump inhibitors (PPIs) and antibiotics are commonly used to treat H. pylori infection, and PPIs can also help to reduce the risk of ulcer relapse 3, 4. In some cases, high-dose PPIs and amoxicillin may be necessary to cure H. pylori infection 5.