Duodenitis: Inflammation of the Duodenum
Introduction:
Duodenitis is an inflammatory condition affecting the mucous membrane of the duodenum, the initial part of the small intestine, extending from the pyloric opening of the stomach to the jejunum. The duodenum measures approximately 25-30 cm or about 12 finger-widths, hence its name.
Physiology:
Food from the stomach, along with gastric juices (chyme), passes into the duodenum, where it mixes with duodenal secretions. The intestinal glands produce a large amount of enzymes and hormones involved in digestion. Bile and pancreatic secretions are also released into the duodenum. Through muscular contractions of the intestinal wall, chyme is mixed with digestive secretions, leading to the breakdown of nutrients.
Classification:
Duodenitis can be acute or chronic. Acute duodenitis accounts for about 6% of cases, while the remaining 94% progress to a chronic course. The diagnosis rate of duodenitis among adults is approximately 20%, with higher incidence in males compared to females.
Causes:
- Acute duodenitis can result from food poisoning, toxin exposure, excessive consumption of spicy food along with heavy alcohol intake, or ingestion of foreign bodies causing irritation to the intestinal mucosa.
- Chronic duodenitis may develop secondary to chronic gastritis, peptic ulcer disease, chronic pancreatitis, food allergies, giardiasis, or obstructive conditions.
- Helicobacter pylori infection is a major cause of chronic duodenitis.
Symptoms:
- Acute duodenitis typically presents with upper abdominal pain, nausea, vomiting, weakness, and fever.
- Chronic duodenitis may manifest in various clinical forms, including ulcerative, gastritis, cholecystitis-like, pancreatitis-like, neurotic, and asymptomatic.
Diagnosis:
The primary method for diagnosing duodenitis is upper endoscopy. Based on endoscopic findings, the type and progression of duodenitis can be confidently determined. Lymphoid gland sampling is also performed to assess inflammation.
- Additional diagnostic methods include:
- X-ray imaging of the stomach and duodenum using contrast agents.
- Measurement of gastric acid secretion.
- General and biochemical blood analysis.
- Collection of duodenal juice samples.
- Stool analysis.
- Tissue biopsy sampling for histological analysis.
Treatment:
Treatment of duodenitis is tailored based on the clinical type of the disease and is comprehensive.
- Duodenitis due to infection requires specific antibiotics to reduce inflammation. Medications may also be prescribed to reduce gastric acid secretion and protect the mucous membrane.
- Duodenitis associated with intestinal inflammation necessitates strict dietary management. Probiotics may be included to support gastrointestinal function.
- In cases of obstruction, a special diet and medications to enhance bowel motility and bind bile may be prescribed.
- In severe cases, surgical intervention may be necessary to remove obstructions and restore bowel passage.
Prevention and Outlook:
- Primary prevention involves maintaining a healthy diet, avoiding smoking, and reducing alcohol consumption. Prompt treatment of any gastrointestinal diseases is advisable.
- Prevention of duodenitis recurrence includes regular monitoring and appropriate treatment. Response to treatment is usually positive.
- Adherence to preventive measures and receiving prompt treatment for duodenitis improves outcomes.