Duodenitis is inflammation and damage in the lining of the duodenum, the part of the bowel that begins immediately after the stomach. Where the changes are confined to the bulb, the first part of the duodenum, a report may sometimes use the word “bulbitis”.
At endoscopy there may be redness, swelling, a fragile lining or erosions.
Duodenitis is not cancer.
What causes duodenitis?
Duodenitis can have more than one cause. The most important are:
- Helicobacter pylori (H. pylori) infection
- Too much stomach acid reaching the duodenum
- Aspirin and NSAID painkillers
- Smoking
- Some infections
- More rarely, conditions such as Crohn’s disease and coeliac disease
So seeing duodenitis at endoscopy does not on its own show what is causing it.
Are bulbitis and duodenitis the same thing?
Not exactly. The bulb is the first part of the duodenum, immediately after the stomach.
- Bulbitis The inflammation is mainly in the bulb.
- Duodenitis Is a more general term for inflammation of the lining of the duodenum.
What does erosive duodenitis mean?
Where the lining of the duodenum shows not only redness but also superficial losses of tissue (erosions), it may be called “erosive duodenitis”.
An erosion and an ulcer are not the same: an erosion describes more superficial damage, an ulcer a deeper loss of tissue.
Can it be related to H. pylori?
Yes.
H. pylori is an important factor in duodenal ulcer disease in particular, and can be related to some pictures of duodenitis too.
Where H. pylori is suspected, it can be investigated by stomach biopsy, a urea breath test or a stool H. pylori antigen test.
What symptoms can it cause?
Some people have no symptoms at all. Others may have pain or burning in the upper abdomen, indigestion, nausea, bloating and discomfort related to meals.
But these symptoms are not specific to duodenitis.
Is a biopsy needed?
A biopsy is not essential in every duodenitis.
But where the endoscopic appearance is unusual, or where coeliac disease, Crohn’s disease, an infection or another condition is suspected, a biopsy may be taken from the duodenum.
To look for H. pylori, stomach biopsies are usually taken from the appropriate regions instead.
A biopsy being taken does not mean cancer is suspected.
Does duodenitis turn into cancer?
Generally no.
Duodenitis is not cancer, and ordinary duodenitis is not expected to turn into cancer over time. What matters is determining the underlying cause of the duodenitis.
How is it treated?
Treatment varies with the cause.
If H. pylori is present, eradication treatment is given. Where the damage is acid-related, acid-suppressing medicines may be used. If aspirin or NSAIDs are being taken, their necessity and risks are assessed.
Prescribed aspirin or blood-thinning medicines should not be stopped without speaking to your doctor.
If a different cause such as coeliac or Crohn’s disease is found, treatment is planned accordingly.
Is a follow-up endoscopy needed?
In simple, uncomplicated duodenitis a routine follow-up endoscopy is not needed for every patient.
Follow-up may be considered where symptoms continue, where an ulcer is present, where the endoscopic appearance is suspicious, where the biopsy result is abnormal, or where there is no improvement despite treatment.
When should more care be taken?
More detailed assessment is needed if duodenitis is accompanied by
Vomiting blood or vomit that looks like coffee grounds · black, tarry stools · severe or worsening abdominal pain · persistent vomiting · unexplained anaemia · unintended weight loss.
Remember
- Duodenitis Describes inflammation and damage in the lining of the duodenum.
- Bulbitis Is inflammation in the first part of the duodenum.
- H. pylori Can be one of the important causes.
- Aspirin and NSAIDs Can damage the lining of the duodenum.
- Duodenitis Is not cancer.
- A biopsy Is not needed in every patient; it matters when an underlying condition is suspected.
This is not enough to make a diagnosis
When duodenitis is found at endoscopy, the severity of the appearance, whether there are erosions or an ulcer, H. pylori status, the medicines being taken and any biopsy results all have to be weighed together.
Sources
- Prof. Ali Tüzün İnce, MD