• Definition of terms

    Inflammatory changes like those seen in gastritis can also affect the upper section of the small bowel, with the severity of such inflammation ranging from inflammation that is limited to the surface of the mucosal layer to ulceration that affects deeper layers of the duodenum, Celiac disease (celiac sprue), an autoimmune disorder that causes damage to the mucosal layer of the small intestine as a result of antibody formation against a specific protein (gliadin), which is commonly found in cereals, represents a special case in this respect – with damage caused as a result of the immune system cross-reacting with the mucosa of the small intestine. Other types of inflammatory changes are caused by pathogens that mainly affect the upper parts of the small intestine, where they can lead to chronic inflammation and damage to the mucosa (e.g. giardia).

  • Causes

    While inflammatory changes that affect the upper section of the small intestine are usually the result of exposure to noxious chemicals such as medications, food components or tobacco smoke, H. pylori infections of the stomach can also play a major role. Other parts of the small intestine are only rarely affected by inflammation, with most cases developing in response the effects of pain medications (NSAIDs such as aspirin, diclofenac or ibuprofen).

  • Frequency of occurrence

    Inflammatory changes affecting the upper section of the small intestine are very common. Every year, new cases of duodenal ulcers are diagnosed in approximately 150 per 100,000 of the general population.

  • Investigations

    One again, gastroscopy is the method of choice – it allows careful evaluation of the duodenum, in particular the very first part of the duodenum, the duodenal cap, which is slightly dilated. Tissue sampling in general – and sampling of stomach tissue in particular (confirmation of H. pylori infection) – forms an essential part of the diagnostic process. In rare cases, samples will be taken directly from the area affected by the inflammation. Ultrasound or CT scans are not recommended, except in certain very specific cases.

  • Treatment

    Medication to reduce the amount of acid produced by the stomach is the first line of treatment. Once again, this is because this type of treatment allows the gastric mucosa to heal naturally. This type of medication includes proton pump inhibitors (PPI) such as Omeprazole and Pantoprazole, but also includes H2-receptor antagonists such as Ranitidine. Additional measures include the avoidance of triggers such as certain types of pain medication (NSAIDs) and diet modifications. In order to ensure long-term recovery, it may also be necessary to reduce the exposure to, and adverse impact of, certain stressful situations. The advent of PPIs has meant that physicians rarely ever have to resort to surgery. In patients who test positive for Helicobacter pylori infection, eradication therapy is the treatment of choice. In the majority of cases, this involves a combination of antibiotics and PPIs, to be taken for a duration of one week. A follow-up examination is then performed after a certain period of time in order to confirm that the infection has been successfully eradicated.

  • Follow-up

    Follow-up endoscopy procedures are not essential in patients who have been treated for duodenal ulcers. They may, however, be useful in patients who have been treated for large ulcers. Just as in patients with gastric ulcers, the success of eradication therapy should be confirmed with breath tests and stool tests.