Many questions regarding
duodenitis remain unanswered. However, the evidence suggests that
duodenitis is a clinical entity which can give rise to
dyspepsia and, on rare occasions, gastrointestinal haemorrhage. Conventional and double contrast radiology has only a small part to play in the diagnosis of
duodenitis but is important in helping to exclude other lesions such as
duodenal ulcer. Provided care is taken during the fibre-optic visualization of the duodenal bulb, the endoscopic appearances of moderately severe
duodenitis correlate well with the histological changes seen. A diagnosis of apparent
duodenitis should be confirmed by the histological criteria described. Treatment at present is similar to that of
peptic ulcer, with the withdrawal of any predisposing and precipitating factors such as
aspirin, alcohol and smoking.
Antacids may relieve the symptoms. It is not yet known what effect these measures may have on the
duodenitis as opposed to the symptoms of
dyspepsia. The H2-receptor antagonist,
cimetidine, should be effective in treating
duodenitis but double blind clinical and endoscopic studies are required to confirm this. The place of surgery is as yet undefined. With the data at present available, it appears that
duodenitis is part of the pathophysiological spectrum of the
duodenal ulcer diathesis rather than a separate disease. It may represent both the production and healing phases of duodenal ulceration. In some patients the duodenal mucosa may proceed from normal to
duodenitis and then to normal again without the development of frank duodenal ulceration (Figure 4). Prospective studies are required which should include a long-term clinical follow-up of a large number of patients with
duodenitis accurately and specifically diagnosed by endoscopy and histopathology.