Tuesday, 3 December 2013

Duodenitis - The Diagnosis and Complications

Duodenitis is defined as a condition of inflammation in the lining of the duodenum, the first section of the small intestine. 
After taking the family history, recording the symptoms and a complete physical examination, the most common test which your doctor order is Endoscopy.
The aim of the test is to allow your doctor to visualize the duodenum and it surrounding area to check for any abnormality, including shallow, eroded areas in the wall of the intestine, bleeding, etc. 
In the study of 50 patients with endoscopically diagnosed duodenitis who had undergone double-contrast upper gastrointestinal (GI) examinations. Duodenitis was diagnosed on the original radiographic reports in six of 37 patients (16%) with mild-to-moderate duodenitis, five of 13 patients (38%) with severe duodenitis, and 11 of 50 patients (22%) with all grades of duodenitis on endoscopy. Subsequent analysis of the films revealed one or more radiologic signs of duodenitis (including folds more than 4 mm in thickness, mucosal nodularity, bulbar deformity, and erosions) in 18 of 37 patients (49%) with mild-to-moderate duodenitis, eight of 13 patients (62%) with severe duodenitis, and 26 of 50 patients (52%) with all grades of duodenitis on endoscopy(13),

IV. Complications
1. Hemorrhage
Inflammation of the stomach lining may lead to the formation of an ulcer (lesion) in the  the duodenum or stomach. In the study to investigate epidemiological, clinical, and etiological characteristics of acute upper gastro-intestinal bleeding between January 2003 and December 2008, researchers at the Medical Unit C, Ibn Sina Hospital, found that in 1389 registered cases, 66% of the patients were male, 34% were female. Mean age was 49. 12% of patients had a history of previous hemorrhage, and 26% had a history of NSAID and aspirin use. Endoscopy was performed in 96%. The gastroduodenal ulcer was the main etiology in 38%, followed by gastritis and duodenitis in 32.5%(14).

2. Iron deficiency anemia
Iron deficiency anemia is a result of internal bleeding. Men and postmenopausal women with iron deficiency anemia are routinely evaluated to exclude a gastrointestinal source of suspected internal bleeding. Forty-three of the 45 women fulfilled the entry criteria and were enrolled. Their mean age was 35 +/- 15 years and their mean hemoglobin level 9.3 +/- 2.3 g/dl. Twenty-eight upper gastrointestinal lesions were demonstrated in 24 of the 43 patients (55.8%): erosive gastritis in 12 (27.9%), erosive duodenitis in 4 (9.3%), erosive esophagitis in 3 (7.0%), hiatus hernia (with Cameron lesions) in 3 (7.0%), active duodenal ulcer in 1 (2.3%) and hyperplastic polyp (10 mm) in 1 (2.3%)(15).

3. Peritonitis
There is a report of a  case of a 62-year-old man with Candida krusei peritonitis secondary to duodenal perforation due to Candida duodenitis that was successfully treated with a 14-day course of caspofungin, according to Department of Human Pathology, University of Messina(16).

4. Etc.  

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(13) http://www.ncbi.nlm.nih.gov/pubmed/2016037
(14) http://www.ncbi.nlm.nih.gov/pubmed/21991509 
(15) http://www.ncbi.nlm.nih.gov/pubmed/16544728
(16) http://www.ncbi.nlm.nih.gov/pubmed/20632210 

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