Duodenitis: symptoms, causes, diet and treatment

The duodenum is the first part of the small intestine, just after the stomach. An NHS Borders patient information leaflet explains that duodenitis happens when your immune system senses a threat to the lining of the duodenum, for example an infection or damage from stomach juices, and triggers inflammation to fight infection-causing germs and heal the damage.

Duodenitis is often found at the same time as problems in the stomach. The NHS describes gastritis as irritation (inflammation) of the stomach lining and stomach ulcers as sores in the stomach, and its stomach ulcer page also covers sores in the intestine (duodenal ulcers). Your doctor will usually work out which parts of the upper digestive tract are involved.

The NHS Borders leaflet lists the symptoms below. Many overlap with indigestion, gastritis and ulcers, so symptoms alone cannot tell you the cause.

• Burning, cramping or hunger-like pain in your stomach.

• Gas or a bloated feeling.

• Lack of appetite.

• Nausea and vomiting.

• A full feeling soon after starting a meal.

• Tar-coloured or dark stools.

• Fatigue and a low blood count, or anaemia, if ulcers are bleeding.

According to the NHS Borders leaflet, causes include Helicobacter pylori (H. pylori) infection, taking non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin or ibuprofen for a long time, coeliac disease (an allergy to gluten, in the leaflet's words), Crohn's disease, drinking alcohol and smoking.

The NHS adds that the main causes of stomach ulcers are H. pylori infection and regular use of anti-inflammatory painkillers, and that stomach ulcers are more common in people who smoke and become more likely with age. The NHS lists the same drivers for gastritis: H. pylori, anti-inflammatory painkillers and aspirin, drinking too much alcohol, being very stressed and unwell, and stomach surgery.

The NHS Borders leaflet is published by a hospital endoscopy unit. A gastroscopy is a test in which a thin flexible tube with a camera is passed through the mouth and down into the stomach. For gastritis, the NHS says a GP might refer you for a gastroscopy if it is not getting better or is causing severe symptoms, and for a suspected stomach ulcer you may be referred for one.

Before that, the NHS says a GP may arrange tests to find the cause of upper tummy symptoms, such as a breath test to check for H. pylori (you are given a special drink or tablet and your breath is checked afterwards), a stool test or a blood test. See our gastroscopy page for what to expect.

The NHS Borders leaflet says one or more of these treatments may help.

• Antibiotics to treat H. pylori infection.

• Acid suppressant medication.

• Avoiding NSAIDs such as aspirin and ibuprofen. The leaflet adds that if you take aspirin for a health problem such as heart disease or stroke, you should not stop until you have checked with your healthcare provider, and that if you take NSAIDs for arthritis or pain, you should check with your provider about other pain medicines.

• Adopting a gluten-free diet if coeliac disease is the cause.

• Reducing alcohol intake and stopping smoking.

The NHS does not set out a specific diet for duodenitis, but its advice for gastritis and stomach ulcers is commonly applied to upper digestive inflammation, and your doctor can advise which parts fit your cause. For gastritis, the NHS suggests reducing drinks that contain caffeine, such as tea, coffee, cola and energy drinks, losing weight if you are overweight, and not eating 3 to 4 hours before going to bed. It says to avoid food or drink that is acidic (such as orange juice), fizzy, spicy or fatty, not to drink alcohol and not to smoke.

For stomach ulcers the NHS advises eating smaller meals, having your evening meal 3 to 4 hours before bed, keeping to a healthy weight and managing stress, and avoiding foods and drinks that trigger symptoms, which can include fatty or spicy foods, coffee and chocolate. If coeliac disease is the cause, a gluten-free diet is part of the treatment, as the NHS Borders leaflet says.

The NHS says to see a GP if you have tummy pain or indigestion for longer than 1 week, or if your tummy pain is getting worse or keeps coming back.

It says to ask for an urgent GP appointment or get help from NHS 111 if you have symptoms and you have lost your appetite, feel full after a very small meal, have lost weight without trying, feel a lump in your tummy, have pain or difficulty swallowing, or keep being sick.

Call 999 or go to A&E if you are vomiting bright red blood or your vomit looks like ground coffee, your poo is black, sticky and extremely smelly, or you have severe tummy or chest pain that started suddenly. Do not drive yourself.

The NHS says untreated gastritis may get worse and cause a stomach ulcer. For stomach ulcers it lists bleeding from the stomach or intestine, iron deficiency anaemia caused by bleeding, a hole in the stomach wall that can cause peritonitis, and an increased risk of stomach cancer from an untreated H. pylori infection.

That is why persistent upper tummy pain should not simply be treated with over-the-counter remedies indefinitely, and why a GP may check for H. pylori and review any anti-inflammatory painkillers you take.

On the NHS, a GP can arrange an H. pylori test and prescribe acid-reducing medicines, with referral to endoscopy if symptoms are severe or persistent. Some people choose private gastroenterology or private endoscopy for quicker access. In both settings, finding and treating the cause, particularly H. pylori or regular NSAID use, is the main goal.