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chronic duodenitis

  I recently had an EGD performed to rule out celiac
  as a potential cause of Zn and Fe malabsorption.
  Biopsy results showed slightly shortened villi in
  some areas, but the findings were not consistent
  with celiac sprue.  Biopsy results did show marked
  chronic inflammation within the lamina propria
  consistent with chronic duodenitis.  No organisms
  were identified.
  What causes chronic duodenitis?  Is this inflammation
  driven by stress?  Food allergy?  Bacteria?
  Also, given the associated malabsorption problem,
  what can be done to reduce the inflammation?  Does
  chronic duodenitis have long term implications?
  Many thanks,
  Chris Lund
Dear Chris,
Duodenitis implies inflammation of the first portion of the small intestine. In this area the most common cause of inflammation is damage from stomach acid. The most common cause of duodenitis is secondary to Helicobacter pylori infection. You mentioned biopsies of the duodenum, however, it is necessary to biopsy the stomach to diagnose this particular bacteria. It can also be diagnosed with a blood test. Nonsteroidal anti-inflammatory drugs such as aspirin and ibuprofen can also cause duodenitis. Other rare causes of duodenitis include acid hypersecretory states such as in patients with Zollinger-Ellison syndrome or systemic mastocytosis. If Helicobacter pylori infection is ruled out the treatment for duodenitis is acid suppression with either histamine receptor antagonists (such as ranitidine, cimetidine or famotidine) or proton pump inhibitors (omeperazole or lansoprazole) and avoiding nonsteroidal anti-inflammatory drugs. I hope you find this information helpful.
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