Duodenitis is defined as a condition of inflammation in the lining of the duodenum, the first section of the small intestine.
I. Symptoms
1. Abdominal pain
In a report of Thirty nine children with recurrent abdominal pain
aged between 5.5 and 12 years, underwent endoscopic duodenal biopsy. Duodenal inflammation was graded by the duodenitis
scale of Whitehead et al (grade 0, 1, 2, and 3). In 13 out of 39
patients (33%) definite signs of inflammation were found (grade 2 and
3). Intestinal permeability to 51Cr-EDTA in patients with duodenitis
(grade 1, 2, and 3) was significantly higher (4.42 (1.73)%) than in
patients with normal (grade 0) duodenal biopsy appearances (3.3 (0.9)%)(1).
2. Loss of appetite, epigastric pain and weight loss
Parasitic infection cause of Duodenitis can lead to loss of appetite and weight loss, according to the study of An extremely uncommon case of parasitic infection presenting as eosinophilic ascites in a young patient, by thye research team at the GATA Haydarpasa Training Hospital(2).
3. Other symptoms
In the study of over a 15 month period, 124 referred patients were evaluated in a
prospective cohort analysis with a standardised investigation including
duodenal biopsies and aspirate, blood tests and faecal parasite and
calprotectin tests. Recovered subjects were recruited for symptom
analysis, researchers at the Haukeland University Hospital, found that There were significant associations between persistent Giardia
positivity, microscopic duodenal inflammation and a positive
calprotectin test. In patients with persisting symptoms after metronidazole treated Giardia
infection we commonly found chronic Giardia infection and microscopic
duodenal inflammation, especially in illness duration less than 7
months. Both these findings subsided over time. Increasingly,
investigations could not determine a definite cause for the persistent
symptoms. The very long-term post-giardiasis diarrhoea, bloating, nausea and abdominal pain documented here need further study(3).
4. Etc.
II. Causes and Risk factors
A. Causes
1. Medication
Prolonged use of nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin), naproxen (Aleve), or aspirin, in some people, it can lead to irritation causes of inflammation in the lining of the duodenum. There is a report of a 40-year-old previously healthy white man presented to the emergency
department at American University of Beirut Medical Center, Beirut,
Lebanon, with developed symptomatic severe transmural duodenitis
and periduodenal mesenteric streaking, consistent with a complicated
ulcer, probably associated with very short-term exposure to tiaprofenic
acid(3a).
2. Bacteria infections (Helicobacter pylor)
In the study of 138 (92 males, 46 females) patients aged 4.5-85 years [mean (7) =
45+/-SD 17.8 years] who had upper gastrointestinal endoscopy were
analyzed for presence of H. pylori, found that eighty-three had histopathology
alone, while 55 others had both histology and culture. Endoscopic
diagnosis included duodenal ulcer (DU) (n=35, 23%); gastric ulcer (n=4,
3%); gastric cancer (n=14, 9%); NUD, including gastritis (n=49, 32%); duodenitis
(n=47, 31%); and normal (n=16, 11%). Overall, H. pylori was positive in
107 of 138 (77.5%) patients. There was a significant association of H.
pylori with DU and NUD (p<0.000). Three-quarters of cases of normal
endoscopy harbored H. pylori. The finding of 80% and 85% H. pylori in
gastritis and duodenitis, respectively, was of interest(4).
3. Gastroesophageal reflux disease
In the study to determine the relationship between symptoms and H. pylori eradication
and to determine whether H. pylori eradication results in symptoms or
endoscopic findings of GERD, researchers at the University of Wisconsin Medical School, Milwaukee, showed that he presence of epigastric pain was significantly associated with
persistent H. pylori infection 1 month after therapy (odds ratio 2.3,
95% CI: 1.02-5.2; P=0.041), as was nausea (OR 7.1, 95% CI: 0.93-55.6;
P=0.029). The presence of epigastric pain was significantly associated
with ulcer relapse at 6 months (OR 7.5, 95% CI: 3.6-15.7; P < 0.001)
as was nausea (OR 5.1, 95% CI: 1.7-16.0; P=0.002). Heartburn was not
associated with eradication of H. pylori or ulcer relapse. New onset reflux
symptoms were reported by 17% (17 of 101 patients) at 6 months and were
not significantly different in patients with (15%) and without (22%)
persistent H. pylori infection (P=0.47)(5).
4. Parasitic infection
There is a report of a case of a 24-year-old male patient admitted for recent
ascites and splenomegaly of unknown origin. The patient was referred to
our institution with complaints of diarrhea, epigastric pain, abdominal
cramping and weight loss over the past three weeks, Upper gastrointestinal system endoscopy performed a few days later
revealed diffuse severe erythematous pangastritis and gastroduodenal
gastric reflux. Duodenal biopsies showed chronic nonspecific duodenitis. Antrum and corpus biopsies showed chronic gastritis. The final diagnosis was consistent with parasitic infection while the clinical, sonographic and histological findings suggested an eosinophilic ascites(6).
5. Nucleic acids by phases of cavitary secretion
In the study of the concentration of nucleic acids in the cavitary secretion
phase reflects the state of the gastroduodenal mucosa and
physicochemical properties of the mucus of Sixty patients with
gastroduodenal diseases (chronic gastritis, chronic duodenitis from surface to atrophic and during exacerbation), sgowed that changes in the distribution of nucleic acids by phases of cavitary secretion were revealed. A decrease in the total content of nucleic acids in cavitary contents was paralleled by decreased activity of chronic gastritis and duodenitis and normalization of colloid and gel-forming properties of the mucus(7)
6. Viral infection
In the study to investigate endoscopic and histopathological findings in the duodenum of
patients with Strongyloides stercoralis (S. stercoralis)
hyperinfection, reseachers at the indicated that twenty-four (96%) of the patients investigated were under
immunocompromised condition which was mainly due to a human T
lymphotropic virus type 1 (HTLV-1) infection.
The abnormal endoscopic findings, mainly edematous mucosa, white villi
and erythematous mucosa, were observed in 23 (92%) patients. The degree
of duodenitis
including villous atrophy/destruction and inflammatory cell infiltration
corresponded to the severity of the endoscopic findings(8).
7. Celiac disease, Whipple's disease and Crohn's disease
In studied the count and identification of inflammatory cells in duodenal biopsies of specific duodenitis. In celiac disease
there is an increase of lymphocytes in the epithelial layer, and rich
population of plasmacells in the lamina propria of duodenal mucosa. In
Whipple's disease
the reticulum cell component of lamina propria is increased, while
total inflammatory cells are within normal limits, and both lymphocytes
and plasmacells are decreased. The comparison between duodenal and
jejunal findings shows similar data in celiac and Whipple's disease. In Crohn's disease
the inflammatory cell count differs from controls only in presence of
radiological or endoscopical features of duodenal involvement(9).
8. Toothpick ingestion
There is a report of two patients with duodenal inflammation secondary to toothpick ingestion. In the first patient, there was acute onset of severe abdominal pain, with findings on computed tomography consistent with marked duodenal inflammation. Endoscopy revealed a toothpick embedded in the wall of the duodenum with associated ulceration. In the second patient, 4 months of chronic abdominal
pain was evaluated by upper endoscopy which revealed a toothpick
embedded in a 1-cm ulcer found in the third portion of the duodenum(9a).
9. Etc.
B. Risk Factors
1. Smoking and gender
In the study of the extent of duodenitis
on the site opposite the ulcer determined by histological
examination, showed that Sixty per cent of the duodenal ulcers were healed after
three weeks. By univariate analysis, the following factors affect the
healing; pain radiation
to back and pain duration during treatment (p less than 0.001),
multiple or deep ulcers, narrowing of duodenal bulb (p less than 0.01),
number of pain attacks and poor appetite (p less than 0.05). By the
stepwise logistic regression model, the following factors were selected
as predictors for healing of duodenal ulcer with 76% correct
classification: pain radiation
to back (p = 0.002), deep ulcer (p = 0.013), multiple ulcers (p =
0.028). Number of cigarettes/day (p less than 0.007) and male sex (p =
0.036). By this model, the prediction of healing could be accurately
assessed in 78% in a new sample. Individual treatment should be carried
out on the basis of these factors(10).
2. Alcohol abuse
Even though, there is no any relation existing between the percentage of cases with atrophic inflammation and the kind of drinks or the content of ethanol
in them, but examinations concerning the secretory function of the stomach
showed lower values of hydrochloric acid secretion, both in basic
conditions and after pentagastrin stimulation, in patients addicted to alcohol as compared to the control. Continuous abuse of alcohol
predisposes to atrophic inflammation of the gastric mucosa, and the
appearance of this type of inflammatory changes is related to the
duration of addiction. The longer the addiction, the lower the secretion
of hydrochloric acid is(11).
3. Stress
GDD in the young is a very frequent pathology, which may be triggered
off by abrupt changes in life style, especially in those patients who
are unable to react positively to changes in the outer world. GD
pathology arises most frequently during the first five months of
military service, especially within the third and the fourth month(12).
4. Etc.
III. Diagnosis
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.
IV. Prevention
A. The do`s and do not`s list
1. Avoiding spicy foods
Prolonged intake spicy foods incinerates the risk of irritation and inflammation of the lining of stomach and duodenum.
2. Changes in food tolerance and lifestyle
If you develop Duodenitis as result of bacterial infection, changes in food tolerance and lifestyle can be helpful. The prevalence of food
intolerance decreased from 71% to 44% among patients with peptic ulcer disease (PUD) (P <
0.0001) and from 76% to 63% among patients with duodenitis (G/D) (P = 0.09).
Tolerance improved for coffee, orange juice, fried foods, spicy foods and fruits, according to the study by Haukeland University Hospital(17).
3. Quit smoking
In the study to investigate whether cigarette smoking has an additive effect on the clinical presentation and course of disease in Helicobacter pylori-positive dyspeptic patients, researchers at the Tel Aviv University, indicated that Gastric and duodenal ulcers were significantly less prevalent in
non-smokers than in current or past smokers (gastric 1.8%, 4.1%, 6.3%;
duodenal 39.8%, 50%, 51.4%, respectively) (P < 0.05). The incidence
of gastrointestinal bleeding was significantly lower in non-smokers than
in current or past smokers (7.1%, 8.1% and 20.7%, respectively) (P <
0.05). Bacterial density, as assessed by the UBT value in 244 patients,
was higher in non-smokers (mean 352.3 +/- 273 units) than in past
smokers (mean 320.8 +/- 199) or current-smokers (mean 229.9 +/- 162) (P
< 0.05)(18).
4. Excessive alcohol drinking and stress
Excessive drinking and stress are associated with the risk of Duodenitis(19)(20).
5. Avoiding prolonged use of anti-inflammatory drugs, such as Ibuprofen and Aspirin
Prolonged use of nonsteroidal anti-inflammatory drugs (NSAIDs), such as
ibuprofen (Advil, Motrin), naproxen (Aleve), or aspirin, in some people,
it can lead to irritation causes of inflammation in the lining of the
duodenum(21).
6. Moderate exercise
Exercises can reduce stress at work and at home(22), thus, reducing the risk of Duodenitis.
7. Etc.
B. Phytochemicals to prevent Duodenitis
The aim of phytochemicals is to enhance the inmmue function ain fighting against invasion as result of bacterial, viral and parasitic causes of inflammation
1. Gingerole
Gingerole, is also known as gingerol, a
phytochemical of Flavonoids (polyphenols) found in fresh ginger. and in variety of other plants.
The herb has been used to treat nausea and vomiting of pregnancy, motion
sickness, rheumatoid arthritis, relieve migraine, etc. In the investigation of the effectiveness of chemical constituents of Zingiber
officinale Rosc. (Zingiberaceae)in treating oxidative stress found that
compounds [6]-gingerol, [8]-gingerol, [10]-gingerol and [6]-shogaol of the
herb scavenges of 1,1-diphenyl-2-picyrlhydrazyl (DPPH), superoxide and
hydroxyl radicals, inhibitsof N-formyl-methionyl-leucyl-phenylalanine (f-MLP)
induced reactive oxygen species (ROS) production in human polymorphonuclear
neutrophils (PMN), lipopolysaccharide induced nitrite and prostaglandin E(2)
production in RAW 264.7 cells, according to the study of "Comparative
antioxidant and anti-inflammatory effects of [6]-gingerol, [8]-gingerol,
[10]-gingerol and [6]-shogaol" by
Dugasani S, Pichika MR, Nadarajah VD, Balijepalli MK, Tandra S, Korlakunta
JN(23).
2. Rutin
Rutin also known as rutoside,
quercetin-3-O-rutinoside and sophorin is a Flavonols,
belong to Flavonoids (polyphenols) of Phenolic compounds found orange,
grapefruit, lemon, lime, berries mulberry,
cranberries, buckwheat etc. In the investigation of Rutin, a natural
flavone derivative and its anti inflammatory effect found that Oral
administration of rutin reduced rat paw
swelling starting 2 hours after lambda-carrageenan injection. Rutin reduced significantly (p < 0.05) and in a
dose-dependant manner the polymorphonuclear neutrophils chemotaxis to
fMet-Leu-Phe, according to the study of "Anti-inflammatory effect
of rutin on rat paw oedema, and on neutrophils chemotaxis and
degranulation" by Selloum L, Bouriche H, Tigrine C, Boudoukha C.(24).
3. Catechin
Catechin is phytochemical of
Flavan-3-ols, in the group of Flavonoids (polyphenols), found abundantly in
white tea, green tea, black tea, grapes, wine, apple juice, cocoa, lentils, etc. In the research on polyphenolic compounds (included catechins) in the berries of
edible honeysuckle and their biological effects, including recommended
utilization, are reviewed found that These berries seem to be prospective
sources of health-supporting phytochemicals that exhibit beneficial
anti-adherence and chemo-protective activities, thus they may provide protection
against a number of chronic conditions, e.g.,
cancer, diabetes mellitus, tumour growth or cardiovascular and neurodegenerative
diseases, according to "Phenolic profile
of edible honeysuckle berries (genus lonicera) and their biological
effects" by Jurikova T, Rop O, Mlcek J, Sochor J, Balla S, Szekeres L,
Hegedusova A, Hubalek J, Adam V, Kizek R.(25). Also in the preparation of the gel of Chinese medicine catechu, and to observe the
release mechanism in vitro and anti-inflammatory activity in rats, found that
the optimum condition of extraction from catechu was as follows, the
concentration of ethanol, ratio of raw material to solvent, ultrasonic time, and
extraction temperature were 50% , 1: 12, 35 min and 60 degrees C, respectively.
The formulation of catechu gel was carbomer-9 400.5 g, glycerol 5.0 g, the
extracts of catechu 50.0 mL, and triethanomine 0.5 mL The gel was
semitransparent and stable. The drugs released quickly. The catechu gel reduced
the paw edema considerably in dose-dependent manner compared to
carrageenan-induced rat, according to "[Preparation and pharmacodynamics studies on
anti-inflammatory effect of catechu gel].[Article in Chinese]" by Zheng
X, Zheng C.(26).
4. Cinnamic acid
Cinnamic acid is a phytochemical in the
class of Hydroxycinnamic acids, found abundantly in cinnamon, aloe. etc. In the sudy of the ulcer-preventive properties of aqueous extract of ginger
rhizome (GRAE) belonging to the family Zingiberceae, found that compositional
analysis favored by determination of the efficacy of individual phenolic acids
towards their potential ulcer-preventive ability revealed that between cinnamic
(50%) and gallic (46%) phenolic acids, cinnamic
acid appear to contribute to better H(+), K(+)-ATPase and Helicobacter
pylori inhibitory activity, while gallic acid contributes significantly to
anti-oxidant activity, according to "Gastroprotective Effect of Ginger Rhizome (Zingiber
officinale) Extract: Role of Gallic Acid and Cinnamic Acid in H+, K+-ATPase/H. pylori Inhibition and
Anti-oxidative Mechanism" by Nanjundaiah SM, Annaiah HN, M Dharmesh S.(27).
5. Resveratrol
Resveratrol is a phytochemical in the
class of Stilbenoids, found abundantly in skins and seed of grape wine, nuts,
peanuts, etc. In the observation of Resveratrol's effects
in exhibition of several physiological activities including anticancer
and anti-inflammatory activities in vitro and in experimental animal models, as
well as in humans, found that Anticancer activity of this compound is mainly due
to induction of apoptosis via several pathways, as well as alteration of gene
expressions, all leading to a decrease in tumor initiation, promotion, and
progression. Resveratrol exhibits
anti-inflammatory activity through modulation of enzymes and pathways that
produce mediators of inflammation and also induction of programmed cell death in
activated immune cells. Resveratrol has
been shown to produce no adverse effects, even when consumed at high
concentrations, according to "Potential of
resveratrol in anticancer and anti-inflammatory therapy"
by
Udenigwe CC, Ramprasath VR, Aluko RE, Jones PJ.(28). Also in the study of implantation and growth of metastatic cancer cells at distant
organs is promoted by inflammation-dependent mechanism, found that resveratrol remarkably inhibited hepatic
retention and metastatic growth of melanoma cells by 50% and 75%, respectively.
The mechanism involved IL-18 blockade at three levels: First, resveratrol prevented IL-18 augmentation in the blood of
melanoma cell-infiltrated livers. Second, resveratrol inhibited IL-18-dependent expression of
VCAM-1 by tumor-activated hepatic sinusoidal endothelium, preventing melanoma
cell adhesion to the microvasculature. Third, resveratrol inhibited adhesion- and
proliferation-stimulating effects of IL-18 on metastatic melanoma cells through
hydrogen peroxide-dependent nuclear factor-kappaB translocation blockade on
these cells, according to "Resveratrol prevents inflammation-dependent hepatic melanoma
metastasis by inhibiting the secretion and effects of interleukin-18" by
Salado C, Olaso E, Gallot N, Valcarcel M, Egilegor E, Mendoza L,
Vidal-Vanaclocha F.(29).
6. Etc.
C. Antioxidant to prevent Duodenitis
The aim of antioxidants is to enhance the inmmue function ain fighting against invasion as result of bacterial, viral and parasitic causes of inflammation.
1. Quercetin
Since it contains high amount of antioxidants, onion enhances the immune system
in fighting against the forming of free radicals and foreign invasion, thus
eeducing the symptoms of inflammatory conditions such as arthritis and gout and
infection caused by bacteria, including E.coli and salmonella,etc., according to
the study of Antibacterial and antioxidant
activities of quercetin oxidation products from yellow onion (Allium cepa) skin.(30).
2. Bromelain
Today Pineapple is widely cultivated for
commercial and its rich of vitamins and mineral and digesting enzyme bromelin
which seems to help digestion at the end of a high protein meal. It is second
only to banana as America's most favourite tropical fruit. In the classification of bromelain is a mixture of proteinases derived from
pineapple stem and its effect in
gastrointestinal tract, found that bromelain enzymes can remain intact and
proteolytically active within the murine gastrointestinal tract. They provide
further support for the hypothesis that oral bromelain may potentially modify
inflammation within the gastrointestinal tract via local proteolytic activity
within the colonic microenvironment, according to "Proteolytic activity and immunogenicity of oral
bromelain within the gastrointestinal tract of mice" by Hale LP.(31). Also Bromelain also increases the immune function in fighting the invasion of foreign
substances such as bacteria and virus, thus decreasing the risk of inflammation
and infection according to the study of "Bromelain treatment reduces
CD25 expression on activated CD4+ T cells in vitro" by Secor ER Jr,
Singh A, Guernsey LA, McNamara JT, Zhan L, Maulik N, Thrall RS., posted in
PubMed(32).
3. Polyphenols
Polyphenols, one of more powerful form of antioxidant not only helps to improve
the immune system fighting against the forming of free radicals and guarding our
body from foreign invasion, such as virus and bacteria, thus reducing the risk
of inflammation and lessening the risk of oxidation of low-density lipoprotein
(LDL) cause coronary heart disease, according to the study of "Plant polyphenols
as dietary antioxidants in human health and disease" by Kanti Bhooshan Pandey
and Syed Ibrahim Rizvi, posted in PubMed Central(33).
4. Catechins
Catechins are a category of polyphenols contained epicatechin (EC),
epigallocatechin (EGC), epicatechin gallate (ECG) and epigallocatechin gallate
(EGCG) and 25-100 times more potent than vitamins C and E that help to protect
the body from oxidative damage by enhancing the immune function in fighting
against forming of free radicals cause of cancer, according to the study of
"Green tea catechins augment the antitumor activity of doxorubicin in an in vivo
mouse model for chemoresistant liver cancer" by Liang G, Tang A, Lin X, Li L,
Zhang S, Huang Z, Tang H, Li QQ.(34).
5. LycopeneLycopene, one of the powerful antioxidant in tomatoes, not
only helps the immune system in neutralizing the forming of free radicals in the
body and according to Harvard investigation as it found that men who ate more
than 10 servings tomato-based foods daily (like cooked tomatoes and tomato
sauce,) had a 35 percent lower risk of developing prostate cancer than those who
ate the least amount of these foods. The benefits of lycopene was more
pronounced with advanced stages of prostate cancer. Also according to the study
of "Chemoprevention of prostate cancer with lycopene in the TRAMP model" by
Konijeti R, Henning S, Moro A, Sheikh A, Elashoff D, Shapiro A, Ku M, Said JW,
Heber D, Cohen P, Aronson WJ.(35),.
6. Etc.
D. Diet to prevent Duodentitis
1. Purple grape juices
In the evaluation of the protection of organic and conventional purple grape
juices and theirs effect against the oxidative damage provoked by carbon
tetrachloride (CCl(4)) found that in the alkaline version of the comet assay
performed on whole blood, it was observed that CCl(4) was capable of inducing
mainly DNA damage class 4 and 3 frequencies, which was significantly reduced in
groups that received both purple grape juices. This implies that both grape
juices have an important antigenotoxic activity, according to "Antioxidant and antigenotoxic activities of purple
grape juice--organic and conventional--in adult rats" by Dani C, Oliboni
LS, Umezu FM, Pasquali MA, Salvador M, Moreira JC, Henriques JA(36).
2. Garden strawberry
In the observation of Ethanolic extract of Fragaria vesca (EFFV) of Fragaria vesca L. and its effect on
Ulcerative colitis and Crohn's disease (chronic recurrent inflammatory bowel disease (IBD)) found that EFFV at 500 mg/kg showed significant
amelioration of experimentally induced IBD, which may be attributed to its
antioxidant and anti-inflammatory properties, according to "Effect of fruit extract of Fragaria vesca L. on experimentally induced inflammatory bowel disease in albino rats" by Kanodia L,
Borgohain M, Das S.(37).
3. Lime
Since it contains high amount of flavonoid, it helps to improve the immune
system fighting against forming of free radical causes of tumor and cancer,
according to the study of "Dietary intake of selected flavonols,
flavones, and flavonoid-rich foods and risk of cancer in middle-aged and older
women" by Wang L, Lee IM, Zhang SM, Blumberg JB, Buring JE, Sesso HD.(38).
4. Papaya leaves
In the assessment of ethanolic extract of Carica
papaya leaves and its anti-inflammatory
activity effect found that the extracts significantly reduced the persistent
oedema from the 4th day to the 10th day of the investigation. The extracts also
produced slight mucosal irritation at high doses. The study establishes the anti-inflammatory activity
of Carica papaya leaves, according
to "Anti-inflammatory activities of ethanolic extract of Carica papaya leaves" by Owoyele BV, Adebukola OM, Funmilayo
AA, Soladoye AO.(39).
5. Celery
High amount of vitamin C in celery helps to increase the immune function
infighting against the forming of free radicals, and irregular cell growth
causes of tumor and cancer, according to the study of "Vitamin C and
cancer: what can we conclude--1,609 patients and 33 years later?" by
Cabanillas F.(40). Also High amount of flavonoid in celery helps to reduce the risk of oxidative stress
as a result of its antioxidant activity, according to the study of
"Influence of flavonoid extracts from celery on oxidative stress induced
by dichlorvos in rats" by Cao J, Zhang X, Wang Q, Jia L, Zhang Y, Zhao
X.(41).
6. Etc.
V. Treatment
A. In conventional medicine perspective
A.1. Antibiotics
If the causes of the disease is as a result of bacterial infection, then antibiotic is the primary choice of treatment such as, Amoxicillin, Clarithromycin (Biaxin), Metronidazole (Flagyl), etc. for 14 days to prevent re-infection or recurrence. In the study to assess the duodenal infection by Mycobacterium avium-intracellulare is a common
opportunistic disease in HIV-infected patients (Individuals with CD4
counts <50 cells/mm3 are at highest risk) found that the patient was treated with rifampicine, isoniazide, ethambutol, and
pyrazinamide in association with stavudine, lamuvidine and efavirenz.
Despite improvement of general condition, fever persisted and the
patient died after 40 days of treatment. The main symptoms are
diarrhea, abdominal pain, weight loss, and fever(41a).
Other in the study of the prevalence of Helicobacter pylori infection in patients with erosive duodenitis
(ED), the associated gastric histological lesions and their response to
eradication therapy with omeprazole plus two antibiotics, showed that a 1-week twice daily therapy with omeprazole plus two antibiotics
(clarithromycin plus amoxycillin or metronidazole) was very effective in
H. pylori eradication, duodenal erosion healing, symptomatic
improvement, and in disappearance of associated histological gastritis.
These observations suggest that ED should be considered a variant form
of duodenal ulcer disease and treated accordingly(41b).
Side effects include yeast overgrowth, gastrointestinal trouble, etc.
A.2. Of the causes of the disease is as a result of elevated stomach acid, then medication include
1. Proton pump inhibitors
According to the study by Uniwersytet Mikołaja Kopernika w Toruniu, Collegium Medicum w Bydgoszczy, Proton pump inhibitors
(PPI), are characterized by high effectiveness, selectivity and few
adverse events. Development of PPI was an important issue in aspect of
acid-related diseases treatment. Nowadays following PPI are available on
the market: omeprazole, lansoprazole, pantoprazole, rabeprazole and
esomeprazole. In children these drugs are the most frequently use in
gastritis and duodenitis,
ulcer disease with coexistence of Helicobacter pylori infection and
gastroesophageal reflux disease. Pharmacokinetics of PPI is slightly
different in children than in adults and so far there is a lack of
randomised studies assessing the efficacy of PPI i developmental period
medicine on numerous groups of patients(41c).
Side effects include nausea,
diarrhea, abdominal pain, fatigue, dizziness, etc.
2. Histamine H2-receptor antagonists
Histamine H2-receptor antagonists, such as, Cimetidine (Tagamet), Famotidine (Pepcid), Nizatidine (Axid), etc.
According to the study by Dr. Mackinnon M and research team, treatment with cimetidine for 6 weeks resulted in a significant improvement in symptoms and in the endoscopic appearance of the duodenitis
when compared to treatment with placebo. The symptomatic and endoscopic
improvement, however, was not associated with any significant change in
the histological grading of the duodenitis.
Side effects include headache, tiredness, dizziness, confusion, diarrhea, constipation, rash, etc(41d).
According to the Department of Family Medicine, Cathay General Hospital, Taipei, Taiwan, in the study of all the patients aged ≥ 20 years with a diagnosis of cirrhosis
hospitalized for variceal bleeding and non-variceal upper GI adverse
events (oesophageal, gastric, duodenal ulcer, bleeding; gastritis and duodenitis)
in 2006, using ICD-9-CM diagnosis codes from inpatient
claims from the Taiwan National Health Insurance Database, found that Concomitant use of proton pump inhibitors
and histamine-2 receptor antagonists tended to decrease the upper GI
toxicity associated with non-selective NSAIDs and celecoxib(41f).
3. Proton pump inhibitors and low-dose aspirin
In the study to investigate the effect of histamin H₂ receptor antagonist (H₂RA) or proton pump inhibitor (PPI) for the prevention of upper gastrointestinal lesions associated with low-dose aspirin, found that suggest that the combined administration of low-dose aspirin and PPI is
effective for the prevention of upper gastrointestinal lesions
associated with low-dose aspirin. Also, the pharmacists should be
especially careful for upper gastrointestinal lesions development within
two years after administration of low-dose aspirin, regardless of
combined whether H₂RA or PPI(41e).
B. In herbal medicine perspective
1. Herbal combination of Symphitum officinalis and Calendula officinalis
In a study of a total of 170 patients were treated--137 only with the herb combination of Symphitum officinalis and Calendula officinalis of (78 with duodenal ulcer and 59 with gastroduodenitis), 33--with the herb
combination together with antacid (21 with duodenal ulcer and 12 with
gastroduodenitis), Dr. Chakŭrski I and the team found that the spontaneous pains disappeared in 90 per cent of the patients--in the
group with and in the group without antacid, the dyspeptic complaints
faded in over 85 per cent but in the patients, treated with herbs
and antacid the mentioned complaints disappeared several days earlier.
The palpitation pains, in both groups, disappeared in more than 90 per
cent of the patients within the same time. Gastric acidity, in both
groups, showed a statistically insignificant tendency to decrease prior
and post treatment. The gastroscopically control revealed that the ulcer
niche, in both groups, was healed in almost the same percentage of the
patients(42)
2. Suggested Starting Formula(43)
Aloe vera juice 70 wt%
Cabbage juice 20 wt%
Honey 10 wt%
Dosage: 3 times a day before meal
C. In traditional Chinese medicine perspective
According to the article of Herbs and Foods to Help Cure Naturally by NFA clinic of Oriental Medicine, epigastric pain including peptic ulcers is mostly the result of metabolic imbalance among liver, stomach and spleen. The function of one organ is depending on the function of another organs in Oriental medicine. They are understood not only by its function but also by its relationship with others. The article also suggested that Lu Hui, Yi Tang are ideal herbs to treat peptic ulcers
1. Lu Hui (Aloe Vera), the bitter and cold herb has been used in TCM to drain fire and guides out accumulation: for (chronic) constipation, strengthens the Stomach and kills parasites, clears heat and cools the Liver: for epigastric discomfort, enhancinmg the functions of Large Intestine, Liver, Stomach channels. Cautions: due to its cold property, dosage should be made considering the constitution of each patients. Some persons show allergy reaction to aloe vera
2. Yi tang (Honey), the sweet, slightly warm herb has been sued in TCM to tonifie the Spleen, the middle burner Qi (stomach and spleen), alleviate pain, moisten the Lungs and stops cough by enhancing the functions of Lung, Spleen, Stomach channels.
3. Gan Cao (Licorice) the sweet and neutral herb has been used in TCM to tonifie the Spleen, moisten the Lungs, stop coughing, clear heat and relieves fire toxicity, moderates spasms and alleviates pain, by enhancing the functions of all 12 channels(42).
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