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Duodenitis
Duodenitis is defined as a condition of inflammation in the lining of the duodenum,the first section of the small intestine.
Treatment 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) orproton 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).
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) orproton 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).
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Sources
(41a) http://www.ncbi.nlm.nih.gov/pubmed/20099679
(41b) http://www.ncbi.nlm.nih.gov/pubmed/9391784
(41c) http://www.ncbi.nlm.nih.gov/pubmed/17598663
(41d) http://www.ncbi.nlm.nih.gov/pubmed/7042248
(41e) http://www.ncbi.nlm.nih.gov/pubmed/21372542
(41f) http://www.ncbi.nlm.nih.gov/pubmed/22226322
(42) http://www.ncbi.nlm.nih.gov/pubmed/7336704
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