The duodenum is the first part of the small intestine. It is attached to the pyloric end of the stomach, from which it receives partially digested food. At the other end, the duodenum is continuous with the second part of the small intestine, known as the jejunum.
The length of the duodenum is about 25-38 centimeters. The duodenum is bent into a C-shaped tube that lies within the upper middle quadrant of the abdominal cavity. This region is also referred to as the epigastrium.
The duodenum is a important region of the digestive system and plays key roles in the digestive and absorptive processes. Apart from the stomach, the duodenum also communicates with other organs of the digestive system, such as the gallbladder and pancreas.
A variety of digestive problems may affect the duodenum. The duodenum can also get affected by diseases that are present in the neighboring organs in the abdominal cavity, such as the stomach, common bile duct, gallbladder, and pancreas. All these can cause pain in the duodenum.
Pain arising from the duodenum is typically felt as abdominal pain. However, duodenal pain is difficult to isolate and identify. This is because of the coiled structure of the intestine and the presence of many other structures in the abdominal cavity.
Therefore, duodenal pain may be attributed to other structures located within the abdominal cavity. Conversely, pain arising from other structures in the abdomen may be erroneously attributed to the duodenum. In order to identify pain that arises specifically from the duodenum, one must consider other accompanying signs and symptoms.
Signs and Symptoms
Duodenal pain is only a symptom of an underlying condition. Pain in the duodenum may occur due to many different causes. Not all causes of duodenal pain reside within the duodenum. Since duodenum lies in close proximity to other abdominal organs such as the stomach, liver, pancreas, gallbladder, transverse colon and other parts of the small intestine, it is difficult to label abdominal pain as duodenal pain without considering other accompanying signs and symptoms.
- Duodenal pain gets worse when eating. Pain is also higher just after a meal.
- Duodenal pain may also be accompanied by nausea and vomiting.
- Problems within duodenum may cause loss of appetite and body weight.
- Eating even a small quantity of food may cause a sensation of abdominal bloating. Visible abdominal distension may occur in some cases.
- Diarrhea may also accompany duodenal pain.
- Blood may be present in the stools. Bloody stools are medically referred to as melena.
- Jaundice and fever may also be present, especially in cases where the neighboring organs are diseased.
Causes of Pain in the Duodenum
Being a part of the digestive tract, the duodenum has to continuously contend with a variety of factors that can cause injury and inflammation. For example, the duodenum receives partially digested food material from the stomach. This mix of partially digested food also contains powerful enzymes and concentrated hydrochloric acid.
Digestive enzymes from the pancreas also enter the duodenum to aid the digestion of food. All these substances need to be neutralized quickly. Otherwise, they can start digesting the duodenal tissue and cause pain.Duodenal pain can be caused by a variety of problems within the duodenum. The following are some of the potential causes of duodenal pain.
Duodenitis refers to an inflammation of the tissues of the duodenum. Inflammation of the duodenum can occur due to many reasons. However, the most common reason for duodenitis is excessive influx of gastric acid and enzymes. This can occur in conditions such as gastritis, in which the tissues of the stomach are also undergoing inflammation.
Both gastritis and duodenitis can be caused by excessive usage of non-steroidal inflammatory drugs and infection with the bacteria, Helicobacter pylori. Duodenitis can also occur along with inflammation of the pancreas (pancreatitis), bile duct (cholangitis), and gallbladder (cholecystitis).
Read more on duodenitis.
Duodenal ulcers are open sores that may arise as a complication of duodenal inflammation. The ulcers in the duodenum may be accompanied by ulcers in the esophagus and the stomach. Peptic ulcers are very common in the duodenal region. When the duodenal ulcers come in contact with food, gastric acid and enzymes, pain occurs. Pain caused by eating may disrupt normal feeding behavior of an individual, resulting in loss of body weight.
Small bowel cancer or duodenal cancer is a rare type of malignant growth in the duodenum. The origin of the small bowel cancer may either be within the duodenum or elsewhere in the body. In the early stages of duodenal cancer, no symptoms may occur. Duodenal pain may begin as the tumor continues to grow.
Small intestinal bacterial overgrowth
The normal bacterial flora in the gut mainly resides in the large intestine or the colon. Compared to the colon, the small intestine does not have a large bacterial population. Under certain circumstances, such as AIDS, surgery, inflammatory bowel disease and diabetes, the bacterial population in the small intestine may start growing.
This condition is known as small intestinal bacterial overgrowth (commonly abbreviated as SIBO). The overgrowth of bacteria within the small intestine interferes with the normal digestion and absorption processes. The inflammatory response against the bacteria can also result in pain. However, small intestinal bacterial overgrowth does not always cause abdominal pain.
Duodenal pain may also be associated with the presence of duodenal diverticula. The term “diverticula” refers to small pouch-like outgrowths from the wall of the intestine. In many cases, the appearance of diverticula does not cause any symptoms. However, inflammation of these diverticula may cause pain. Inflammation can sometimes cause the diverticula to rupture, with potentially fatal consequences.
Read more on diverticulitis.
Treating Duodenal Pain
The exact treatment for duodenal pain can be prescribed only after identifying the underlying cause. Determination of the cause of duodenal pain may require multiple investigations such as stool tests, blood tests, abdominal ultrasound, x-ray study of small intestine and endoscopy of the upper gastrointestinal tract.
The treatment for duodenal pain will vary based on the nature of the underlying cause. For example, if the duodenal pain is caused by microbial infections, antibiotics may be prescribed. If gastric acid is eating away the duodenal wall and causing pain, then medications to suppress and neutralize gastric acid will be given. In case of duodenal cancer, radiation therapy, chemotherapy and surgery will be considered.
Apart from treating duodenal pain, a doctor may also prescribe some dietary and lifestyle changes. These changes may include avoiding oily and spicy foods, reducing intake of alcohol and caffeine, and cessation of smoking.