Is duodenitis a dyspeptic myth?

In 502 fibreoptic oesophagogastroduodenoscopies performed over 30 months, 14 cases (2.8%) of symptomatic duodenitis without an associated duodenal ulcer were diagnosed. Follow up (1 to 3-5 years) including repeat endoscopy and double-contrast barium meal showed that duodenal ulcers later developed in 6 patients. All have undergone surgery. A further 2 patients continued to complain of dyspepsis, and repeat endoscopy showed duodenitis, confirmed by conventional light microscopy (haematoxylin and eosin). The remaining patients are symptom-free. Repeat endoscopy and histological examination were either normal or showed mild inflammation of the duodenal mucosa. These findings suggest that duodenitis can cause symptoms and may be part of the pathophysiological spectrum of duodenal ulceration rather than a separate disease. It may represent both the production and healing phases of duodenal ulceration.