63 year old male presents to the Emergency Department with one day of generalized abdominal pain. Reports nausea and multiple episodes of non-bloody, non-bilious vomiting. No recent antibiotics or travel. Past medical history includes hypertension and alcohol abuse.  Vital signs are: Temp 99.9F, HR 112, RR 16, SpO2 100% RA, BP 150/89. On exam, patient has tenderness in the epigastric region. Labs demonstrate a WBC of 13 and lactate of 3.5. CT scan reveals inflammation suggestive of duodenitis. What is the most appropriate treatment at this time?

A. NPO, IV fluids, pain control

B. Azithromycin and Flagyl PO

C. Emergent surgical consultation

D. IV PPI, Ceftriaxone, Octreotide

Answer: A. NPO, IV fluids, pain control 

Duodenitis is inflammation of the mucosa of the duodenum. It is similar in presentation to gastritis and stems from the same etiology. Some causes of duodenitis include:

• H. Pylori

• Excessive NSAID use

• Alcohol consumption

• Physiologic stress

• Overproduction of gastric acid

• Radiation therapy

• Bariatric Surgery

• Autoimmune Disease 

In this patient a history of excessive alcohol use is the most likely etiology. Management of duodenitis is removal of the inciting agent and supportive care. In this case, NPO, IV fluids, pain control, while also adding high dose PPI is the appropriate answer. While H. Pylori is a potential cause of these symptoms, the answers provided were not an appropriate antibiotic regimen. H. Pylori infections are treated with either quadruple (bismuth, tetracycline, metronidazole, PPI) or triple (clarithromycin, amoxicillin, PPI) therapy. 

References: 

Gratton, M. C., & Bogle, A. (2016). Chapter 78: Peptic Ulcer Disease and Gastritis. In Tintinalli's emergency medicine: a comprehensive study guide (8th ed., pp. 514-517). essay, Mc Graw-Hill Education.