The main causes leading to the development of the inflammatory process in the mucous membrane of the duodenum are:
- abuse of fried, spicy, smoked and sour foods,
- abuse of high caffeine drinks (energy, coffee, strong tea, cola),
All of the above factors contribute to enhanced secretion of hyperacid gastric juice, that is, containing an increased concentration of hydrochloric acid. It enters the cavity of the duodenum, initially causing irritation, and then acute inflammation of its mucous membrane. When the disease becomes chronic, atrophic and degenerative processes occur in the intestinal wall.
Duodenitis often develops as a secondary process against the background of a number of the following pathologies of the digestive system:
- peptic ulcer and duodenal ulcer,
- chronic gastritis,
- infection of the stomach and duodenum with the bacterium Helicobacter pylori,
- impaired blood supply and innervation of the duodenal wall,
- chronic colitis, enteritis, pancreatitis, hepatitis,
- cirrhosis of the liver,
- helminthic invasions (giardiasis, ascariasis).
Forms of the disease
Depending on the duration of the disease and the activity of the inflammatory process, acute and chronic duodenitis is isolated. Acute, in turn, is divided into catarrhal, ulcerative and phlegmonous.
Phlegmonous form of acute duodenitis is an indication for surgery.
Chronic forms of duodenitis are classified according to various criteria:
- on the localization of the lesion (diffuse, local, post-bulbar, bulbar),
- by reason of occurrence (primary or secondary),
- according to the degree of morphological changes (atrophic, interstitial, superficial),
- according to the features of the endoscopic picture (nodular, erosive, atrophic, hemorrhagic, erythematous).
There are also special forms of the disease (tuberculosis, fungal, immunodeficient duodenitis).
The features of clinical manifestations distinguish the following forms of duodenitis:
- Ulcers-like. The patient complains of periodically arising "hungry" or nocturnal pains in the epigastric region, which are stopped by taking antacids or food. Often there is a bitter burp and heartburn.
- Gastritis. The pain occurs 20-30 minutes after eating. Dyspeptic syndrome is expressed (lack of appetite, nausea, vomiting, flatulence, unstable stool, belching).
- Pancreatitis-like and cholecystoid. The clinical picture is reminiscent of biliary colic. Patients complain of severe acute pain in the left or right hypochondrium, dyspeptic disorders.
- Neurovegetative. It develops as a result of hormonal duodenal insufficiency and manifests itself in dumping syndrome, asthenoneurotic autonomic disorders.
- Mixed In the clinical picture of the disease there are signs of various clinical forms.
- Asymptomatic. Most often observed in elderly patients. It proceeds without any signs and is found by chance when examining the gastrointestinal tract for another pathology.
One of the first symptoms is cramping, aching or stitching pains localized in the epigastric region. In some patients, they occur on an empty stomach, and in others, shortly after a meal. Also characteristic of duodenitis:
- nausea, vomiting,
- excessive sweating (hyperhidrosis),
- general weakness, dizziness.
Basically, the diagnosis of duodenitis is carried out according to FEGDS. As additional methods are used:
- contrast radiography of the gastrointestinal tract with barium sulfate,
- gastric sensing with laboratory examination of gastric juice (pH determination, a number of biochemical tests),
- duodenal sounding,
- laboratory tests - complete blood count, blood biochemistry, coprogram.
In the scheme of treatment of duodenitis include:
- proton pump inhibitors that reduce the secretion of hydrochloric acid by parietal cells of the stomach,
- antiparasitic drugs for helminthic invasions,
- antibacterial agents when infected with Helicobacter pylori,
Great importance in the treatment of duodenitis is given diet.
In case of acute duodenitis and exacerbation of chronic, Pevsner table No. 1 is assigned. Alcohol, black coffee, chocolate, ice cream, pepper, mustard, fatty fish and meat, spinach, sorrel, lard, fresh baking, smoked meat, pickles and mushrooms are excluded from the diet. The basis of the diet is oatmeal, buckwheat and semolina, mashed soups, eggs (1-2 pieces a day), lean meat, low-fat cottage cheese, yesterday's wheat bread, weak tea.
In chronic duodenitis in remission (in the absence of digestive disorders and pain syndrome), Pevsner treatment table No. 5 is recommended. The diet includes sweet fruits, crumbly cereals, boiled chicken or lean beef, vegetable broth soups, low-fat cottage cheese, wheat bread, compotes, dogrose broth, and weak tea. Alcohol, black coffee, ice cream, spices, fatty fish and meat, fresh pastry, strong meat broths, spinach, lard, sorrel are prohibited.
Phlegmonous form of acute duodenitis is an indication for surgery.
Possible complications and consequences
The main complications of duodenitis:
- periduodenitis (inflammation of the serous membrane surrounding the duodenum),
- development of erosive and ulcerative defects of the duodenal mucosa,
- ulcer perforation,
- ulcerative bleeding
- malignant tumors of the duodenum,
- pyloric stenosis (narrowing of the place of transition of the stomach into the duodenum),
- achlorhydria (a sharp decrease in gastric acidity),
- hormonal duodenal insufficiency,
- high intestinal obstruction (partial or complete),
- peritonitis (with ulcer perforation or development of phlegmonous duodenitis).
With timely and adequate treatment, the prognosis is generally favorable.
Etiology of the disease
Chronic duodenitis occurs due to ineffective treatment of diseases of the gastrointestinal tract. Most often it occurs in men. It can be localized in the duodenum as papillites and diverticulitis (local), as well as in the entire intestinal region. In the latter case, talk about the common duodenitis. The duodenum is associated with the entire human digestive tract. Due to this, the disease spreads through the digestive tract, affecting nearby organs.
The following types of chronic duodenitis are distinguished:
- Hyperplastic is observed with a large lesion area.
- Erosive - with the appearance of small wounds on the intestinal walls.
- Interstitial form - the lesion reaches the deep layers of the body.
- Atrophic is detected in violation of the secretory activity of the gastric juice with the thinning of the walls of the duodenum.
- Superficial duodenitis is manifested when the mucous membrane of the upper parts of the duodenum is damaged.
The variability of this disease is divided into the following types:
- With duodenostasis - is a complex form, the treatment of which is carried out when a patient is hospitalized.
- The combination of enteritis, chronic duodenitis and gastritis is a complex, longer-term treatment.
- Bulbits are minor duodenitis of atopypeptic origin with clear localization.
- Papillitis - develops in a small area, mainly manifested as okolosocochkovy diverticulitis.
The symptoms of chronic duodenitis coincide with those of many other gastric ailments. It is characterized by the following features:
- nausea and vomiting,
- constipation and diarrhea,
- bloating and rumbling in the intestines,
- low pain on palpation,
- weight loss with continued or increased appetite,
- sleep disturbance,
- fast fatiguability,
- discomfort in the navel,
- white bloom on the tongue with a feeling of bitterness or metallic taste,
- pain syndromes in the pancreas.
A distinctive symptom is the appearance of heartburn. When exacerbation of chronic duodenitis appears painful pain syndrome, localized in the stomach, which increases with fasting and after meals. Also, the pain can be felt at night.
The disease may contribute to the exacerbation of the following pathologies:
- abnormalities in metabolism
- nervous and vegetative exhaustion,
- diseases of the digestive organs.
With the local nature of the disease exacerbated:
- bile duct dyskinesia,
Therefore, duodenitis can be confused with these pathologies. Its external signs are yellowing of the epithelium and subicteric sclera. Symptoms of chronic duodenitis and treatment should be interrelated.
The intensity of pain is determined by impaired motor and secretory functions. If the latter is elevated or normal, then pain syndromes are constantly present. The equivalent symptom of chronic duodenitis in adults is rapid food saturation.
Lighter signs are characteristic of the superficial type of pathology. In this case, the treatment of the symptoms of chronic duodenitis is aimed at normalizing the processes of digestion and eliminating irritants. At this type are not marked atrophic phenomena.
The most painful are signs of erosive duodenitis. The foci of inflammation are numerous and are located in the intestine and stomach. There are also small ulcers called erosion. In addition, blood and mucus may be present in the vomit.
Symptomatology depending on the pathology variant
The following clinical forms of duodenitis are distinguished:
The asymptomatic course of the disease is characteristic of the latent form.
When neuro-vegetative marked the following signs:
- general weakness
- fast fatiguability.
In gastritic duodenitis, the following symptoms are characteristic:
- loss of appetite,
- belching with a feeling of bitterness,
- feeling of heaviness
- aching dull pains.
In pancreatitis-like form, the following symptoms are noted:
- vomiting, sometimes with bile,
- there is yellow bloom on the tongue,
- belching with bitterness,
- encircling pain syndromes extending to the back.
Cholecystoid disease is characterized by the following symptoms:
- diarrhea alternating with constipation
- bitterness in the mouth
- pain syndromes in any hypochondrium, aggravated after taking eggs or fatty foods,
- hungry and nocturnal pains that subside after eating.
For the ulcer-like form, the following features are characteristic:
- weakness that occurs 2-3 hours after eating,
- vegetovascular disorders
- appetite disturbance, in which his absence is replaced by periods of his hyper-elevation,
- chest pain, which may be accompanied by a violation of swallowing,
- nausea and vomiting,
- belching sour,
- night pains in the epigastric region,
- cramping hungry or aching pains.
With mixed duodenitis, various symptoms from different forms of this disease are observed.
Treatment of chronic duodenitis
It is carried out identical to that in relation to gastritis:
- In order to reduce the acidity, patients are prescribed H2-blockers of histamine receptors ("Ranitidine").
- Drugs may be used to regulate motor function ("Motilium").
- Three-component therapy for one week or a decade to suppress the activity of Helicobacter pylori (Omeprazole, Clarithromycin, Amoxicillin).
- In the first days of exacerbation, they prescribe diet No. 1, then they move to the fifth table, with remission a full and balanced diet is shown.
- If exacerbated during the week, bed rest may be prescribed.
Drug therapy and surgery
How to treat chronic duodenitis? In order to determine this, you need to find out the reasons for it. The treatment of chronic gastritis and duodenitis is very similar:
- antibiotics to combat Helicobacter pylori,
- means that reduce the secretion of hydrochloric acid in the digestive tract ("Ranisan"),
- antacids for lowering acidity ("Maalox"),
- chemotherapy for helminth infections,
- enzymes ("Festal"),
- coating drugs.
In case of mucosal atrophy, bismuth preparations are prescribed (“De-Nol”). May require normalization of the functioning of the nervous system. For this purpose, prescribed sedatives, as well as herbal remedies. In the secondary form of the disease, which appears on the background of concomitant diseases, drugs are selected depending on the disease that caused the duodenal pathology.
With increased motility of the latter, biliary ducts and gallbladder, patients experience frequent liquid stool and severe pain syndromes. Food digested badly. Vomiting may occur. In order to eliminate pain syndromes, injections of analgesics are used:
For moderate pains, antispasmodics are prescribed.
The cause of increased motility is a spasm of smooth muscles of the ducts and intestines. For its elimination, intramuscular injections are administered:
In order to improve the assimilation of food, antiemetic drugs and enzymes are prescribed (“Bimural”, “Zerukal”).
In the case of reduced motility of the intestine and biliary tract there is a stagnation of the contents in the digestive organ and bile. In this case, the absorption of food is disturbed, as well as its transportation to the small intestine. Treatment is aimed at eliminating stagnation and improving the contractile function of the digestive organs.
The following drugs are prescribed:
- for constipation - laxatives,
- mineral waters and salicylic acid preparations to increase the liquid part of bile,
- "Holenzyme" and "Allahol" for choleretic action,
- "Motilium" - to improve the evacuation of food,
- "Duspatalin" - to selectively relieve spasm of smooth muscles of the ducts and intestines without reducing the contractile activity.
Duration of treatment is 1 month.
If there are various obstacles that cause obstruction (mechanical barriers, adhesions) that are not amenable to medical treatment, the symptoms of chronic duodenitis are eliminated by surgical intervention. In this case, complications may occur, manifested in the form of intestinal bleeding, thinning of the walls of this organ of digestion, acute pancreatitis. Rehabilitation involves sanatorium-resort treatment of patients.
They are used in combination with drug therapy. You can use the following methods of treatment:
- decoctions of yarrow and chamomile - herbs pour hot water and insist 30 minutes, take 100 ml 30 minutes before meals,
- squeezed juice is squeezed out of a crushed fresh aloe leaf, the reception is carried out every time an hour before meals ½ tsp,
- in the same dose and at the same time take honey
- to reduce the viscosity of bile and stimulate the emptying of the gallbladder, a decoction of corn silk is prepared, which is prepared in the same way as the first decoction.
Diet for chronic duodenitis
Reduce inflammation by using the right diet. At the same time, food intake during the day should be fractional (5-6 meals), it should be chopped. The diet for chronic duodenitis in adults depends on comorbidities and the form of duodenitis.
The following products should be excluded:
- strong tea, coffee, too hot and cold drinks,
- garlic and onions,
- mustard, pepper and other condiments of sharp direction,
- ice cream,
- smoked meat,
- canned food.
The diet includes the following dishes:
- dogrose decoction,
- fruit and vegetable juices,
- tea with milk,
- boiled fish and chicken,
- lean meat
- cheese, milk, cottage cheese, sour cream,
- fruits that do not contain a lot of acid, it is better to use them in baked form,
- vegetable puree of beets, carrots, zucchini, potatoes, pumpkins,
- they are in the form of soups cooked in a broth of lean fish or meat,
- milk soups.
In case of ulcerative form or combination of duodenitis with chronic enteritis, diet No. 1 is prescribed, if the main disease is accompanied by gastritis with secretory insufficiency, diet No. 2, and in concomitant pathologies of the biliary tract and liver, diet No. 5, and for pancreatitis-like duodenitis, diet No. 5l.
Prevention and prognosis
To prevent the disease, it is necessary to eat regularly and fully, to detect parasitic diseases in a timely manner, to treat them, like those in relation to the digestive organs, to limit the ingestion of irritating and spicy foods.
Gastroduodenitis has a favorable prognosis, subject to the recommendations of a gastroenterologist on the use of a particular diet and maintaining a healthy lifestyle. If the full course of treatment fails and the diet is not followed, chronic gastroduodenitis can turn into a stomach ulcer. In this case, more serious complications and deterioration of the patient's condition will be noted.
Chronic duodenitis is a disease that occurs against the background of undertreated gastrointestinal pathologies or may be associated with unhealthy diets and bad habits. It has its forms, each of which is characterized by its inherent features. The disease can be incorrectly diagnosed due to the similarity of symptoms with other gastrointestinal pathologies, however, drug treatment is in many ways similar to that in relation to gastritis. In this case, you can combine conservative treatment with folk remedies. You must also follow a diet, the number of which is determined by the doctor. With ulcerative duodenitis, the most strict first diet is used. Basically, the fifth number applies.
Duodenitis - the ulcer will not pass
About duodenitis They are talking when there are problems with the duodenum. The key manifestations for this pathological process are considered to be negative changes in the state of the mucous membrane. These include: atrophy, emerging inflammatory processes, erosion.
This organ (duodenum), being an important component of the digestive system, largely ensures its normal functioning.
Food that has gone there is subject to specific processing by the digestive juices produced by the pancreas. In addition, finding food here can be considered a preparatory stage, before its further absorption.
Do not forget that, thanks to the duodenum, a certain list of hormones is produced that help maintain the normal functioning of the entire digestive system. In addition, these hormones are actively involved in numerous metabolic processes of the body. So, in this article, we will try to talk in more detail about duodenitis, understand what kind of ailment it is, and most importantly, how to conduct its treatment.
Causes of duodenitis
The disease can be an integral companion of many serious diseases of the digestive system, among which are the following:
- inflammation affecting the pancreas
- inflammation of the gallbladder
- peptic ulcer
- intestinal colitis
- allergic reaction to certain foods
- multiple stomach problems, including gastritis
- various liver diseases
However, on the other hand, such complications in the duodenum may be a single, independent, independent disease. The list of factors capable of provoking the occurrence of duodenitis is quite extensive, here are the most fundamental:
- Helicobacter bacterium
- frequent stressful situations
- large-scale disregard for the basics of healthy eating (excessive abuse of spicy, fried food, all kinds of “fast food”)
- addiction, especially “friendly” relationships with alcoholic beverages, tobacco
Since such a disease is actively developing on the background of a surge of emotions, severe stress shocks, in many cases, duodenitis is ascertained in people with a weakened autonomic nervous system.
Classify two main forms of the disease: acute, chronic.
The first can be characterized by pronounced symptoms inherent in acute inflammation. Acute duodenitis, usually occurring in conjunction with acute inflammation of the intestine, stomach, is able to appear:
- Catarrhal, that is, when the disease affects only the mucosa itself. Wherein mucous membrane the walls of the duodenum, does not undergo significant structural changes of its composition, erosion is not observed.
- An erosive and ulcerative variety, characterized by the formation of lesions on the affected areas of the mucous membrane, possibly even numerous.
- Atrophied - when there is a significant thinning of the mucous, with the gradual “extinction” of its secretory function.
- Finally, the latter type is much more dangerous - phlegmonous, characterized by pronounced negative symptoms: rapid deterioration of health, excessive tension of the gastric muscles, fever, abdominal pain are increasing sharply. In fact, this is an acute purulent inflammation of the intestinal wall. It is extremely rare on its own, able to get active development in people who have a low bactericidal ability of gastric juice.
Unfortunately, the treatment is indicated operatively, the possible complications can be:
As for the first three points, then, as a rule, their development is not so critical, the result of treatment is overwhelmingly positive.
After timely treatment, the pain disappears completely, approximately after a few days.
But the situation with phlegmonous duodenitis is much more complicated.
The chronic stage of the disease is a very long process, with possible episodes of relapse, during which, the focus of inflammation makes quite negative changes in the structure of the mucous membrane. In the overwhelming majority of cases, the disease is prescribed for a long time, acquiring a chronic course. The male half of the population is subject to illness twice as often as the female.
The chronic form of the disease is divided into primary, secondary. Primary duodenitis is the result of an illiterate, irresponsible approach to the issue of nutrition, is rare. But secondary duodenitis is a much more “popular” phenomenon, and its development is observed in conjunction with other inflammatory diseases of the digestive organs already present in the body’s arsenal. For example, this list consists of a gastric ulcer, chronic gastritis.
Unsatisfactory activity duodenal ulcer, due to intestinal obstruction, poor peristalsis, is one of the key factors provoking the rapid development of secondary duodenitis. This condition is called duodenostasis.
Symptoms of duodenitis
The key symptoms are distinguished by their versatility, here are the most basic signs:
- significant pain that occurs in the area of the stomach, and especially aggravated at night
- nausea and vomiting, systematic feeling of bitterness in the mouth
- general weakening of the body
- heartburn is likely
- in some cases headaches may be troubling
- increased heartbeat
Treatment of duodenitis
An integrated approach to the therapeutic process is extremely important to achieve a positive result. The main tasks during treatment are:
- Conducting appropriate measures aimed at the complete elimination of the Helicobacter bacterium.
- The adoption of protective measures for the preservation of the mucous membrane of the duodenal wall. For example, a decrease in the secretion of hydrochloric acid, the use of drugs with enveloping properties.
- Normalization of the digestive processes through the use of enzyme drugs.
- If the culprit is the presence of an intestinal infection (giardiasis, helminthiasis), then most likely they will be prescribed appropriate chemotherapy.
All of the above will help combat the disease in chronic duodenitis.
If it is determined that the cause of intestinal problems is duodenostasis, then initially, it is required to accurately diagnose the true cause of its manifestation.
For example, when the basis of the problem lies in the disruption of the normal functioning of the digestive organs, they try to adhere to a conservative approach to the therapeutic process. Apply drugs "forging" bile, contributing to its secretion.
Duodenal intubation and intestinal lavage have a high degree of effectiveness.
However, it should be remembered that in our body "extra parts" is not provided. It is desirable that the withdrawal of all unnecessary intestines carried out independently.
Intestinal irrigation is of course permissible, only after a preliminary, thorough examination.
It is necessary to take into account the fact that the cleansing procedure can provoke the occurrence of dysbacteriosis.
In the formation of intestinal adhesions, any other mechanical obstacles, to which conventional therapy does not apply, resort to surgical intervention.
Food with duodenitis
Competently chosen nutritional ration can surely be considered the most important condition for a successful treatment process. For ten days, it is strongly recommended that the most gentle mode of consumption of food. The number of receptions should not be less than four, portions are small.
A complete ban is imposed on products that, at least in the slightest degree, can provoke an irritating reaction of the mucous membrane. These include: any fried, spicy, salty dishes, flour products, vegetables. At the same time, in the category of permissible products, fall:
- mucous soups, which are based on semolina, oatmeal
- liquid porridge
- no more than two soft-boiled eggs per day
- steamed omelets
Approximately ten days later, a slight expansion of the nutritional assortment is allowed, by moderately adding to the diet of wiped soups, fish or meat cutlets, of course, steamed. A further increase in the list of approved products should be carried out only after agreement with the attending physician, however, it is necessary to forget about sharp, irritating mucous membrane products for a long time - this is clear. Of course, the intake of alcoholic beverages is absolutely not acceptable.