Duodenitis - Causes, symptoms and treatment. MF.

Recently, diseases of the digestive system are more common than before. This is due not only to the deterioration of the quality of food products, but also to the constant presence of a person in a stressful state, which disrupts the functions of internal organs. One of these diseases is the defeat of the duodenum( PDC).

The gut is located between the gastric outlet and the jejunal primary, ensuring the progression of the food lump to the lower intestine and taking part in the digestion and absorption of nutrients. In the lumen of the intestine, the digestive juice formed in the pancreas and the bile from the gallbladder, necessary for the cleavage of the molecules of proteins, fats and carbohydrates, are excreted through the corresponding ducts. Inflammatory diseases of the duodenum are called duodenitis - the most common of the diseases of this organ.

Duodenitis can be an independent disease or be combined with the pathology of other parts of the digestive tract, for example, it can develop against a background of gastritis, pancreatitis, cholecystitis, enteritis, that is, against the stomach, pancreas, gallbladder, small intestine, respectively. As a result of the fact that the activity of all parts of the digestive tract is closely related, the inflammation of the DPC can not only be caused by diseases of these organs, but vice versa, as a primary disease, it can cause violations of their function.

Causes of duodenitis

Duodenitis can be primary and secondary. More common is the latter type. Primary type, as a rule, develops as a result of constant errors in nutrition and diet disorders, for example, when you regularly eat irritating substances in food products - acidic, salty, spicy, hot, fatty, fried foods, as well as alcohol.

Secondary duodenitis develops against the background of already existing pathology of the digestive system, such as:
- Gastritis, especially caused by Helicobacter Pylori - a microorganism colonizing the gastric mucosa and initiating the formation of erosions and ulcerative defects.
- Stomach ulcer, accompanied by too acid reaction of food content, causes its aggressive effect on the mucosa of the duodenum.
- Pancreatitis and cholecystitis cause insufficient enzymatic activity in the process of digestion of food and violation of the passage of food pulp from the DPC, that is, duodenosis develops - stagnation of the contents in the lumen of the intestine. The wall of the intestine is stretched, its blood supply is disturbed and there is a disruption of the integrity of the mucous membrane.
- Hepatitis and cirrhosis contribute to the disruption of the formation of bile acids involved in the digestion of fatty foods, so that undigested particles irritate the mucous membrane.

In addition, the acute and chronic form of the disease. The acute form develops due to such conditions as:

- Acute food poisoning, as well as food-borne virus infections( rotavirus, enteroviruses) or bacterial( staphylococcus, enterococcus and others) of nature. In this case, isolated PDK infection is rare, mainly lesions of the gastrointestinal tract by type of gastroenteritis or enterocolitis.
- A gross violation of the diet, for example, overeating fatty or spicy food, as happens in celebrations and feasts.
- Acute or chronic diseases of other organs of the digestive system.
- Burns mucous while swallowing poisonous chemicals, such as acids, alkalis, solvents. In this case, the poisonous substance before reaching the PDC affects the mucosa of the esophagus and stomach, therefore duodenitis is combined with the symptoms of esophagitis and acute gastritis.
- Foreign bodies - bones from plums, apricots, phytobezoirs( clumps of stuck undigested residues with the use of large amounts of grapes, for example), not only mechanically injure the mucous membrane, but also with prolonged exposure in the lumen of the gut disrupt its blood supply.

The chronic form, as a rule, develops as a result of an incomplete acute duodenitis or asymptomatic course of it, as well as due to chronic diseases of other organs of the digestive system. Contribute to the chronic process of frequent stress, bad habits, inaccuracies in the diet and frequent meals "dry-sour".

Symptoms of duodenitis

Clinical manifestations of duodenitis can be different depending on the reasons for which it was caused. The leading symptom of all forms of the disease is pain in the epigastric region( between the ribs in the upper half of the abdomen) and in the peripodal region.

In acute duodenitis, pain is intense, abrupt, occurring more often two to three hours after eating or at night( hungry pains).If duodenitis is combined with gastritis with high acidity of the stomach, pain can occur even after 15-20 minutes after eating. Such clinical forms are called ulcerative and gastritic.

When poisoning and toxic infections occur nausea, vomiting, fever, frequent loose stools. When chemical burns of the mucous organs of the gastrointestinal tract, the symptoms of esophageal lesions come out in the first place - acute pain in the oral cavity, in the neck and chest, nausea, vomiting, respiratory disorders. There may be a loss of consciousness and a painful shock.

With errors in nutrition, the patient notes aching pain in the abdomen, a feeling of raspryaniya, bloating, belching with a rotten smell, frequent stools or constipation.

If the inflammation of the mucous membrane of the duodenal ulcers involves the exit zone of the pancreatic and bile duct( nipple pectora), symptoms of pancreatitis and cholecystitis may be noted - intense pain in the abdomen left or right, and shingles, frequent vomiting of bile, belching with bitter taste, yellow skin tintand eyeballs due to mechanical jaundice. Such variants of the flow are called pancreato and cholecystoid.

All symptoms of acute duodenitis with competent treatment stop after 7-10 days. With ineffectiveness or lack of treatment, as well as gross violation of diet during the recovery period, the chronic form of the disease often develops, which is characterized by dull, almost constant epigastric pain, nausea, alternating diarrhea and constipation, bloating, loss of appetite, weight loss. With a prolonged course of the inflammatory process in the mucous membrane, the process of absorption and supply of nutrients to other organs in the body, in particular, the nervous system, is disrupted. This is manifested by asthenic-vegetative symptoms - fast fatigue, weakness, sleep disorders, irritability, weight loss, lack of appetite, unpleasant sensation of a full stomach after eating, constant nausea.

Diagnosis of duodenitis

The diagnosis can be assumed already during the interview and examination of the patient. When probing the anterior abdominal wall, soreness, rumbling in the projection of the duodenum, bloating are determined.

To determine the nature and cause of duodenitis, the doctor prescribes additional methods of examination:

- General blood and urine tests, biochemical blood analysis, stool examination( allows to determine the content of undigested fatty particles and starch indicating pancreatic gland failure, as well as latent blood in intestinalbleeding).
- Fibroesophagogastroduodenoscopy( FEGDS) - visual examination of the mucous membrane of the esophagus, stomach and duodenum with a thin probe inserted through the oral cavity. It is the most informative method of diagnosis, since it allows you to evaluate the intestine from the inside. According to the picture obtained during the study, erythematous, erosive, hemorrhagic, atrophic forms of duodenitis are isolated.

PHEGS in erosive gastroduodenitis

- Radiography, including with contrast, can be prescribed if it is not possible to perform PHAGS, but has less informative value. When defects and ulcers of the mucous membrane is characterized by a symptom of "niche" - the ingression of barium suspension into the damaged area of ​​the mucosa.
- Analysis of the reaction of gastric juice obtained during gastroscopy, allows you to assess the level of acidity in the stomach and the need to take drugs that lower it.
- US of internal organs is prescribed to exclude pancreatitis, cholecystitis, hepatitis, cirrhosis of the liver, structural anomalies of the gallbladder and bile ducts, and so on.

Treatment of duodenitis

Treatment of duodenitis varies depending on its cause. The main direction in the treatment of all forms of the disease is strict adherence to rational nutrition.

Thus, for food poisoning and toxic infections, detoxification therapy is prescribed by intravenous administration of solutions or a plentiful drink, as well as antibiotics, after which it is necessary to take probiotic preparations for normalization of the intestinal microflora( linex, normobact, etc.).

When poisoning with chemicals shows fasting for one to two days, then - drugs to suppress the production of hydrochloric acid in the stomach and funds with enveloping effects.

For the treatment of acute and chronic duodenitis due to infection of the stomach, the Helicobacter bacterium is prescribed antimicrobial drugs - clarithromycin, metronidazole, amoxicillin. In addition, for the suppression of increased acid production in the stomach and its neutralization, the following drug groups are shown:
- proton pump inhibitors - ransoprazole, omeprazole, etc.
- antihistamine blockers - cimetidine, ranitidine, etc.
- antacids - algal, phosphalugel andetc.

In the case when the inflammation of the duodenum is combined with impairments in the function of other organs, enzyme preparations are prescribed that improve the digestion of food( creon, hermitale, mikrazim, pancreatin, etc.), as well as prokinetics that improveThe massage bolus from the stomach into the intestine( Motilium) and antispasmodics eliminating pain syndrome( papaverine, no-spa, etc.).

If congestion of the contents in the gut( duodenosis) is caused by organic causes( adhesions, tumors, etc.), surgical treatment is indicated.

Lifestyle

For the successful treatment of acute duodenitis and the prevention of recurrences of the chronic form, rational nutrition, adequate rest, exclusion of stressful situations and bad habits is shown.

The notion of rational nutrition includes observing the frequency of food intake four to six times a day in small portions and receiving high-calorie, but at the same time low-fat food with the preferred use of dishes cooked in boiled or stewed.

uses products such as:

- products that have an enveloping effect on the gastric mucosa and DPC - flaxseed, oats, potato and cornstarch,
- cereal and ground soups,
- lean meats and fish, better inmeatballs, meatballs,
- scrambled eggs, dairy dishes,
- baked fruits, stewed vegetables,
- hardened bread, biscuits,
- butter and vegetable oil in small quantities.

- canned food, smoked products,
- spicy seasonings, spices,
- alcohol, coffee, lemonade,
- fast food,
- raw fruits and vegetables,
- fatty meat and fish.

In an acute period, the diet should be more strict with a gradual expansion of the menu as it recovers.

Adherence to simple dietary guidelines during and after acute duodenitis significantly reduces the chances of a process that can significantly impair the quality of life. Therefore, if a person even once in his life suffered duodenitis, then he should always take care of proper nutrition.

Complications of

In case of untimely access to medical care or failure to follow a diet for chronic duodenitis, complications such as:

- adhesive small intestinal obstruction due to overgrowth of connective tissue at the site of permanent inflammation in the mucosa and in the submucosal structures,
- ulcer of the bulb of the duodenumguts, including those complicated by hemorrhage,
- malabsorption absorption of the nutrients, leading to weight loss, unstable stools,eniyu activity and degeneration of internal organs.

Prevention of complications is the treatment started on time and following the recommendations of the attending physician.

Forecast

Prognosis for acute and chronic form of the disease is favorable. Complete recovery after acute duodenitis occurs almost always, if factors that have an irritant effect on the mucous membrane of the duodenum are excluded.

If the patient develops complications, the prognosis for life remains favorable, and for health it is doubtful due to a violation of the function of the internal organs. In some cases, in the presence of scar lesions of the bulb of the gut, with frequent exacerbations of peptic ulcer( 3-4 times a year or more), with a decrease in body weight of more than 15%, anemia and other laboratory abnormalities, dystrophy, and, if necessarysurgical treatment, the patient can be assigned a disability.

Doctor therapist Sazykina O.Yu.