Gastroduodenitis - Causes, symptoms and treatment. MF.

Gastroduodenitis -( gastroduodenitis; gastro-stomach + duodenum duodenum + -it - inflammation) - an inflammatory disease of the duodenal mucosa and the pyloric zone of the stomach. Gastroduodenitis manifests itself in the form of nausea, an unpleasant aftertaste in the mouth, pain in the epigastric region and a feeling of overflow of the stomach. Symptoms of gastroduodenitis are very similar to the symptoms of gastritis: a decrease in appetite, belching, rumbling in the stomach, diarrhea or, conversely, constipation.

Classification of gastroduodenitis

Depending on the prevailing etiological factor, the following are distinguished:

primary( exogenous) gastroduodenitis;
secondary( endogenous) gastroduodenitis.

The prevalence is as follows:

common gastroduodenitis;
localized gastroduodenitis.

Depending on the level of acidity gastroduodenitis varies:

gastroduodenitis with a normal secretory function;
gastroduodenitis with a decreased secretory function;
gastroduodenitis with increased secretory function.

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Causes of gastroduodenitis

There are many reasons for gastroduodenitis. There are endogenous and exogenous causes of its development.

Among endogenous causes of gastroduodenitis, great importance is attached to increased acid formation, reduction of mucus formation, disruption of hormonal regulation of secretion. In addition, the development of gastroduodenitis is predisposed to diseases of the liver and biliary tract, endocrine pathology.

Among the exogenous etiological factors of the appearance of gastroduodenitis are isolated physical, such as acute, cold or hot food, chemical( pesticide exposure).The most important factor is the ingestion of Helicobacter pylori into the digestive tract.

How the gastroduodenitis

develops When pathological etiological factors are exposed to the mucous membrane of the stomach and duodenum, an inflammatory reaction develops, which leads to a disruption in the physiological regeneration of the mucosa and the development of its atrophy. All these factors lead to disruption of the secretory and motor functions. As a rule, with gastroduodenitis, there is an increase in the tone and motility of the stomach, dyskinesia of the duodenum.

Symptoms of gastroduodenitis

Symptoms of gastroduodenitis are diverse and depend on the degree of structural changes in the mucosa, their location, the stage of the pathological process, the functional state of the stomach and the metabolic disturbances in the body. Common signs of gastroduodenitis are weakness, lethargy, disturbed sleep, often headaches. Objectively, with gastroduodenitis, paleness of the skin, manifestations of vitamin deficiency are observed. The severity of these symptoms depends on the degree of disturbance of metabolic processes in the body.

Diagnosis of gastroduodenitis

Endoscopic examination with gastroduodenitis

Endoscopically, gastroduodenitis usually shows focal or diffuse hyperemia of the mucosa, edema, hypertrophy of folds, etc.

Sometimes the mucosa appears pale, thinned, with smoothed folds. This is typical of an atrophic process, but the presence or absence of atrophy and its degree can only be assessed histologically.

Histological examination for gastroduodenitis

Histological examination of the mucous membrane of the stomach and duodenum is an obligatory method for diagnosing gastroduodenitis, which allows to reliably estimate the degree of inflammatory, dystrophic processes.

Evaluation of the secretory function of the stomach with gastroduodenitis

Evaluation of the secretory function of the stomach can be carried out using the method of intragastric pH-metry.

Intragastric pH-metry allows to estimate the pH in the area of the body and antrum of the stomach with a special probe with two built-in electrodes. The normal pH in the area of the body of the stomach on an empty stomach is 1.7-2.5 in children older than 5 years, after the introduction of the stimulant( histamine) - 1.5-2.5.The antral part of the stomach, carrying out the neutralization of the acid, normally has a pH above 5, that is, the difference between the pH of the body and the antrum is normally above 2 units. Reduction of this difference indicates a decrease in the neutralizing capacity of the antrum and the possible acidification of the duodenum.

Secretory function is considered to be reduced if all indices in both basal and stimulated fractions are reduced. The secretory function is considered to be elevated, if even individual indicators are raised even in one of the fractions.

Chronic gastroduodenitis in children often occurs with normal or increased secretory function, a slight decrease in indicators with a good response to the stimulant is a manifestation of the individual norm. The true decrease in gastric secretion is characterized by refractoriness to the introduction of the stimulant and is typical for severe atrophic forms of gastritis, which are rare in children.

Examination of motor function in gastroduodenitis

Evaluation of motor function is performed based on anthroduodenal manometry. You can also evaluate gastric motility by electrogastrography( EGG), as well as ultrasound of the stomach with a preliminary filling it with water.

X-ray examination with gastroduodenitis

X-ray examination of the stomach with barium is not a diagnostic method for CGD, but it can be used to evaluate evacuation function in differential diagnosis with other diseases( congenital malformations, pyloric stenosis, tumors, chronic duodenal obstruction, etc.).

Diagnosis of HP infection with gastroduodenitis

Diagnosis of HP infection is mandatory for clarifying the type of gastroduodenitis and subsequent treatment. There are 2 groups of methods for diagnosing Helicobacteriosis:

The histological method is quite reliable and is the gold standard in the diagnosis of Helicobacteriosis.
Bacterioscopy - the detection of Hp in cytological smears from a biopsy on glass, the methods of coloring are the same.

Treatment of gastroduodenitis

Treatment of gastroduodenitis is a long, sequential, stage. It includes a rational general, food and motor regimen, a diet, antacid preparations with increased acid production( vikalin, almagel), agents that stimulate reparative processes, multivitamins, indications - spasmolytic, sedative drugs, phytotherapy, mineral water, in cases of secondary gastroduodenitis with decreased acid productionenzyme preparations are shown. Complex treatment of combined diseases of the digestive system is necessary.

Treatment of gastroduodenitis begins with a diet.

Diet for gastroduodenitis

Croups and vegetables, ground, on meat, mushroom, fish broths;lean meat( chopped, roasted), chicken boiled, steamed, stewed, fried cutlets without coarse crust, low-fat ham, fish, low-fat boiled, well-soaked lean chicken, chopped black caviar;milk( if it does not cause diarrhea), butter, kefir, curdled milk, cream, sour cream non-acidic, fresh non-acid curd, mildly rubbed cheese;soft-boiled eggs, fried omelette;porridge, well-brewed or wiped( buckwheat, semolina, rice);flour dishes,( except for baking), bread stale white, gray, uneducated biscuits;vegetables, fruits boiled, raw in grated form;fruit, vegetable juices( also acidic);tea, coffee, cocoa in water with milk, jujube, sugar. Table salt to 12-15 g. Add vitamins C, B1, B2, PP.

Power five times.

When eating, observe the following rules:

Food and drink should not be too hot or too cold;
You should never swallow solid food without chewing it carefully.
There are better several times a day little by little.

Since chronic gastroduodenitis is characterized by a cyclic course of the disease with alternation of exacerbation with periods of remission, treatment should be carried out in accordance with the following principles:

during the acute period, the patient is prescribed a bed rest, usually at least 7-8 days;
requires a mandatory diet. Proper nutrition contributes to the fact that chronic gastroduodenitis is easier to treat and does not deliver too strong pain;
for the neutralization of Heliobacter pilori is carried out drug therapy, which consists in the reception of bismuth tricalium dicitrate, amoxicillin, macrolides and metronidazole. Therapeutic course lasts from 7 to 10 days;
if gastroduodenitis has led to increased acidity of the stomach, patients are advised to take omeprazole and H2-blockers of histamine receptors;
excellent results show physiotherapy, sanatorium treatment and exercise therapy.

Medication for gastroduodenitis. Treatment regimens of gastroduodenitis

Because one of the key causes of the appearance of gastroduodenitis is infection, treatment is not without antibiotic therapy.

Drugs of choice for the treatment of gastroduodenitis:

1. de-nol and metronidazole( treatment course10-14 days) + tetracycline antibiotics( treatment course 7-10 days);
2. clarithromycin and omeprazole in combination with metronidazole( course of treatment 7 days);
3. metronidazole + amoxicillin( 10 days course of treatment) + ranitidine( 2 times a day before meals for 2 weeks);
The choice of treatment regimen depends on the characteristics of gastroduodenitis. For the first symptoms of gastroduodenitis, consult a gastroenterologist for advice and treatment.

Chronic gastroduodenitis in children

Chronic gastroduodenitis is characterized by nonspecific inflammatory structural rearrangement of the mucous membrane of the stomach and duodenum, as well as secretory and motor-evacuation disorders.

In children, unlike adults, isolated lesions of the stomach or duodenum are relatively rare, in 10-15% of cases. Much more often observed combined defeat of these departments. The duodenum, being a hormonally active organ, has a regulating effect on the functional and evacuation activity of the stomach, pancreas and bile ducts.

Causes of gastroduodenitis in a child

Leading role belongs to alimentary reasons: irregular and malnourished nutrition, abuse of spicy food, food "vsuhomatka" and psychogenic factors. The significance of these factors is increased when there is a hereditary predisposition to diseases of the gastroduodenal zone. Psychotraumatic situations in the family, school, and the circle of communication are often realized in the form of vegetative-vascular dystonia, affecting the secretion, motility, blood supply, regenerative processes and the synthesis of gastrointestinal hormones. Also, long-term medication( glucocorticoids, NSAIDs), food allergies and other factors that reduce local specific and nonspecific mucosal protection are important.

One of the main causes of chronic gastroduodenitis in children and adults is Helicobacter pylori infection. Duodenitis develops against a background of gastritis caused by Helicobacter pylori, and metaplasia of the intestinal epithelium of the duodenum. Helicobacter pylori settles on the sites of metaplastic epithelium and causes in them the same changes as in the stomach. The foci of gastric metaplasia are unstable to the contents of the duodenum, which leads to erosion. Therefore gastroduodenitis, associated with Helicobacter pylori, is often erosive.

All these factors have a toxic-allergic effect and cause morphological changes in the mucosa of the duodenum. In these conditions, the role of acid-peptic damage to the mucous membrane increases in the occurrence of evacuation-motor disorders and a decrease in intraduodenal pH.Damaging factors first cause irritation of the mucosa, and later - dystrophic and atrophic changes in it. At the same time, local immunity changes, autoimmune aggression develops, synthesis of hormones regulating motor-secretory function of the pancreatobiliary system is disrupted. In the latter also there are inflammatory changes. This leads to a decrease in the synthesis of secretin and the saturation of pancreatic juice with bicarbonates, which in turn reduces the alkalization of the intestinal contents and promotes the development of atrophic changes.

Symptoms of gastroduodenitis in children

Chronic gastroduodenitis is characterized by a polymorphism of symptoms and is often combined with other diseases of the digestive system, and therefore it is not always possible to distinguish the manifestations caused by gastroduodenitis itself from the symptoms caused by concomitant pathology.

Gastroduodenitis in the exacerbation phase is manifested by aching cramping pains in the epigastric region, occurring 1-2 hours after eating and often radiating to the hypochondrium( more often right) and the peripodal region. Eating or antacids reduces or stops pain. Pain syndrome can be accompanied by a feeling of heaviness, raspiraniya in the epigastric region, nausea, hypersalivation. In the mechanism of development of pain syndrome and dyspeptic phenomena, the main role belongs to dyskinesia of the duodenum. As a result, duodenogastric reflux intensifies, causing a bitter eructation, sometimes vomiting with an admixture of bile, less often heartburn.

When examining patients, attention is paid to the pallor of the skin and low body weight. The tongue is covered with a white and yellowish-white coating, often with the imprint of the teeth on the lateral surface. When palpation of the abdomen determine the soreness in the pyloroduodenal region, less often around the navel, in the epigastric region and hypochondrium. Mendel's symptom is characteristic. Many patients have positive symptoms of Ortner and Kehr.

Children with chronic duodenitis often have vegetative and psychoemotional disorders: periodic headaches, dizziness, sleep disorders, fatigue, which is associated with a violation of the endocrine function of the duodenum. Vegetative disorders can manifest themselves as a clinical picture of the dumping syndrome: weakness, sweating, drowsiness, increased intestinal peristalsis, occurring 2-3 hours after ingestion. With a long break between meals, there may be signs of hypoglycemia in the form of muscle weakness, tremors in the body, a sharply increased appetite.

In view of the developmental peculiarities and the predominant localization of the pathological process, several variants of chronic gastroduodenitis with characteristic clinical manifestations are isolated.

Yazvennopodobny chronic gastroduodenitis ( mainly bulbit): the most common variant, often combined with antral gastritis( anthroduodenitis) and peptic ulcer of the stomach. At the heart of its development lie factors that lead to increased aggressiveness of gastric juice and acidification of the contents of the duodenum. For bulbitis in the phase of exacerbation is characterized by ulcerative pain syndrome. The pains are localized in the epigastric region, appear on an empty stomach or 1.5-2 hours after a meal and at night. Seasonality of exacerbations is distinct.
Gastritis-like chronic gastroduodenitis , combined with atrophic fundus gastritis or enteritis. In this variant, a diffuse atrophic process can spread to the duodenum. When combined with chronic duodenitis and enteritis, the disease manifests itself as symptoms of food intolerance, digestion and absorption disorders.
Cholecystitis-like chronic duodenitis , developed against duodenosis. Cholecystitis promotes the emergence and progression of inflammatory-dystrophic changes in the duodenum due to chronic duodenal obstruction of functional or organic origin. With duodenostasis, permanent or paroxysmal pain prevails in the epigastric region and to the right of the navel, a feeling of swelling, rumbling, nausea, belching bitterness, vomiting of bile.
Pancreatitis-like local duodenitis ( papillitis, papillose diverticulitis).Papillitis often develops as a result of the spread of inflammation to the large papilla of the duodenum with duodenitis or it can be part of the inflammatory process localized in the pancreatobiliary system. Diverticulitis is a lesion of the diverticulum, which is located mainly in the near-parotid zone. Local duodenitis leads to disruption of the evacuation of pancreatic juice and bile in connection with the attachment of papillitis, which manifests itself as symptoms of biliary dyskinesia. The pain is localized mainly in the right upper quadrant and is associated with the intake of fatty foods;a slight icteric sclera and slight icterus of the skin are possible. Sometimes the symptoms of pancreatitis are observed( the pain is localized in the left hypochondrium, sometimes surrounding it, accompanied by flatulence, a violation of the stool, transient intolerance to milk).

Chronic gastroduodenitis has a cyclic course: the phase of exacerbation is replaced by remission. Exacerbations occur more often in the spring and autumn, are associated with a violation of diet, overload at school, various stressful situations, infectious and somatic diseases. The severity of an exacerbation depends on the severity and duration of the pain syndrome, dyspeptic phenomena and disruption of the general condition. Spontaneous pains last an average of 7-10 days, palpation pain remains 2-3 weeks. In general, exacerbation of chronic duodenitis lasts 1-2 months. Incomplete remission is characterized by the absence of complaints in the presence of moderate objective, endoscopic and morphological signs of duodenitis. In the stage of remission, there are no clinical, nor endoscopic, nor morphological manifestations of inflammation in the duodenum.

Diagnosis of gastroduodenitis

Diagnosis of chronic gastroduodenitis is based on clinical observation, the study of the functional state of the duodenum, endoscopic and histological( biopsy of the mucosa) studies.

With functional duodenal probing, the changes characteristic of duodenitis are revealed: the dystonia of the sphincter of Oddi, the pain and nausea at the time of the introduction of the stimulus into the gut, the reverse flow through the probe of the solution of magnesium sulfate due to spasm of the duodenum. At a microscopy of duodenal contents the lowered intestinal epithelium, often and vegetative forms of lamblia are found out. To evaluate the functional state of the duodenum, the activity of enzymes of enterokinase and alkaline phosphatase in duodenal contents is determined. The activity of these enzymes is increased in the early stages of the disease and decreases as the severity of the pathological process worsens.
The study of gastric secretion also matters. Its parameters for acidodepitic duodenitis( bulbite) usually are elevated, and when combined duodenitis with atrophic gastritis and enteritis - decreased.
The most informative method for diagnosing gastroduodenitis is PEGD.
X-ray examination of the duodenum is of little importance in the diagnosis of chronic duodenitis, but it allows to identify various motor-evacuation disorders that are associated with the disease or are its cause.

Treatment of gastroduodenitis in a child

Treatment for chronic gastroduodenitis in children is carried out according to the same principles as in chronic gastritis.

During the acute period of the disease, bed rest is shown for 7-8 days.
The diet is very important. In the first days of illness recommend table number 1, in the future - table number 5. During the period of remission, a full-fledged diet is shown.
For the eradication of Helicobacter pylori, a three-component treatment is performed: bismuth titrate dicitrate( eg, De-Nol) in combination with amoxicillin or macrolides and metronidazole for 7-10 days.
With increased acidity of the stomach, recommend H2-blockers of histamine receptors, as well as omeprazole 20 mg on an empty stomach for 3-4 weeks.
According to the indications, the means regulating the motor skills [metoclopramide, domperidone( motilium), drotaverin] are used.
In the process of rehabilitation, physiotherapy, exercise therapy, and sanatorium treatment are prescribed.

Prevention of gastroduodenitis

Prophylaxis of gastroduodenitis includes rational food, general and motor conditions, a well-balanced diet, observance of all elements of a healthy lifestyle. Optimum treatment and rehabilitation of gastroduodenitis is one of the most effective measures aimed at the prevention of peptic ulcer disease.

Prevention of gastroduodenitis in children

When the gastroduodenal zone of a child is very important to observe the principles of age-related nutrition, to protect the child from physical and emotional overload. Secondary prevention includes adequate and timely therapy, supervision and regular consultations of a children's gastroenterologist.

Forecast of gastroduodenitis

With irregular and ineffective treatment, chronic gastritis and gastroduodenitis recur and become the main pathology of adults, which reduces the patient's quality of life and ability to work.

Do respiratory care for gastroduodenitis be given? Answer: no