Duodenitis: symptoms, treatment
- Causes of duodenitis
- Duodenitis classification
- Duodenitis: symptoms
- Diagnosis of duodenitis
- Treatment of duodenitis
Causes of duodenitis
Depending on the origin of the duodenitis is divided into:
- primary (isolated process, not associated with other ailments, occurs in less than a third of patients);
- secondary (develops due to other diseases).
Primary duodenitis may be due to:
- poor nutrition;
- side effects of a number of drugs (glucocorticosteroids, aspirin, nonsteroidal anti-inflammatory drugs);
- alcoholic beverages;
- bacterial infections;
- allergies (usually food);
- immune breakdowns;
- burdened heredity;
Secondary duodenitis is formed on the background of:
- gastritis (mucosal islets appear in the duodenal bulb, whose structure is similar to the gastric one, they are called gastric metaplasia, they are colonized by the harmful microorganisms Helicobacter pylori, which, in turn, provoke inflammation and / or erosion, and also contribute to subsequent relapses);
- peptic ulcer disease with localization of defects in the duodenum;
- liver disease;
- diseases of the biliary tract;
- intestinal diseases;
- cardiovascular ailments (mucous membrane is damaged due to disorders of its blood circulation);
- renal failure.
In their everyday work, various specialists (clinicians, endoscopists, pathologists) use different classifications of duodenitis. However, all emit:
- acute duodenitis;
- chronic duodenitis.
According to the location of inflammation, duodenitis is divided into:
- bulbit or proximal duodenitis (only the bulb is affected) - the most common form;
- post-bulbar or distal duodenitis (inflammation detected in the zlukovichny departments);
- papillitis or local duodenitis (the process is localized in the area of the duodenal papilla);
- diffuse or total duodenitis (the whole organ is involved).
At endoscopic examination according to visual data the following types of duodenitis are established:
- erythematous (mucous swollen and reddened);
- hemorrhagic (hemorrhages when hemorrhages are detected);
- atrophic (this method is able to detect only indirect signs of atrophy - thinning of the mucous membrane, visualization of translucent blood vessels, a histological evaluation allows final confirmation of atrophic changes);
- erosive (in the case of formation of superficial defects in the mucosa - erosion)
- nodular (when small formations resembling nodules are visible).
In addition, endoscopists often evaluate the degree of activity of the existing inflammation (I-III).
Considering and analyzing the structure of the duodenal mucosa under a microscope, pathologists distinguish:
- superficial duodenitis (only superficial layers of the mucous membrane were changed);
- diffuse or interstitial duodenitis (the entire thickness of the duodenal mucosa is affected)
- atrophic duodenitis.
Duodenitis can begin both suddenly and gradually. Often, he manifests after some dietary excesses, alcohol consumption, stress. Duodenitis is usually difficult to distinguish from other ailments of the digestive system. After all, it is characterized by the same clinical signs as for most other gastroenterological ailments:
- pain (weak or very intense pain associated with the type and time of eating, occur in the upper abdomen: the epigastric zone, hypochondria);
- signs of gastric dyspepsia (heaviness, burning or discomfort in the epigastric zone; belching, nausea, bloating);
- problems with stools (chronic diarrhea or systematic constipation, alternating them);
- psycho-emotional disorders (unmotivated irritability, tearfulness, rapid emotional exhaustion, etc.).
Depending on the combination of symptoms in duodenitis, the following clinical forms may be present:
- ulcers-like (the most frequent variant, "night" and "hungry" pains at the top of the abdomen are extremely reminiscent of those characteristic of peptic ulcer, they are combined with sour belching and persistent constipation);
- gastritis-like (pain occurs after eating, they are often accompanied by symptoms of gastric dyspepsia);
- cholecystoid (pain similar to biliary colic, feeling of bitterness in the mouth, vomiting of bile);
- pancreatoid-like (patients have mostly left hypochondrium, there may be "shingles" pain, diarrhea, vomiting);
- nerve vegetation (sweating, episodes of nausea and weakness, rapid heartbeat, etc.);
- mixed (with this form, patients show signs of various other forms of duodenitis);
- asymptomatic (set in the case of the complete absence of clinical manifestations, common among elderly patients).
Diagnosis of duodenitis
A competent specialist is able to suspect duodenitis after a conversation with a patient who has come to him and his examination. But for the final verification of this not too frequent diagnosis, a comprehensive and comprehensive examination is necessary. Its volume may be different, because the clinical situations in different patients differ. As a rule, the doctor first recommends:
- endoscopic examination - fibrogastroduodenoscopy (the main method, which shows the state of the duodenal mucosa, the presence of hemorrhages, ulcers, motor disorders and allows you to get biopsies for histological evaluation or detection of microorganisms in them);
- chromogastroduodenoscopy (using specific dyes - methylene blue, congo-mouth, endoscopists can indirectly assess the presence and prevalence of areas of gastric metaplasia in the duodenal mucosa and take exactly the mucosal samples from them - biopsies);
- histological (pathological) assessment of the structure of the duodenal mucous membrane (fixes inflammatory changes and their severity, the development of atrophy, gastric metaplasia, infection of Helicobacter pylori, distinguishes between various forms of duodenitis);
- X-ray examination (duodenal fluoroscopy using contrast suspension and double contrasting can detect advanced severe duodenitis with gross thickened folds of the mucous membrane and / or erosions, assess motor-evacuation abilities, establish post-ulcer cicatricial deformity and distinguish it from spasm characteristic of duodenitis);
- Helicobacter pylori microbial detection tests: rapid methods for the study of biopsy specimens, enzyme-linked immunosorbent assay for feces and blood, bacteriological, molecular genetic, respiratory with urea;
- ultrasonography (sometimes with severe duodenitis, an experienced specialist can sometimes notice a thickened wall of an inflamed duodenum or signs of dysmotility, but the method is needed to rule out ailments of the pancreatobiliary system, liver, kidneys);
- endoscopic ultrasonography (the study can be highly informative in case of local duodenitis with a lesion of the major duodenal papilla, as well as pancreatitis, scars and stones in the ducts, tumor process);
- duodenal intubation (a slightly forgotten technique that examines the quality of duodenal secretion, preservation of abdominal duodenal digestion; reveals a parasitic lesion);
- computer gastroenterography (modern methods of analysis of the motor activity of the duodenum) or duodenokinesitography;
- examination of feces and blood for the presence of parasitic agents.
In the case of secondary duodenitis, individual patients may be additionally prescribed floor manometry, retrograde cholangiopancreatography, a CT or MRI procedure, biochemical blood tests, a coprogram, fecal elastase-1 evaluation, fibroilecolonoscopy, 24-hour monitoring of gastric pH, enterography, hepatopathy, an index, heparoscopic elastase, enterrographic therapy, 24-hour monitoring of gastric pH, enterography, hepatopathy, hepterone colonoscopy, 24-hour monitoring of gastric pH, enterrography, hepatopathy, hepatocolonoscopy, 24-hour monitoring of gastric pH, enterrography, hepatopathy, hepterone colonoscopy; renography, ultrasound of the heart and other methods.
Treatment of duodenitis
Basically, patients with exacerbation of duodenitis are treated in an outpatient setting. However, some patients still have to be sent to the hospital. The indications for this are:
- intense pain and / or dyspeptic symptoms;
- periduodenitis (transition of inflammation from the duodenum to nearby organs and tissues);
- bleeding erosion;
- suspicion of duodenal obstruction;
- decompensated or serious comorbidities;
- suspicion of the possible oncological nature of the process;
- diagnostic difficulties;
- failure of outpatient treatment.
Therapeutic measures for duodenitis should be comprehensive. All patients need an orderly regimen of the day, refusal from smoking and alcohol, measured walks. They are recommended both diet therapy and taking the necessary medication.
Patients with duodenitis should change their certain eating habits. It is advisable fractional food, the volume of a single portion should be placed in the palms of the patient. If the patient has already begun to be treated with highly effective modern medicines, then grinding and rubbing is necessary only with severe duodenitis. Boiled dishes are allowed. They must be warm, as the cold may aggravate the spasm and motor disturbances (the patient recurs clinically or the pain increases).
It is advisable to remove all foods from the diet that can irritate or damage the duodenal mucosa, stimulate the production of digestive juices and alter duodenal motility. Such undesirable products are all sour berries, juices, fruits, spicy seasonings, ketchups, garlic, radishes, cress, onions and green onions, radishes, fatty meats, red fish, smoked meats, rich fish or meat broths, pickles, lard, mushrooms, cream, full-fat milk, marinades. It is desirable to limit the amount of coffee, strong tea, salt (up to 10 g).
The patient is recommended rice, buckwheat, semolina, oatmeal porridge, mucous and dairy soups, soft-boiled eggs, non-acidic kissels, omelets, vegetable casseroles and souffles, unleavened and low-fat cottage cheese, vegetarian soups (boiling meat: veal, chicken, rabbit can be added to them turkey), noodles, lean meat in the form of steam cutlets, dumplings, meatballs, doctor sausage, puddings, biscuits, white dried bread, drying, sweet ripe fruit without coarse fiber. Vegetable fats are of particular importance, their quota is about a third of all fats consumed. Various vegetable oils (soybean, sunflower, corn, pumpkin, etc.) are allowed.
If the accompanying pathology permits, then when achieving remission of duodenitis most of the dietary restrictions are removed. Nutrition can correspond to the normal diet of a healthy person (table number 15).
After examining the results of the survey, the doctor develops an individual regimen of medication. Its composition and duration vary. However, in most cases are used:
- antacids and alginates for the relief of symptoms caused by excessive acid production (Maalox, Renny, Relzer, Almagel, Gelusil-Lac, Rutacid, Phosphalugel, Gaviscon, Compensation, etc.);
- colloidal bismuth adsorbing antacids (vicire, ventrisol, de-nol, vikalin), which neutralize excess hydrochloric acid, protect the duodenal mucosa and fix;
- sekretolitiki - means for lowering gastric acid production (famotidine, pantoprazole, esomeprazole, lansoprazole, etc.);
- antiparasitic drugs or anthelmintic drugs (they are selected only after a clear definition of the type of parasite that has settled in the body, since the anthelmintic drugs are very toxic, patients are recommended macmorrhosis, fasizin, tinidazole, amnochoquinoline, vermitox, nemozol, metronidazole, praziquantel, chloro-chlorine, chlorosiline, chlorosiline, amyloquinoline, vermitox, nemozol, metronidazole, praziquantel, chloro-chlorine, chlorosaccharide
- control of Heicobacter pylori (there are now several internationally verified rigid eradication schemes, which may include combinations of the few specific antibiotics, secretolytics, bismuth preparations);
- antispasmodics, which eliminate spasm and, consequently, pain (phenicaberan, duspatalin, meteospasmil, drotaverin, buscopan, papaverine, etc.);
- regulators of duodenal motility (domperidone or motilium, itopride or ganaton, metoclopramide or cerucal);
- multienzyme agents for the correction of the digestive function in the case of atrophic duodenitis (pancytrate, micrazyme, creon, hermital, panzinorm, etc.);
- reparants to accelerate the healing of the duodenal mucosa (solcoseryl, kaleflon, sea buckthorn oil, etaden, biogastron, riboxin, carnitine, etc.);
- cholespasmolytics to relax the sphincter apparatus located in the thick duodenal papilla (odeston, olimethin, platifillin, belladonna preparations, etc.);
- psychotropic drugs (amitriptyline, eglonil, attarax, phenazepam, elenium, seduksen, relanium, pyrazidol, etc.).
Sometimes pharmacotherapy is supplemented with some physiotherapeutic procedures that have analgesic, anti-inflammatory and antisecretory action. Patients with duodenitis are recommended electrophoresis with papaverine, dalargin, novocaine or platyfillin, ultrasound, decimeter waves, Bernard currents, UHF, mud cure (sapropel, sludge, peat mud), conifers, valerian or radon baths, paraffin baths, aphants, lymph, and paraffin.
If the patient has been verified erosive duodenitis, it is not enough to focus only on the positive dynamics, which consists in the disappearance of clinical symptoms. But clinical improvement is not always accompanied by normalization of the endoscopic picture. Therefore, endoscopic control is needed to confirm the healing (epithelization) of erosions.
During remission, sanatorium-resort treatment is indicated to patients with duodenitis.