Duodenitis is an inflammation of the mucosa of the duodenum. The duodenum is immediately after the stomach - separated by the pylorus - and is the initial section of the human small intestine.
Mechanisms of duodenitis development are not fully understood. As a rule, the inflammatory process in the duodenum develops as a result of exposure to the body of factors that exert an irritating and damaging effect on the mucous membrane of the digestive tract or disrupt the relationship between aggression factors and the factors of gastroduodenal zone protection.
Acute and chronic duodenitis is isolated from the clinical course. Accordingly, the symptoms and treatment will also differ depending on the form of the disease.
Why does duodenitis develop, and what is it? By duodenitis means a systemic inflammatory disease of either the duodenal mucosa or the organ itself.
The following factors contribute to the emergence of acute duodenitis in the duodenum:
- abuse of food and beverages irritating the mucous membrane of the digestive organs - smoked, spicy, fried, fatty, coffee, alcohol;
- food poisoning;
- damage to mucous foreign objects, for example, ingestion of indigestible food particles;
- getting into the duodenal intestine of infections - staphylococci, Helicobacter pylori, clostridia, enterococcus.
Chronic duodenitis can be primary and secondary. Primary chronic duodenitis occurs with malnutrition( acute, irritating, hot food, alcohol), smoking.
More common secondary chronic duodenitis - it develops against the background of already existing inflammatory diseases, for example, chronic gastritis, duodenal ulcer, improper treatment of acute duodenitis.
Duodenostasis plays an important role in the development of secondary duodenitis - insufficient mobility of the duodenum as a result of obstruction or poor peristalsis.
There is no generally accepted classification of chronic duodenitis. Taking into account the developmental peculiarities and the primary localization of the process, four variants are distinguished:
- chronic, mainly bulbitis, acid-assisted genesis;
- chronic, combined with atrophic gastritis or enteritis;
- chronic, developed against duodenosis;
- local duodenitis( papillitis, papillose diverticulitis).
According to the prevalence of the process, duodenitis is of the following types:
- diffuse - the mucosa of the whole duodenum is inflamed;
- focal - inflammation is limited to a small area;
- proximal - the area of the duodenum adjacent to the stomach( bulb) is inflamed;
- distal - inflammation develops in the area of transition to the small intestine.
In addition, on the endoscopic pattern distinguishes :
- surface chronic;
- atrophic chronic;
- interstitial chronic;
- erosive and ulcerative chronic.
For the duration of the process flow, the following are distinguished:
- acute - the time period is no more than 1 month;
- chronic - the duration of the disease is more than six months, the periods of improvement( remission) are replaced by exacerbation( relapse).
Accordingly, depending on the form of duodenitis, the symptoms and methods of treatment will differ. Establish an accurate diagnosis will help qualified diagnosis.
Symptoms of duodenitis
For inflammation of the 12-типерстной guts are characterized by pain in the stomach, vomiting, nausea, weakness throughout the body, soreness in the probing of the epigastric zone. If necessary, to clarify the diagnosis, duodenofibroscopy is prescribed, with the help of which inflammatory processes in the gut are detected.
With phlegmonous duodenitis, which is very rare, the muscles of the abdominal wall are strained, the general condition of the patient deteriorates sharply, fever, increased ESR, neutrophilic leukocytosis. In this case, carrying out duodenofibroscopy and duodenal sounding is contraindicated.
The clinical picture of chronic duodenitis is characterized by the variety and nonspecificity of symptoms in adults, as well as the significant similarity of symptoms with other diseases of the digestive organs. Chronic duodenitis, as a rule, is combined with peptic ulcer, chronic gastritis, enteritis, pancreatitis, chronic diseases of the biliary tract.
The severity and nature of other concomitant diseases of the gastrointestinal tract significantly determines the clinical symptomatology of chronic duodenitis. Depending on the clinical manifestations, several main forms of chronic duodenitis are distinguished: ulcerous, gastritic, cholecystoid, pancreatic and neuro-vegetative forms.
You can diagnose duodenitis by endoscopic results after a gastroscopy. Often used and other additional diagnostic methods that allow you to correctly determine the form of the disease:
- X-ray of the DPC and stomach;
- duodenal sounding;
- biochemical analysis of gastric juice and pH determination;
- biochemical blood test.
In the case of secondary duodenitis, individual patients may additionally be prescribed floor gauge manometry, retrograde cholangiopancreatography, CT or MRI procedures, biochemical blood tests, coprograms, assessment of fecal elastase-1, fibroileo colonoscopy, 24-hour gastric pH monitoring, enterography, hepatocholecystography, electrocardiography, renography, ultrasound of the heart and other methods.
Treatment of duodenitis
With duodenitis, treatment begins with the elimination of the cause that caused inflammation of the duodenum.
First of all, with acute duodenitis, this is a diet and a strict stationary regime. In the first two days, doctors recommend washing the stomach with a solution of potassium parchment, after which an empty stomach is taken about thirty grams of magnesium sulphate, diluted in 300 milliliters of clean water.
From the second day it is rational to take enveloping body preparations, and to neutralize the pain - antispasmodics in the form of papaverine and drotaverine. Phlegmonous duodenitis usually requires treatment with antibiotics, hospital stay, and sometimes - surgical intervention.
In the chronic course of duodenitis antacid, antispasmodic, astringent, anticholinergic and ganglion blocking medications are prescribed. You can treat the disease with the help of vitamin therapy, which suggests replenishing the body with such elements: A, B6, B12.Still can apply drip infusions of protein hydrolysates intravenously.
If a secondary duodenitis is diagnosed with gastritis, then it should be treated in conjunction with the therapy of the underlying ailment. Patients with a chronic form of pathology should be constantly under the supervision of a doctor, and also necessarily conduct anti-relapse treatment.
How to treat duodenitis? In addition to diets with acute duodenitis or during an exacerbation of chronic forms, the patient may be prescribed medication:
- antispasmodics ( for pain relief) - Platifillin, Drotaverin;
- wrapping agents ( for mucosal protection) - De-nol, Vis-nol;
- antacids ( drugs that reduce the increased acidity of gastric juice) - Omeprazole, Pantoprazole, Almagel;
- for the detection of Helicobacter pylori - antibiotics;
- in the case of parasitosis - their chemotherapy( Metronidazole, Vormil);
- with duodenosis - a means of strengthening the motility of the digestive tract( Domperidone).
Physiotherapeutic procedures will effectively complement medical treatment: electrophoresis, mud therapy, microwave therapy, as well as sanatorium treatment.
In the treatment of duodenitis, proper nutrition plays a very important role, because the work of the digestive system directly depends on what the person eats. The therapeutic diet in this case consists of rejection of the following products of :
- of oily, heavy food;
- meat smoked products;
- of spicy seasonings;
- carbonated drinks;
- coffee and strong tea;
- of acid fruits - apples, orange, etc.
It is better to stick to a strict diet for a month, after which the diet can be enriched with various sausages, sausages, cereals, vegetable salads, raw fruits and vegetables, and an omelet. During the treatment of duodenitis, it is also important to exclude foods that are strictly prohibited for this disease. These include the above products.
To prevent not only the development of inflammation of the duodenal ulcer, but also its exacerbations, it is necessary to adhere to a rational diet. It is necessary to avoid frequent use of sharp, fried, spicy dishes, eating dry. Do not abuse alcohol, strong coffee and tea. It is necessary that the diet contains not only carbohydrates and fats, but also a sufficient amount of protein.