Duodenitis is an inflammation of the mucous membrane 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 for the development of duodenitis 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 action on the mucous membrane of the digestive tract or disturbing the relationship of aggression factors and factors of gastroduodenal zone protection.
According to the clinical course, an acute and chronic form of duodenitis is isolated. Accordingly, the symptoms and treatment will also vary depending on the form of the disease.
Causes
Why does duodenitis develop and what is it? By duodenitis means a systemic inflammatory disease of either the duodenal mucosa or the organ itself.
Occurrence of acute duodenitisand the duodenum is promoted by the following factors:
- abuse of food and drinks, 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, clostridium, enterococcus.
Chronic duodenitiscan 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.
A major role in the development of secondary duodenitis is played by duodenostasis - insufficient mobility of the duodenum as a result of obstruction or poor peristalsis.
Classification
The conventional classification of chronic duodenitis is absent.Taking into account the peculiarities of development and preferential localizationprocess, there are 4 options:
- chronic, predominantly bulbitis, acid-pathogenic genesis;
- Chronic, combined with atrophic gastritis or enteritis;
- Chronic, developed against duodenosis;
- local duodenitis (papillitis, papillose diverticulitis).
By the prevalence of the processduodenitis happens of such kinds:
- diffuse - the mucous membrane 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.
Besides,the endoscopic picture distinguishes:
- superficial chronic;
- atrophic chronic;
- interstitial chronic;
- erosive and ulcerative chronic.
By the duration of the currentprocess are:
- acute - period of time 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
Inflammation of the 12-типерстной guts is characterized by pain in the stomach, vomiting, nausea, weakness throughout the body, soreness in the palpation 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.
Diagnostics
To diagnose duodenitis it is possible by results of an endoscopic picture after carrying out of a gastroscopy. Often used and other additional diagnostic methods that allow you to correctly determine the form of the disease:
- X-ray of the duodenum and stomach;
- duodenal sounding;
- coprogramme;
- biochemical analysis of gastric juice and pH determination;
- blood chemistry.
In the case of secondary duodenitis, individual patients may additionally be prescribed floor manometry, retrograde cholangiopancreatography, CT or MRI procedures, biochemical blood tests, coprograms, assessment of fecal elastase-1, fibroileo-colonoscopy, 24-hour monitoring of gastric pH-metry, enterography, hepatocholecystography, electrocardiography, renography, ultrasound of the heart, etc. methods.
Treatment of duodenitis
When duodenitis treatment begins with the elimination of the cause that caused inflammation of the duodenum.
First of all, with acute duodenitis, it 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, holinolitic 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.
Medication Therapy
How to treat duodenitis? In addition to a diet with acute duodenitis or during a period of exacerbation of its chronic form, the patient may be prescribed and medication:
- antispasmodics(to relieve pain) - Platyphylline, Drotaverin, No-Shpa;
- enveloping agents(to protect the mucosa) - De-nol, Vis-nol;
- antacids(drugs that reduce the increased acidity of gastric juice) - Omeprazole, Pantoprazole, Almagel;
- when Helicobacter pylori is detected - antibiotics;
- whenparasitosis- Chemotherapy them (Metronidazole, Vormil);
- atduodenesis- funds that enhance the motility of the digestive tract (Domperidone).
Physiotherapeutic procedures will effectively complement the medical treatment: electrophoresis, mud therapy, microwave therapy, and also sanatorium treatment.
Diet
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 ofrejection of the following products:
- fatty, heavy food;
- meat smoked products;
- spicy seasonings;
- pickles;
- carbonated drinks;
- alcohol;
- coffee and strong tea;
- acid fruits - apples, orange, etc.
A strict diet should be followed for a month, after which the diet can be enriched with various sausages, sausages, cereals, salads from vegetables, raw fruits and vegetables, and an omelette. During the treatment of duodenitis, it is also important to exclude foods that are strictly prohibited for this disease. These include the above products.
Prevention
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.
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