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Each organ of the gastrointestinal tract( GIT) performs its functions and tasks for digesting food, and in strict sequence. So, in the stomach, the food masses are treated with hydrochloric acid, when entering the duodenum( duodenum) - bile and digestive enzymes. The bile is produced in the liver, deposited in the gallbladder and is delivered to the small intestine via the bile ducts. Pancreatic juice, rich in various enzymes, is produced in the pancreas and also enters the PDK.
The biochemical environment in the stomach and small intestine is different, which is facilitated by the presence of a "barrier" between these organs in the form of a pylorus, that is, a special muscular sphincter formation. Theoretically, the contents of the primary parts of the small intestine should not return to the stomach if the sphincter is excellent. However, it has been established that even in completely healthy people, a very small number of food masses from the WPC can be introduced into the stomach, which has a physiological( normal) character. This occurs mainly at night, that is, during the functional "rest" of the digestive organs, and is explained by the temporary relaxation of the gatekeeper.
But there are many conditions in which dietary masses of WPC containing bile and enzymes find themselves in the stomach much more often and in the daytime. This process is called duodenal-gastral reflux( reverse flow, casting) and has many causes, which are mainly associated with impaired functionality of the gatekeeper.
In addition, a violation of the motility of the stomach and PDC leads to stagnation of food masses and the development of duodenosis, which also negatively affects the condition of all the organs of the digestive tract.
The motility of the bile is affected by several internal organs
. Reasons for
. As already indicated, the injection of bile into the stomach can occur for various reasons. They all come from a functional pyloric insufficiency of the stomach, adjacent to the duodenum. The pyloric muscle fibers become "weak" and insufficiently close the lumen between the organs, which causes bile in the stomach. An important point is the presence of increased pressure in the PDC, which develops in many diseases.
In most clinical cases, the inverse release of bile, i.e. duodenal-gastric reflux, is not a separate pathology. Rather, it is a syndrome of certain gastrointestinal diseases and is combined with other signs of these diseases. It can also form as a consequence of some primary pathologies of the stomach or intestine.
In general, all the provoking factors and causes of casting bile can be represented in the following form:
- congenital anomaly of the structure of the gastric sphincter, resulting in insufficient closure of the space between the stomach and the DPC;
- pathological conditions characterized by increased pressure in the small intestine due to decreased clearance of PDC - neoplasm, mechanical trauma, fibrotic processes after peptic ulcer;
- physiological conditions with increased pressure in the PDC: in the late stages of pregnancy, the uterus squeezes on the stomach, liver, small intestine, from where the contents begin to be pushed backwards. In these cases, bile in the stomach is considered a temporary phenomenon, completely disappearing after childbirth;
- chronic inflammation of the mucosa of duodenum( duodenitis);
- receiving patients with antispasmodics required for other indications( for example, by relieving pain syndrome, antispasmodics can also relax the sphincters, which causes reflux of bile into the stomach);
- surgical interventions on the digestive organs, which lead to increased pressure in the PDC or disturb the anatomical integrity of the pylorus;
- conditions, accompanied by disorders of nervous regulation of the stomach and small intestine;
- overeating, especially before going to bed, which leads to excessive formation of bile and pancreatic juice. That is why in a dream, when the sphincter relaxes, the contents of the intestine, with a lot of bile, are in the stomach;
- features nutrition with a predominance of products that cause increased bile formation and bile excretion. There is a discrepancy between the amount of bile in the DPC and the need for it, which can cause the contents to be thrown into the stomach.
Wrong motor skills of the digestive organs and non-physiological distribution of bile, leading to a change in acidity and biochemical environment, forms the corresponding clinical symptoms. And their severity directly depends on the amount of bile, which occurs in the stomach at each episode of reflux, and on the frequency of casting.
Overweight is considered the most frequent factor provoking the development of duodenogastric reflux
. If there is a lot of bile in the stomach, then the acidity in it increases significantly, and this causes a large area of the mucous membrane. The more often this occurs, the less time remains for regeneration processes, and each new reflux of bile still affects the organ more seriously. During the so-called physiological casts( during pregnancy, in a dream without overeating), bile portions are very small, and the stomach environment quickly "copes" with them without the slightest harm to the mucous membrane.
In cases where bile enters the stomach frequently and in significant amounts, the epithelium of the mucosa is damaged in a large area, the chemical indices of the contents change noticeably. These pathological processes are accompanied by the formation of a definite clinical picture, and the developed symptoms make it possible to suspect diseases of the gastrointestinal organs that occur with duodenal gastral reflux. These signs are not specific, that is, they are characteristic for the casting of bile, but they indicate a serious unhappiness in the body. Therefore, if a person has discomfort or abdominal pain, whether or not associated with food intake, as well as dyspeptic symptoms, he should always consult a therapist or gastroenterologist.
With a reverse cast of bile, the patient complains of:
- pains of a diffuse nature, covering mainly the upper abdomen or navel area;often they are spastic and strong enough;
- in most cases, the pain syndrome develops some time after eating;
- if a large amount of bile appears in the stomach, it is often thrown into the esophagus. Thus patients complain of dryness and a taste of bitterness in a mouth, a thirst, a heartburn, an eructation by bitter or air, a nausea. In some cases, vomiting develops in the contents of the stomach with bile, sometimes meteorism( swelling of the intestine).
The presence of such complaints, especially bitterness in the mouth and vomiting of bile, help to suggest the presence of duodenal gastral reflux and many of the diseases that it accompanies. When examining the patient, the doctor also pays attention to the color of the skin and mucous membranes, the lagging of the tongue( with yellow bile in the stomach it acquires a yellow coating).Palpating( probing) the stomach, the doctor finds out that the greatest soreness is localized in the upper part, that is, in the zone of location of the stomach, liver, gall bladder, the initial sections of the small intestine.
One of the brightest manifestations of the presence of bile in the stomach is the severe pain in the stomach
The greater the prescription of the bile reflux syndrome, the more pronounced the clinical picture, the more likely the possibility of the spread of the pathological process and the formation of new symptoms characteristic of more serious and dangerous diseases.
If the patient consults a specialist not at the initial stages of reflux, it is possible that he developed pathologies such as gastroesophageal reflux disease, atrophy of the mucous membranes, intestinal metaplasia, toxic-chemical chronic gastritis, benign or malignant tumors. In such situations, timely and correct diagnosis is given great importance.
The results of diagnostic measures are important at any stage of the disease. The earlier the patient is determined the cause of abdominal pain, heartburn, nausea and other symptoms, the more likely will be a positive outcome of treatment. At the same time, it is important that the person himself understands the seriousness of the signs that appeared and turned for help in time. As a rule, diagnostics and therapeutic measures are carried out by therapists and gastroenterologists.
During the patient's visit to the doctor, the following diagnostic steps are performed:
- Patient survey( clarification of complaints, prescription, anamnesis and heredity issues).
- Inspection of the patient( determination of clinical manifestations of the disease).
- Laboratory tests - analysis of gastric juice for the presence of pancreatic enzymes and bile, other tests according to indications.
- Tooling methods.
As already indicated, the clinical signs of the presence of bile, which enters the stomach from the PDK, do not indicate the development of any specific disease. Therefore, their findings are not enough for the final diagnosis. To find out what pathological processes occur in the organs of the digestive tract, and to establish the correct diagnosis, it is necessary to determine not only the anatomical changes, but also functional disorders. For this, the following methods of instrumental diagnostics are carried out:
- endoscopy of the stomach and duodenum( GGDS);
- intragastric pH-metry, that is round-the-clock monitoring of acidity of gastric contents;
- anthroduodenal manometry( a study of the motility of the gastrointestinal tract);
- ultrasound scanning.
All the information obtained is necessary in order to differentiate diseases that occur with the accumulation of bile in the stomach or simply have similar symptoms. Thus, during the diagnosis, such pathologies as hyperacid gastritis, erosive gastritis, stomach ulcer or duodenal ulcer, duodenitis, cholecystitis, pancreatitis, cholelithiasis, biliary dyskinesia, cholangitis are confirmed or excluded. Quickly and correctly established diagnosis allows you to appoint a timely and optimal treatment to the patient.
Fibrogastroduodenoscopy can accurately determine any morphological changes in the digestive system
Methods of treatment
Treatment of bile transfer to the stomach is complex and, in most cases, carried out on an outpatient basis. Hospitalization of the patient is necessary for severe background diseases, and also, for a short period, for instrumental diagnosis.
What to do with the reverse current of bile and how to get it out of the stomach, should determine the attending physician, which is based on the identified causes and mechanism of this process. Directions of ongoing therapy should concern both the normalization of the activity of the muscular structures of the pylorus, and the condition of the duodenum, acidity in the stomach, the chemical composition of bile.
Therefore, the main stages of therapy are as follows:
- symptomatic treatment( pain relief, emergency acidity reduction);
- pathogenetic drug treatment, acting on mechanisms of pathology development( normalization of gastric motility and DPC, decrease in acidity, liquefaction and alkalization of bile, restoration of bile duct tone, decrease in pancreatic secretion);
- changing lifestyle and nutrition.
The last point in the therapy scheme is of paramount importance. While medications are prescribed in a course, diet and a healthy lifestyle should be carried out continuously. The patient should understand that smoking and alcohol contribute to the development of dyskinesia of the digestive tract, so they must be excluded. It is also dangerous and obesity, which creates an increased pressure in the abdominal cavity and slows down the bowel motility.
Proper nutrition plays an important role in the therapy of reflux
Therefore, every patient suffering from reflux should normalize physical activity and be sure to adhere to the following dietary rules that will help get rid of bile in the stomach and prevent this phenomenon from happening again:
- to eliminate fatty, spicy food,smoked products and marinades;
- food to cook by methods of boiling, baking, putting out, "steamed";
- it is recommended to prepare meals in a crushed form;
- drink up to 2 liters of fluid per day;
- give preference to lean fish, poultry, meat;
- every day use dairy products, alkaline contents of the stomach, a variety of fruits and vegetables;
- eat every 2.5-3 hours;
- after eating for 1 hour do not bend over, do not engage in physical work.
In the vast majority of cases, the prognosis for the syndrome of casting bile into the stomach is favorable. With the help of medicines, therapeutic nutrition and exclusion of all provoking factors, one can completely get rid of pathology.