Chronic duodenitis exacerbation. Treatment of concomitant diseases. Treatment of acute duodenitis

Chronic duodenitis is a disease duodenum, in which inflammation and degeneration of the mucous membrane is observed, subsequently complicated by atrophy.

This disease has a polyetiological nature, and depending on the causes that cause it, doctors distinguish two types of chronic duodenitis:

primary type – an independent disease;
secondary type is a disease that develops as a complication of other diseases of the gastrointestinal tract, primarily gastritis.

According to medical statistics, duodenitis most often occurs in adult men.

Reasons for the development of primary duodenitis

First of all, you need to know that this form of duodenitis is extremely rare. The reasons for its appearance may be:

irregular meal schedule;
abuse of spicy, fatty, rich in fiber food;
exceeding the norms of carbohydrates and fats in the diet;
malicious eating habits: smoking, alcoholism, regular intake of coffee and strong green tea.

Many doctors do not recognize that the above reasons could provoke the development of duodenitis chronic type. They believe that these are only factors contributing to its development.

One of probable causes Chronic primary inflammation of the duodenum is considered to be untreated acute duodenitis suffered by the patient previously.

The most popular development version of this disease– imbalance between the factors of defense and aggression. When the factor of aggression, namely excessive secretion of pepsin and of hydrochloric acid, prevails over protective factors – uniform cellular regeneration tissues of the mucous surface of the intestine, all conditions are created for the manifestation of duodenitis.

Reasons for the development of secondary duodenitis

The lion's share of all clinically recorded cases of chronic duodenitis is of the secondary type of the disease. The main reasons for its occurrence:

The role of Helicobacter pylori infection in the development of secondary type duodenitis is extremely important. Most patients with this disease simultaneously suffer from a chronic form of Helicobacter gastritis.

It is Helicobacter pylori, which previously provoked the inflammatory process of the gastric mucosa, that “occupies” the metaplastic zones of the duodenal epithelium. As a result of exposure to hydrochloric acid from the gastric contents, inflammation and erosion develop in these areas.

In addition, the development of this disease directly depends on the condition intestinal microflora. With Achilles' disease of the stomach, dysbacteriosis and bacterial infections progress. pathogenic flora“seeds” the small intestine and duodenum.

Symptoms of the disease

Pain is the most characteristic symptom chronic duodenitis. Localization - the junction of the ribs under the sternum, or otherwise the area “under the stomach”. Pain with gastroduodenitis is similar to pain syndrome with peptic ulcer or gurgle.

The intensity of the pain varies (from weak, aching, to sharp, strong). Usually the pain appears a couple of hours after eating, and disappears after eating or taking special antacids.

With distal duodenitis, the pain is concentrated on the right and radiates under right shoulder blade. And also the pain intensifies after eating fried and saturated fat food, which often confuses the symptoms, leading to believe that the patient has cholecystitis. Pain is associated with dyskinesia of the bile ducts.

The pain can be localized in the upper epigastric zone (similar to pain with gastritis) or radiate to the back and under left rib. If the pain is girdling in nature, this indicates that in addition to duodenitis, the patient has papillitis (a disease associated with impaired outflow of pancreatic juice and bile from the duodenum).

No less important symptoms diseases, this various kinds dyspeptic disorders:

distension and heaviness in epigastric region;
nausea and heartburn;
the tongue is thickly coated;
bitterness in oral cavity, bitter belching is evidence that the patient has gastroduodenal reflux;
vomiting (appears during exacerbation of chronic duodenitis).

During the period of exacerbation, the following vegetative disorders are also characteristic:

profuse sweating;
rapid heartbeat;
weakness and tremor of the upper extremities;
sudden feeling of hunger;
frequent urge to defecate (usually loose stools).

Such disorders are most often observed in young people.

During an objective personal examination of the patient, the attending physician records pain of moderate intensity upon palpation of the epigastrium, tension in the muscles of the abdominal wall.

Patient examination program

The patient examination program includes the following mandatory activities:

taking anamnesis and examining the patient;
taking blood, stool and urine tests;
BAC: determination of the content of chlorides, glucose, potassium, proteins, a-amylase, urea, creatinine, sodium and aminotransferases;
duodenal intubation;
fibrogastroduodenoscopy and collection of duodenal biopsy;
biopsy analysis for the presence of Helicobacter pylori;
fluoroscopy and ultrasound.

FEGDS is an extremely informative way to assess the state of the microrelief of the mucous surface, determine the location and evaluate atrophic changes in erosive-inflammatory foci. This is method No. 1, which allows you to almost accurately diagnose chronic duodenitis and promptly begin treatment.

If, for reasons of obstruction or swelling of the target area, the patient cannot undergo FGDS, he is prescribed fluoroscopy. Confirmation of the disease will be chaotic peristalsis (sometimes reverse), spasms and “irritable” duodenal syndrome, detected on fluoroscopy.

Treatment of the disease

Treatment of chronic duodenitis must be carried out comprehensively, that is, with direct involvement in the therapy process neighboring organs. Throughout the entire period of treatment, the patient is prescribed rest and bed rest. It is necessary to follow a special therapeutic diet.

During the period of treatment and recovery after illness, the patient is prohibited from spicy, fried, fatty foods and foods, fresh vegetables rich in abrasive fiber, carbonated and alcoholic drinks, cigarettes, coffee and strong green tea. The first 2 days of the diet are preferable therapeutic fasting. For the next 2–3 weeks, you will have to eat fractionally: 5–6 times a day, in small portions. Food should be ground or liquid: soups, liquid porridges, jelly. The diet should not contain products that mechanically or chemically irritate the mucous membrane: coarse fiber from fresh vegetables, fresh bread, chocolate, sweets based on molasses and trans fats, etc.

Therapeutic agents are necessary to comprehensively alleviate the patient’s condition, eliminate all causes of inflammation of the mucous membrane and further restore it. The complex must include:

medications with an enveloping effect;
antibacterial drugs;
antispasmodics and choleretic agents;
enzymes that normalize digestive function;
vitamins that have a general strengthening effect on the body and increase its immune defense.

Before you start treating duodenitis with medication, you should also discuss with your doctor the possibility of taking aids from the arsenal of traditional medicine. Sometimes, with a superficial form of the disease, treatment can be limited to diet and medicinal herbal decoctions:

An infusion of tansy, cloves, dandelion flowers and wormwood. Take 10–15 grams of each herb, add 500 ml of boiling water and place in a dark place for 3 days. The finished infusion is consumed before meals, one teaspoon at a time.
Oatmeal jelly is the best folk remedy. Thanks to its enveloping property, it softens the irritating effect of food on areas of inflammation of the mucous membrane, promoting rapid healing. To prepare this jelly you will need 2 quality spoons oatmeal, a glass of boiling water and a teaspoon of starch. Pour boiling water over the flakes and leave them to swell. After 8–10 hours, the solution is filtered through a strainer, and after adding starch, it is brought to a boil. You need to drink jelly lukewarm, half a glass before meals.

The best effect of therapy can be achieved by taking a course of medications prescribed by the doctor and following a strict therapeutic diet, supplementing and strengthening it with soft folk remedies treatment of the disease.

Causes

Why does duodenitis develop, and what is it? Duodenitis means systemic inflammatory disease either the mucous membrane of the duodenum, or the organ itself.

The occurrence of acute duodenitis and the following factors contribute to the duodenum:

abuse of food and drinks that irritate the mucous membranes digestive organs– smoked, spicy, fried, fatty, coffee, alcohol;
food poisoning;
mucosal damage foreign objects, for example, ingestion of indigestible food particles;
entry into the duodenum of infections - staphylococci, Helicobacter pylori, clostridia, enterococci.

Chronic duodenitis can be primary and secondary. Primary chronic duodenitis occurs when poor nutrition(eating spicy, irritating, hot foods, alcohol), smoking.

Secondary chronic duodenitis is more common - it develops against the background of existing inflammatory diseases, for example, chronic gastritis, duodenal ulcer, improper treatment 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

There is no generally accepted classification of chronic duodenitis. Taking into account the peculiarities of development and preferential localization There are 4 options for the process:

chronic, predominantly bulbitis, of acidopeptic origin;
chronic, combined with atrophic gastritis or enteritis;
chronic, developed against the background of duodenostasis;
local duodenitis (papillitis, peripapillary diverticulitis).

According to the prevalence of the process duodenitis can be of the following types:

diffuse – the mucous membrane of the entire 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, According to the endoscopic picture they are distinguished:

superficial chronic;
atrophic chronic;
interstitial chronic;
erosive-ulcerative chronic.

By duration The process is distinguished:

acute – the period of time is no more than 1 month;
chronic – the duration of the disease is more than six months, periods of improvement (remission) are replaced by exacerbation (relapse).

Accordingly, depending on the form of duodenitis, symptoms and treatment methods will differ. Install accurate diagnosis Qualified diagnostics will help.

Symptoms of duodenitis

Inflammation of the duodenum is characterized by pain in the stomach, vomiting, nausea, weakness throughout the body, and pain when palpating the epigastric zone. If necessary, to clarify the diagnosis, duodenofibroscopy is prescribed, with the help of which inflammatory processes occurring in the intestine are detected.

With phlegmonous duodenitis, which is very rare, the muscles of the abdominal wall are tense, general state The patient's symptoms deteriorate sharply, with fever and neutrophilic leukocytosis. In this case, duodenofibroscopy and duodenal intubation are contraindicated.

The clinical picture of chronic duodenitis is characterized by diversity and nonspecificity of symptoms in adults, as well as significant similarity of symptoms with other diseases of the digestive organs. Chronic duodenitis, as a rule, is combined with enteritis and chronic diseases of the biliary tract.

Expression and character of others concomitant diseases organs of the gastrointestinal tract largely determines clinical symptoms chronic duodenitis. Depending on the clinical manifestations There are several main forms of chronic duodenitis: ulcer-like, gastritis-like, cholecyst-like, pancreatic-like and neuro-vegetative forms.

Diagnostics

The diagnosis of duodenitis can be made based on the results of the endoscopic picture after gastroscopy. Other additional diagnostic methods are often used to correctly determine the form of the disease:

X-ray of duodenum and stomach;
duodenal intubation;
coprogram;
biochemical analysis gastric juice and pH determination;

In case of secondary duodenitis individual patients may additionally prescribe floor manometry, retrograde cholangiopancreatography, CT or MRI procedures, biochemical blood tests, coprogram, assessment of fecal elastase-1, fibroileocolonoscopy, 24-hour monitoring gastric pH-metry, enterography, hepatocholecystography, electrocardiography, renography, ultrasound of the heart, etc. .methods.

Treatment of duodenitis

For duodenitis, treatment begins with eliminating the cause that caused inflammation of the duodenum.

First of all, in case of acute duodenitis, it is a diet and a strict hospital regime. In the first two days, doctors recommend rinsing the stomach with a solution of potassium parchment, after which about thirty grams of magnesium sulfate diluted in 300 milliliters of clean water is taken on an empty stomach.

From the second day, it is rational to take drugs that envelop the organ, and to neutralize pain, antispasmodics in the form of papaverine and drotaverine. Phlegmonous duodenitis usually requires treatment with antibiotics, hospital stay and sometimes surgery.

At chronic course For duodenitis, antacid, antispasmodic, astringent, anticholinergic and ganglion-blocking medications are prescribed. The disease can also be treated with the help of vitamin therapy, which involves replenishing the body with the following elements: A, B6, B12. They can also use drip infusions of protein hydrolysates intravenously.

If diagnosed secondary duodenitis with gastritis, it must be treated in conjunction with the treatment of the underlying disease. Patients with a chronic form of the pathology must be constantly under medical supervision, and must also undergo anti-relapse treatment.

Drug therapy

How to treat duodenitis? In addition to the diet for acute duodenitis or during an exacerbation of its chronic form, the patient may be prescribed medications:

Diet

In the treatment of duodenitis plays a very important role proper nutrition, because the work of the gastrointestinal tract system directly depends on what a person eats. Therapeutic diet V in this case comprises refusal of the following products:

fatty, heavy foods;
smoked meats;
hot seasonings;
pickles;
carbonated drinks;
alcohol;
coffee and strong tea;
sour fruits - apples, oranges, etc.

It is better to adhere to a strict diet for a month, after which the diet can be enriched with various sausages, frankfurters, cereal porridges, vegetable salads, raw fruits and vegetables, as well as omelettes. During 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 duodenum, but also its exacerbations, you must carefully adhere to rational nutrition. Must be avoided frequent use hot, fried, spicy dishes, dry food. Do not abuse alcoholic beverages, strong coffee and tea. It is necessary that the diet contains not only carbohydrates and fats, but also a sufficient amount of protein.

Duodenitis is a common stomach disease among all age categories of the population. Its symptoms occur in 10% of adults at least once in their lives. In a child, it can lead to the appearance of pathology food allergy or ingestion of small objects if swallowed.

What is gastric duodenitis

Eating spicy, smoked foods and alcohol provokes inflammatory lesion mucous tissue of the duodenum. Toxic substances and heavy metals enter the human body with water, food, air, causing it inside acute poisoning, burns, ulcerations of the gastrointestinal mucosa. As a result, a violation of the relationship between the factors of the aggressive state and the protective reaction of the gastroduodenal zone is formed.

Spicy fried foods have harmful influence on the body, beneficial microflora, interfere with the digestive process. Alcohol does not allow the production of mucin, the deficiency of which weakens the condition of the human body, leads to dysfunction of the stomach, and contributes to the occurrence of inflammatory processes in the gastrointestinal tract.

Symptoms and types of disease

It is not easy to diagnose gastric duodenitis due to the maximum similarity with gastritis, ulcers, hepatic colic, pancreatitis, gastroduodenitis. It can be predicted if you know the basic clinical picture of the course. Medicine knows the following symptoms:

Painful sensations in the epigastric region. Chronic duodenitis is characterized by constant dull ache after eating or fasting, ulcerative - with nocturnal attacks in the stomach area. Similar symptoms– cramping painful sensations of a girdling nature.
Extreme fatigue. The malaise is associated with the influence of intoxication during the inflammatory process. The consequence is an increase in temperature to 38 0 C.
Stomach dysfunction, digestion of food. The condition is characterized by nausea, vomiting, diarrhea, excessive gas formation, and poor appetite. Enzymes are not synthesized due to inflamed stomach walls.
Bitter taste in mouth and jaundice (due to the release of bile into the esophagus).

Due to the prolonged course of the disease, the functioning of the body is disrupted. Without receiving the necessary nutrients, a malfunction occurs, which manifests itself in neuropsychic agitation, hormonal imbalance, dizziness and changes in skin color. This means that treatment should be done in a timely manner.

The form of duodenitis is:

Spicy– damage to the walls of the organ occurs, which is accompanied by constant cutting pains. Violated digestive process, debilitating nausea, vomiting, liquefied feces, severe flatulence. Without acceptance therapeutic measures may become stagnant.
Chronic– protracted inflammation of the duodenum caused by infection. Swelling mucous tissue prevents the breakdown of food and the flow of bile. Duodenostasis is formed.

At endoscopic examination The types of duodenitis are determined:

Atrophic - form chronic disease, leading to thinning of the intestine and thickening of the epithelial tissue.
Reactive – characterized as acute. It may occur against the background of unsystematic use of anti-inflammatory medications.
Hemorrhagic – formed during long-term use of drugs and large quantity alcoholic drinks. Inherent heavy bleeding. Blood is excreted in feces or vomit.
Interstitial - without the presence of atrophy of the intestinal walls.
Catarrhal - similar to hemorrhagic. Relief comes with following the required diet for a week.
Superficial - there are no significant changes in the deep folds of the epithelium.
Phlegmonous - the presence of pus in the lower region of the duodenum.
Erythematous – a type of chronic duodenitis with weak immunity and general malaise.
Erosive-ulcerative - the presence of cracks, ulcerations and wounds on the walls of the intestine. Digestion of food is impaired. Causes acute pain and is of a deep nature.
Focal - located on a specific area of the intestinal mucosa.

Accurate diagnosis

To prescribe studies, patients should contact a gastroenterologist with signs of duodenitis:

Unpleasant pain in the pit of the stomach: from aching to acute, paroxysmal.
Malaise and bloating after eating.
Belching and unpleasant burning sensation(as a result of reflux).
Nausea, vomiting.
Changes in stool (diarrhea, constipation).
Refusal to eat and a sharp onset of acute hunger.

When palpating the abdomen within the stomach (the area below chest, above the umbilical cavity, between the ribs) unpleasant painful sensations are detected.

Fibrogastroduodenoscopy (FGDS)

Inspection of the surface inside the gastrointestinal tract using video equipment placed at the end of the probe; the following signs of duodenitis are visible, allowing a specialist to recognize it:

Edema tissue.
Hyperemia of the mucous membrane indicates catarrhal duodenitis.
Cracks, visible erosion on internal area – peptic ulcer, the beginning of erosive manifestation.
Straightening the folds – reduced tone of the duodenum.
Bulges on the walls - the occurrence of nodular duodenitis.
Bruising irregular shape– hemorrhagic picture.

Fibrogastroduodenoscopy allows you to perform a biopsy of the mucous membrane to examine a piece of tissue under a microscope and determine the degree of thinning (atrophy) of the intestine and the possibility of a neoplasm.

X-ray contrast study

It is carried out by introducing barium sulfate inside, contrast agent. Diagnostics makes it possible to examine the perineum of the intestine in detail due to the enveloping effect of barium. Pictures during this procedure are taken in different projections.

Thanks to this research, it can be seen probable signs diseases:

Narrowed or expanded areas of the organ.
Flatulence.
Swollen areas of inflammation.
Reflux duodenitis (removal of food debris from the duodenum back into the stomach).

This procedure is the least painful, much more accessible and easier to tolerate by patients, but can only reveal disturbances in the functioning of the stomach, and not changes in the tissues of the organ.

To diagnose the disease, laboratory tests are also prescribed:

A complete blood count will show a decrease in hemoglobin and an increase in the erythrocyte sedimentation rate.
A sample of feces taken for examination contains hidden particles of blood that appear in the presence of cracks and erosions.

Treatment of gastric duodenitis

Treatment of gastric duodenitis begins simultaneously in four directions:

Remove inflammation.
Eliminate chronic manifestations.
Restore the working functions of the duodenum.
Improve digestion of food.

You can treat duodenitis at home. The primary task for recovery is rest, a gentle diet, refusal bad habits. Performance simple rules will help restore blood flow to the duodenum and normalize the working properties of its tissues.

Indications for inpatient treatment for duodenitis are the following conditions:

Exacerbations of the disease.
Suspicion of the occurrence of neoplasms in the small intestine.
Difficult cases.
Clinical picture with ulcers, cracks, erosions.

Medicines

Four groups of pharmaceutical drugs are used for treatment:

Inhibitors (Omeprazole 20 mg) that block the ability of the glands to produce hydrochloric acid, which irritates intestinal tissue. Take 20 minutes before meals, twice a day, morning and evening, 1 tablet. Duration from 7 to 10 days.
Antibiotics (Metronidazole 500 mg) to eliminate infections - 1 tablet twice a day, seven to fourteen days.
Multienzyme medications (Creon 1000), which have an auxiliary effect in the breakdown of food products. One capsule is taken before meals, the second during or after meals, swallowed without opening.
No-shpa (Drotaverine) – antispasmodics – for relieving painful sensations, spasm, muscle relaxation - 2 tablets three times a day.

For each patient, a different method of therapy is selected, paying attention to the form and degree of the disease. Self-medication should not be done to avoid relapse and avoid danger to life.

Folk remedies

In combination with drug therapy, gastric duodenitis can be cured using alternative medicine recipes. For example, good effect achieved by drinking one teaspoon of honey three times a day before meals. It is advisable to use it until the symptoms of the disease completely disappear. Freshly prepared juice also helps in treatment raw potatoes and carrots, which are taken on an empty stomach, ½ cup before meals. Reception period is up to ten days.

Has a healing effect sea buckthorn oil, if it is a natural product, without additives. Ideally, the product should be used every morning and evening before meals, one teaspoon. The course of treatment is up to 1 month. Use traditional medicine beneficial if the patient is allergic to drugs.

Diet

Correct balanced diet in the prevention and treatment of the disease, an essential condition for a positive outcome. The restrictions are strictly adhered to for the first three weeks. Their basis is mucous (enveloping) decoctions of cereals (oatmeal, rice), semolina or buckwheat porridge in liquid form, lean meat, fish, pureed soups.

Meals should be small and frequent up to 5-6 times a day. The last meal is taken no later than 2 hours before bedtime. Food should be warm, no more than 50 0 C. It is forbidden to eat fresh baked goods; it is better to give preference to crackers. It is not recommended to take foods that can stimulate the secretory glands of the stomach, as well as food consisting of coarse fibers plants. Alcohol, carbonated liquids, seasonings and spices are strictly prohibited.

Possible complications

Failure to consult a doctor in a timely manner can lead to gastric perforation and provoke gastric pathology with the occurrence of ulcers. As a result, the following complications will appear:

Weakening and dehydration of the body.
Formation of bleeding.
Intestinal obstruction.

Prevention

Measures to prevent duodenitis include management the right image life, good nutrition, exclusion of spicy, fatty foods from the diet, giving up alcohol and smoking.

Gastric duodenitis is a disease that is easily treatable in the initial stage. When the first symptoms appear, you must immediately consult a doctor and strictly follow his recommendations in order to restore stomach function. You should not self-medicate, avoiding the occurrence of chronic condition. You should always remember the important role of the stomach in general mechanism body and prevent disruptions in its functioning.

Duodenitis is a disease accompanied by inflammation of the intestinal mucosa. Accompanied by general weakness, pain in the stomach, heartburn, belching, nausea, and vomiting. There are acute and chronic forms. Duodenitis is the most common disease of the duodenum; 5-10% of the population have experienced its symptoms at least once in their lives. It equally affects representatives of different age groups.

In men, it is diagnosed 2 times more often due to addiction to alcohol and an unhealthy lifestyle. In the article we will consider in more detail the main causes of the disease, symptoms and first signs, as well as methods of treating duodenitis in adults of various forms.

Duodenitis: what kind of disease is it?

Duodenitis is an inflammatory disease of the mucous membrane of the duodenal wall. More often it develops in combination with and is designated as. The duodenum performs secretory, motor and evacuation functions.

The secretory function consists of mixing chyme with digestive juices, which enter the intestine from the gallbladder and pancreas.
The motor function is responsible for the movement of food gruel.
The principle of the evacuation function is the evacuation of chyme into subsequent sections of the intestine.

As practice shows, acute inflammatory processes of the duodenum in 94% of cases become chronic.

Duodenitis may be independent disease or combined with pathology of other parts of the digestive tract, for example, it can develop against the background of gastritis, pancreatitis, enteritis, that is, against the background of damage to the stomach, pancreas, gall bladder, small intestine respectively.

The disease is classified according to the nature of the lesion:

Non-atrophic (superficial).
Hypertrophic (erosive).
Atrophic.

According to localization - lesions of the proximal (central) and distal parts of the duodenum. Manifests itself in multiple clinical forms:

gastritis-like;
ulcer-like;
cholecyst-like;
pancreatic;
mixed and asymptomatic.

Causes

The main causes of duodenitis in most cases are bacteria Helicobacter pylori(Helicobacter pylori), incorrect location of the organ and disruption of the production of hormones by the intestine. The risk of developing duodenitis exists in people of all age groups. There are acute and chronic forms.

Primary reasons:

eating disorders, consumption of foods that irritate the gastrointestinal mucosa (sour, smoked, spicy, fried);
alcohol, smoking, coffee abuse;

Clinical cases of primary duodenitis are much less common than secondary (developed as a result of another pathology).

Secondary. The development of the disease occurs against the background of other diseases of the gastrointestinal tract - gastric and duodenal ulcers, gastritis, pancreatitis, cholecystitis, hepatitis, infection with the bacterium Helicobacter pylori and others.

There are also a number of predisposing factors that, acting over a long period of time, lead to the occurrence of a chronic form of the disease and periodic inflammation of duodenitis. These include:

unhealthy and irregular diet;
bad habits;
severe stress;
chronic diseases of various organs;
taking some medicines.

Acute duodenitis: what is it?

The acute form of duodenitis appears suddenly. Often precisely after a violation of the diet. Characteristic symptoms is painful sensation in the upper abdomen, nausea, turning into vomiting. Accompanies these signs general weakness, temperature increase.

In acute duodenitis, the pain is intense, sharp, occurring more often two to three hours after eating or at night (hunger pain). If duodenitis is combined with gastritis with increased acidity stomach, pain can occur within 15 - 20 minutes after eating. Such clinical forms are called ulcerative and gastritis-like.

At proper therapy and following a diet, you can get rid of it in a few weeks. If inflammation occurs again, there is a high probability of the disease becoming chronic. According to statistics, this happens in 90% of cases.

Chronic duodenitis

The course of chronic duodenitis (CD) is diverse clinical symptoms, making it difficult to set correct diagnosis. It is often confused with other diseases of the digestive system; most often it is mistaken for a duodenal ulcer, but with less pain and severity of exacerbations. If HD appears dyspeptic disorders, then it is initially misdiagnosed as gastritis.

The course of the disease is usually long-term with periodic exacerbations.

During an exacerbation, the patient complains of headache, general malaise, irritability and poor sleep.
2-2.5 hours after eating, some patients experience increased heart rate, sweating, shortness of breath, weakness and dizziness.
There is significant weight loss or excess weight of the patient.
In addition, severe cardiovascular and neuropsychiatric disorders occur.

According to the degree of structural changes, several variants of chronic duodenitis are distinguished:

Superficial duodenitis

What it is? Superficial duodenitis is an inflammatory process that affects the duodenal mucosa, causing the intestinal wall to significantly swell and thicken. In addition to organic changes, the functionality of the organ is disrupted, motor and enzymatic functions change. Sometimes swelling is found in other digestive organs. The superficial form of duodenitis is never an independent disease. According to statistics, the disorder in combination with gastritis occurs in more than 50% of the population.

Symptoms:

pain and discomfort in the hypochondrium after eating. At advanced stages pain in the stomach and intestines may worsen at night;
general fatigue and apathy may even develop;
constant disturbance of stool: diarrhea or constipation.

Atrophic

Atrophic duodenitis is a chronic form of the disease, which is characterized by atrophy of the mucous membrane of the duodenum, as well as sharp decrease number of goblet enterocytes. This diagnosis has virtually no connection with atrophic gastritis.

Interstitial

No damage to the glands.

Erosive-ulcerative

Features a surface defect mucous membrane intestines due to erosive lesions. Except external factors, the catalyst for development can be surgical interventions on internal organs, sepsis, thrombotic lesions of the veins, diseases of the central nervous system and blood.

Hyperplastic

Manifested by excessive tissue growth.

Patients with chronic duodenitis should be under dispensary observation; anti-relapse treatment is indicated for them.

Symptoms of duodenitis in adults

Duodenitis can begin either suddenly or gradually. It often manifests itself after some kind of dietary excess, alcohol consumption, or stress. Symptoms of duodenitis depend on the cause of the disease and accompanying pathologies digestive organs. The disease is often “masked” as gastritis, hepatic (biliary) colic, which makes diagnosis difficult.

The main symptoms of duodenitis are:

stupid constant pain in the epigastric region of the abdomen or in the right hypochondrium, which intensifies at night, with an empty stomach or palpation;
lack of appetite;
feeling of fullness in the abdomen, especially after eating;
bloating();
bitter belching;
heartburn;
nausea, sometimes with vomiting;
constipation;
weakness, general malaise;
increased body temperature;
dyspepsia.

If symptoms appear, consult a doctor and strictly follow his instructions! You should not self-medicate to prevent the disease from becoming chronic.

Complications

If you fail to apply in a timely manner medical care or non-compliance with diet chronic duodenitis possible serious complications. Inflammation can spread to all layers of the intestinal wall and even affect the peritoneum. In this case, periduodenitis develops, leading to severe violations digestive processes, pain becomes constant, and treatment becomes very difficult.

If the patient develops complications, the prognosis for life remains favorable, but the prognosis for health is questionable due to dysfunction of the internal organs.

Diagnostics

A competent specialist is able to suspect duodenitis after a conversation with a patient who comes to him and his examination. But for final verification of this not very common diagnosis, a comprehensive and comprehensive examination is necessary.

If during diagnosis the doctor suspects malignant formations located in the mucous membrane area, the doctor will prescribe another examination. In this case, the biomaterial is examined in the laboratory of the oncology department.

Diagnosis is based on instrumental methods research:

fibrogastroduodenoscopy (FGDS) with biopsy;
duodenoscopy;
pH-metry;
radiography of the stomach and duodenum;
biochemical blood test;
stool examination;
ultrasound examination (ultrasound)

With the help of research, it is possible to determine what caused the disease, this will subsequently simplify treatment and minimize the risk of relapse.

Treatment of duodenitis

In adults, treatment of duodenitis includes several areas:

elimination of acute inflammation
preventing the disease from becoming chronic
restoration of duodenal function
normalization of digestion

How to treat acute duodenitis?

Treatment of duodenitis with gastritis in the acute phase in the first days involves gastric lavage, strict bed rest and fasting. After this, the disease must be treated with anticholinergic and antispasmodics, enveloping and astringent drugs. Be sure to follow a diet for duodenitis No. 1.

How to treat chronic duodenitis in adults?

Treatment of the chronic form in most cases occurs in a hospital. To the classic drug therapy includes:

antibiotics (to combat Helicobacter pylori);
enveloping drugs – “Sulfacrate”;
enzymes;
chemotherapy agents (if available);
medications that reduce acidity (for example);
drugs that reduce the secretion of hydrochloric acid (ranitidine tablets).

Antispasmodic drugs to relieve spasms:

Drotaverine (Bespa, No-shpa, Spasmoverine, Spasmol)
Papaverine hydrochloride (Papaverine)
Antacids (reduces gastric acidity)
Almazilat (Simagel)

Each patient is selected individual scheme pharmacological therapy depending on the form and clinical features diseases.

As a rule, everything necessary measures carried out at home. To speed up recovery, it is recommended to avoid stress, give up alcohol and smoking. The patient needs good rest and sleep, lungs physical exercise and walks. During the period of remission, patients with duodenitis are recommended to undergo sanatorium-resort treatment.

Prognosis with regular monitoring and timely treatment favorable, in case of duodenitis caused by duodenostasis, after measures aimed at eliminating stagnation, deflation occurs inflammatory symptoms and, as a rule, a cure.

Clinical examination of patients includes their registration, periodic medical examination in the fall and spring with outpatient examination and anti-relapse preventive treatment.

Nutrition and diet

For duodenitis, the patient is prescribed dietary food, usually diet No. 1 (according to Pevzner), which excludes the consumption of foods that irritate the gastric mucosa and duodenum. After the exacerbation of duodenitis subsides, the patient is transferred to diet No. 2 or No. 5, and in case of reduced tolerance to dairy products, diet No. 4, after which he is transferred to 4B. During the period of remission, you can use diet No. 15.

The following foods are encouraged:

products that have an enveloping effect on the mucous membrane of the stomach and duodenum - flax-seed, oats, potato and corn starch,
cereal and pureed soups,
Not fatty varieties meat and fish, preferably in the form of cutlets, meatballs and meatballs,
omelette, dairy dishes,
baked fruits, stewed vegetables,
stale bread, crackers,
creamy and vegetable oil in small quantities.

Boiled dishes are allowed. They must be warm, since cold can aggravate spasms and motor disorders (clinically, the patient will experience renewed or intensified pain).

For the first 12 days with duodenal inflammation, you should not eat meat. Only 2 weeks after the start of the course of treatment and diet, you can include boiled lean meat without skin and veins in the menu: chicken breast, veal. Can cook steam cutlets from lean fish (trout, pollock, pike perch) without bones and skin, and lean meat, passed through a meat grinder.

Diet for duodenitis helps reduce inflammation, promotes the healing of wounds, ulcers and erosions, reduces pain.

Products prohibited for duodenitis, stimulating gastric secretion and food containing coarse plant fibers.

canned food
smoked meats
concentrated broths from meat, fish, mushrooms
fatty meats and fish (pork, duck, mackerel)
pepper, mustard, garlic, horseradish, pepper, onion
ice cream
carbonated drinks
alcohol
raw vegetables and fruits

Menu for the day

The daily diet can be adjusted at your discretion, including more of your favorite permitted foods.

It is recommended to adhere to such a diet for duodenitis from two weeks to a month ( exact time diet must be determined by a doctor). After this, the diet can be expanded even further - add high-quality sausages (not smoked), crumbly cereals, raw fruits, vegetable salads.

With strict adherence to the diet, the patient feels relief after a few days. And if the patient adheres to all the nutritional recommendations described above constantly, then all manifestations of duodenitis can be completely eliminated.

Folk remedies

Before using folk remedies for duodenitis, be sure to consult your doctor!

It is advisable to drink chamomile tea more than twice a day. It is better to drink it chilled. The drink is distinguished by its ability to calm internal organs and reduce inflammation.
Plantain juice and honey. To prepare the composition, you need to take 3 large spoons of plantain juice and 1 small spoon of honey. Mix everything and take 3 large spoons 3 times a day. This remedy is especially effective for erosive duodenitis.
Pour 2 tablespoons of herb St. John's wort perforated with 1 cup of boiling water, cover with a lid, heat in a water bath for 30 minutes, leave for 15 minutes, strain. Drink 0.3 glasses 3 times a day 30 minutes before meals for duodenitis.
For treatment erosive form For diseases, it is recommended to use the following recipe: a teaspoon of flax seeds is poured into a glass of boiling water and left for about 15 minutes. Accept healing composition recommended for empty stomach an hour before breakfast. Treatment with flax lasts about a month.
30 g each of peppermint and lemon balm leaves, 40 g of chamomile flowers. Insist. Drink a glass half an hour before meals.

Prevention

Prevention of duodenitis includes the following preventive measures:

If signs of duodenitis appear, you should not self-medicate with various folk remedies, which can only be additional methods of therapy. IN otherwise possible severe complications in the shape of intestinal bleeding, syndrome, peptic ulcer or intestinal obstruction.

Duodenitis is an inflammatory process that affects the mucous membrane of the duodenum. This is one of the most common gastroenterological diseases. Women get it twice as often as men. In 95% of cases, duodenitis becomes chronic.

Duodenitis – inflammation of the mucous membrane of the duodenum

Causes and risk factors

The main reasons leading to the development inflammatory process in the mucous membrane of the duodenum are:

abuse of fried, spicy, smoked and sour foods;
abuse of drinks with high content caffeine (energy drinks, coffee, strong tea, cola);
smoking;
alcoholism.

All of the above factors contribute to increased secretion of hyperacid gastric juice, that is, containing increased concentration of hydrochloric acid. It enters the cavity of the duodenum, first causing irritation and then acute inflammation its mucous membrane. When the disease becomes chronic, atrophic and degenerative processes occur in the intestinal wall.

Duodenitis often develops as a secondary process against the background of a number of the following pathologies of the digestive system:

peptic ulcer of the stomach and duodenum;
chronic gastritis;
infection of the stomach and duodenum with the bacterium Helicobacter Pylori;
disturbance of blood supply and innervation of the walls of the duodenum;
chronic colitis, enteritis, pancreatitis, hepatitis;
cirrhosis of the liver;
helminthic infestations (giardiasis, ascariasis).

Forms of the disease

Depending on the duration of the disease and the activity of the inflammatory process, acute and chronic duodenitis are distinguished. Acute, in turn, is divided into catarrhal, ulcerative and phlegmonous.

The phlegmonous form of acute duodenitis is an indication for surgical intervention.

Chronic forms of duodenitis are classified according to different criteria:

by localization of the lesion (diffuse, local, postbulbar, bulbar);
by reason of occurrence (primary or secondary);
by the degree of morphological changes (atrophic, interstitial, superficial);
according to the characteristics of the endoscopic picture (nodular, erosive, atrophic, hemorrhagic, erythematous).

There are also special forms of the disease (tuberculous, fungal, immunodeficiency duodenitis).

According to the characteristics of clinical manifestations, the following forms of duodenitis are distinguished:

Ulcer-like. The patient complains of periodically occurring “hungry” or night pain in the epigastric region, which is relieved by taking antacids or food. Bitter belching and heartburn are often observed.
Gastritis-like. Pain occurs 20-30 minutes after eating. Dyspeptic syndrome is pronounced (lack of appetite, nausea, vomiting, flatulence, unstable stool, belching).
Pancreatitis-like and cholecyst-like. The clinical picture resembles an attack of biliary colic. Patients complain of severe acute pain in the left or right hypochondrium, dyspeptic disorders.
Neurovegetative. It develops as a result of hormonal duodenal insufficiency and manifests itself as dumping syndrome, asthenoneurotic autonomic disorders.
Mixed. IN clinical picture The disease exhibits signs of various clinical forms.
Asymptomatic. Most often observed in elderly patients. It occurs without any symptoms and is discovered by chance during an examination of the gastrointestinal tract for another pathology.

Symptoms

One of the first symptoms is cramping, aching or stabbing pains. In some patients they occur on an empty stomach, while in others they occur shortly after eating. Also characteristic of duodenitis:

coated tongue;
heartburn;
belching;
nausea, vomiting;
increased sweating (hyperhidrosis);
general weakness, dizziness.

Diagnostics

Basically, the diagnosis of duodenitis is carried out according to FEGDS. As additional methods apply:

contrast radiography of the gastrointestinal tract with barium sulfate;
gastric probing with laboratory research gastric juice (pH determination, a number of biochemical tests);
duodenal intubation;
laboratory tests - general blood test, blood biochemistry, coprogram.

Duodenitis is one of the most common gastroenterological diseases. Women get it twice as often as men. In 95% of cases, duodenitis becomes chronic.

Treatment

The treatment regimen for duodenitis includes:

Diet therapy is of great importance in the treatment of duodenitis.

In case of acute duodenitis and exacerbation of chronic duodenitis, table No. 1 according to Pevzner is prescribed. Alcohol, black coffee, chocolate, ice cream, pepper, mustard, fatty fish and meats, spinach, sorrel, lard, fresh baked goods, smoked meats, pickles and mushrooms are excluded from the diet. The basis of the diet is oatmeal, buckwheat and semolina, puree soups, eggs (1-2 pieces per day), lean meat, low-fat cottage cheese, yesterday's wheat bread, weak tea.

For chronic duodenitis in remission (in the absence of digestive disorders and pain) it is recommended treatment table No. 5 according to Pevzner. The diet includes sweet fruits, crumbly cereals, boiled chicken or lean beef, soups with vegetable broth, skim cheese, wheat bread, compotes, rosehip infusion, weak tea. Alcohol, black coffee, ice cream, spices, fatty fish and meats, fresh baked goods, strong meat broths, spinach, lard, and sorrel are prohibited.

The phlegmonous form of acute duodenitis is an indication for surgical intervention.

Possible complications and consequences

The main complications of duodenitis:

periduodenitis (inflammation of the serous membrane surrounding the duodenum);
development of erosive and ulcerative defects duodenal mucosa;
perforation of the ulcer;
ulcerative bleeding;
malignant tumors of the duodenum;
pyloric stenosis (narrowing of the junction of the stomach and duodenum);
achlorhydria ( a sharp decline acidity of gastric juice);
hormonal duodenal insufficiency;
high intestinal obstruction(partial or complete);
peritonitis (with perforation of an ulcer or the development of phlegmonous duodenitis).

Forecast

If started in a timely manner and adequate treatment the prognosis is generally favorable.

Prevention

Prevention of duodenitis includes:

balanced diet;
quitting smoking and drinking alcohol;
timely detection and treatment of diseases of the gastrointestinal tract;
regular moderate physical activity.

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