Duodenitis: symptoms and treatment in adults, prognosis. Chronic duodenitis: causes, symptoms and treatment in adults, diet

Chronic duodenitis is a disease of the duodenum, in which inflammation and degeneration of the mucous membrane are 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, fiber-rich foods;
exceeding the norms of carbohydrates and fats in the diet;
harmful 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 chronic duodenitis. They believe that these are only factors contributing to its development.

One of the likely causes of chronic primary inflammation of the duodenum is untreated acute duodenitis, which the patient had previously suffered.

The most popular version of the development of this disease is an imbalance between the factors of defense and aggression. When the aggressive factor, namely the excessive secretion of pepsin and hydrochloric acid, prevails over the protective factors - uniform cellular regeneration of the tissues of the intestinal mucosa, 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 state of the intestinal microflora. With gastric achilles, dysbiosis progresses and bacterial pathogenic flora “inoculates” the small intestine and duodenum.

Symptoms of the disease

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

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 antacid medications.

With distal duodenitis, the pain is concentrated on the right and radiates under the right shoulder blade. The pain also intensifies after eating fried and high-fat foods, 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 the 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 of the disease are various types of dyspeptic disorders:

distension and heaviness in the epigastric region;
nausea and heartburn;
the tongue is thickly coated;
bitterness in the mouth, bitter belching - 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 the direct involvement of neighboring organs in the treatment process. 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 from 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. For the first 2 days of the diet, therapeutic fasting is preferable. 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 begin to treat duodenitis with medication, you should also discuss with your doctor the possibility of taking supplements 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 tablespoons of high-quality 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 from 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 mild folk remedies for treating the disease.

What is duodenitis

Duodenitis is an inflammation that occurs in the initial part of the mucous membrane of the small intestine. An isolated process of only the duodenal bulb is bulbitis. If the stomach is also affected - gastroduodenitis.

The ducts of the pancreas and gallbladder open in the duodenum. Enzymes, bile and juices of the small intestine contribute to the further breakdown of food. They ensure the absorption of nutrients and the movement of the food bolus through the gastrointestinal tract.

The duodenum functions constantly and very intensively. That is why any violations can negatively affect its work and lead to inflammation - duodenitis.

The pathological process in the duodenum leads to reactive inflammation:

pancreas (pancreatitis);
gallbladder (cholecystitis);
bile ducts (cholecystocholangitis).

How to cure a disease - video

Classification of duodenitis

There are two forms of inflammation of the duodenum:

Spicy. This pathology is manifested by pain in the upper abdomen (epigastric region), nausea, and weakness. The patient experiences acute discomfort when palpating (feeling) the abdomen. Vomiting may occur, and most often repeatedly. As the purulent process develops, signs of peritoneal irritation appear, weakness and nausea increase. An acute process can be:
- catarrhal (superficial lesion);
- erosive-ulcerative;
- phlegmonous (purulent).
Chronic. Clinically, this form is manifested by dull, constant pain in the epigastrium, nausea, decreased appetite, and vomiting if the diet is not followed. Patients complain of a feeling of fullness in the upper abdomen, especially after eating.

Chronic duodenitis is divided into:

With an increase in the number and size of the duodenal glands, they speak of hyperplastic duodenitis.

Treatment

A gastroenterologist deals with the treatment of diseases of the gastrointestinal tract, including inflammation of the duodenum. If there are indications for surgical intervention, the pathology is treated by a surgeon.

Inpatient treatment is indicated in the following cases of duodenitis:

severe pain syndrome;
complications such as bleeding, perforation (perforation of the integrity of the intestinal wall), acute pancreatitis, peritonitis;
difficulties in diagnosis;
damage throughout the intestine;
severe concomitant gastrointestinal diseases;
neglect of the process;
suspicion of malignancy.

In all other cases, outpatient therapy is permitted under the supervision of a physician, in compliance with all recommendations.

Treatment lasts from 1–2 months to six months. It depends on the form and severity of duodenitis.

When treating at home, the patient is given the following recommendations:

compliance with the principles of dietary nutrition;
normalization of sleep and rest patterns;
giving up bad habits (smoking, alcohol);
avoiding emotional and physical overload;
refusal of junk food (chips, crackers, soda, candy bars);
providing moderate physical activity (swimming, walking).

Diet therapy

Nutritional therapy is the basis for the treatment of diseases of the gastrointestinal tract.

The main principles of the diet for inflammation of the duodenum:

During an exacerbation, food should be thermally and chemically gentle, pureed, pureed, steamed.
Complete exclusion of fried, salty, spicy, smoked foods.
Pickles, marinades, and sausages are limited in consumption.
Products containing coarse fiber (cabbage, corn, carrots, apples, radishes) are limited.
Prohibited: onions, radishes, mustard, garlic, horseradish, spices, fatty and stringy meat, lard, mushrooms, whole milk, sharp cheeses, baked goods, puff pastry products, rye bread, strong meat broths.
The diet is fractional (5-6 times), in small portions. The patient should not experience severe hunger.

Prohibited products - gallery

Mustard must be avoided
Onions cause irritation to the mucous membranes
Mushrooms are a prohibited product for duodenitis
Baking is contraindicated for patients suffering from inflammation of the duodenum.
Cabbage contains coarse fiber, so intake of the product is limited

Drug therapy

The choice of medications depends on the nature of the inflammatory process.

For the treatment of duodenitis use:

With an ulcer-like course:

Agents that neutralize hydrochloric acid (antacids): Rennie, Phosphalugel, Almagel, Gastal, Gaviscon.
Gastroprotectors. These are drugs that have an antacid, anti-Helicobacter effect and protect mucosal cells from irritation. The drug De-nol is most often used.
Proton pump inhibitors. They reduce the secretion of gastric juice. Recommended: Nolpaza, Omeprazole, Losek, Ultop.

For Helicobacter pylori infection:

triple therapy: Ranitidine, Clarithromycin, Metronidazole;
quadruple therapy: Omeprazole, De-nol, Metronidazole and Tetracycline.

With cholecyst-like course:

Agents that stimulate bile production: Allohol, Ursosan, Nikodin, Flamin, Hofitol.
Medicines that promote the secretion of bile: Motilium, Motilak, Cholecystokinin.
Antispasmodics that relieve pain and spasms: Duspatalin, No-shpa, Dolce.
Enzymes, for example, Creon.

For severe pain, analgesics and antispasmodics are used:

Atropine;
Platyfillin;
Analgin;
Tramal.

For duodenitis, which is accompanied by diarrhea, medications are recommended:

Smecta;
Enterosgel;
Activated carbon.

Drugs that improve intestinal motility:

Domperidone;
Gastrosil;
Cerucal.

Enzyme preparations:

Mezim;
Festal;
Pancreatin.

Pre- and probiotics - to normalize intestinal microflora:

Acipol;
Baktisubtil;
Hilak forte;

What medications to treat the disease - gallery

Rennie neutralizes hydrochloric acid De-Nol protects the mucous membrane from irritation
Nolpaza reduces the secretion of gastric juice
Ursosan stimulates bile production
Motilium promotes bile secretion
No-spa eliminates spasms
Neosmectin is used for diarrhea
Linex normalizes microflora

Physiotherapeutic methods

Physiotherapy is prescribed to treat inflammation of the duodenum. This therapy eliminates pain, improves motility and blood supply to the mucosa.

For this use:

Electrosleep. The nervous system is affected by low-frequency current. This event promotes the restoration of affected tissues, relieves spasms and activates metabolism.
Galvanic collar. Impact on tissues with direct current. The procedure accelerates regeneration, reduces pain, activates blood circulation and nutrition of the affected areas.
Pearl baths. This is a procedure that involves hydromassage. The event is called pearl baths because the water contains many small bubbles that visually resemble small pearls. Baths promote relaxation, relieve pain and spasms. They reduce inflammation and activate microcirculation.
Amplipulse therapy. The event is based on the impact of modular sinusoidal currents on the affected area. The procedure eliminates pain, activates blood circulation, and provides improved tissue nutrition.
Magnetic and laser therapy. The abdomen is exposed to a laser or magnetic field. The measures effectively eliminate spasms and reduce inflammation.
Electrophoresis of antispasmodics. Thanks to the electric current, deeper penetration of painkillers into the tissue is achieved.
Paraffin and mud applications. These are effective measures that reduce inflammation and reduce pain.
Balneotherapy. In the treatment of inflammatory diseases of the duodenum, treatment with mineral waters is used. The following are appointed: Borjomi, Rychal - Su, Essentuki No. 4, Narzan.

With the ulcerative form of duodenitis, you need to wait until the inflammation subsides. Only during remission is it possible to prescribe physiotherapy.

For patients suffering from chronic diseases of the digestive tract, annual sanatorium-resort treatment is indicated (Zheleznovodsk, Essentuki). It is resolved after 3 months after the exacerbation.

If malignant degeneration is suspected, physiotherapy should be completely abandoned.

Surgical intervention

This treatment is indicated for:

a long-term process that does not respond to conservative therapy;
non-healing ulcers and erosions on the mucous membrane;
sudden bleeding;
acute inflammation: phlegmon and/or peritonitis;

Folk remedies

Healing recipes have been used since ancient times to treat diseases of the stomach and intestines.

For this purpose use:

Infusion of viburnum fruits. Pour a glass of boiling water over the raw materials (1–2 tbsp.). Leave for 4 hours in a warm place. Drink the strained infusion 3-4 times a day, one glass at a time.
Propolis solution. Dry propolis (100 g) is poured with alcohol (70%). They insist for 10 days. In this case, the container is shaken daily. The product is filtered. Drink 15 drops diluted in milk (1 tablespoon) before meals, 3 times.
Flax seed. Pour the raw materials (2 tbsp) into a thermos with boiling water (0.5 l). Infuse and filter. Drink half a glass before meals, 3 times a day.
Decoction of marshmallow rhizome. Place chopped marshmallow (1 tbsp) in a glass of water. Cook for 1 minute. Leave for half an hour. Strain the mixture. Take 1 tbsp. l. 3 times before meals.
White cabbage juice. After chopping the cabbage leaves, carefully squeeze out the juice. You need to take half a glass before meals, 3 times.
Sea buckthorn oil. The product is used 1 tbsp. l. before meals, 4 times a day.
Honey. It is recommended to stir the bee treat (1 tsp) in a glass of warm water. You need to drink a glass 3 times a day.
Aloe juice. This remedy is taken 1 tbsp. l. before meals, three times during the day.
Medicinal infusion. Centaury grass and fennel seeds (50 g each) are mixed and poured with a glass of boiling water. Leave for 30 minutes. It is recommended to drink half a glass 2 times a day.

Folk remedies do not exclude, but complement drug therapy. Their appointment must be agreed with the doctor. Especially if the patient is a child. Flax seed helps treat duodenitis
Sea buckthorn oil has a positive effect on the mucous membrane of the digestive tract
Aloe juice is an excellent cure for duodenitis

Homeopathic medicines

Homeopathic remedies can also be used to treat gastrointestinal diseases.

For this purpose, use:

Natrium Sulfuricum;
Phosphoricum;
Gepar Sulfur;
Antimonium Crudur.

It should be noted that there is no specific cure for duodenitis. Therefore, drugs are selected individually for each patient based on symptoms.

Features of treatment for children and adults

In the treatment of duodenitis, it is necessary to take into account the patient’s age and condition:

Children need to calculate the dosage correctly. In addition, many medications are contraindicated for treating children. Therefore, self-treatment is strictly prohibited.
If the duodenum is affected in a pregnant woman, it should be remembered that any medications must be prescribed by a doctor. For example, Atropine can cause miscarriage, and Tetracycline can cause congenital deformities of the fetus. Therefore, during the period of bearing a child, you should not self-medicate. Taking any drug or traditional medicine must be agreed with your doctor.

Duodenitis is a common intestinal disease that occurs in both adults and children. The causes of pathological processes in the duodenum can be very different. The treatment of the disease is based on adherence to the principles of diet therapy, medication and physiotherapeutic methods of influencing the pathological focus. Only timely diagnosis and adequate treatment of duodenitis will help avoid serious complications.

is an inflammation of the duodenum, characterized by a sudden onset, pronounced symptoms, and rapid and complete reversibility of changes in the mucosa. The main clinical signs: acute pain after eating or at night, nausea, vomiting, diarrhea, flatulence, rumbling in the abdomen. Diagnostic measures include conducting a general and biochemical analysis of blood, stool, FGDS, intestinal biopsy, radiography and ultrasound of the abdominal organs. The therapy is highly effective and is aimed at eliminating the causes and symptoms of duodenitis, restoring digestion and all intestinal functions.

General information

Acute duodenitis is an acute inflammatory pathology, most often affecting the mucous membrane of the duodenum, less often affecting the deeper layers of the duodenum. Diseases of the digestive system are extremely common among the population. At the same time, there is an increase in the frequency of pathological processes in childhood due to changes in lifestyle, nutrition and ecology. Inflammation of the duodenum significantly affects the functioning of the entire digestive tract. According to the process, duodenitis is divided into acute and chronic. Both forms differ significantly in both etiology and clinical manifestations. In most cases, acute duodenitis becomes chronic (up to 94%). Most often it develops in men. Depending on the morphological changes in the mucous membrane, the following types of acute duodenitis are distinguished: catarrhal, erosive-ulcerative and phlegmonous.

Causes of acute duodenitis

Acute duodenitis can develop as a result of exposure to internal and external factors. In most cases, the appearance of pathology is associated with poor diet, namely abuse of alcohol, fried, fatty, smoked, spicy foods and coffee. Such food leads to increased acid secretion in the stomach, which reduces the protective properties of the duodenum and increases its sensitivity.

The occurrence of acute duodenitis can also be triggered by infection. The most common pathogens are Helicobacter, staphylococcus, enterococcus, and clostridia. Active reproduction of these microorganisms leads to damage to the intestinal mucosa, the appearance of inflammation, as well as the release of large amounts of fluid into the lumen of the duodenum, which is accompanied by the development of diarrhea.

The functioning of the duodenum is influenced by other diseases of the digestive system: colitis, pancreatitis, cirrhosis of the liver, hepatitis, peptic ulcer, etc. These pathological conditions lead to disruption of blood flow and metabolism in the tissues, which negatively affects the structure of the intestinal mucosa and its protective properties. A decrease in the concentration of bile and pancreatic enzymes leads to digestive disorders in this area of the intestine.

Reflux syndrome (return of intestinal contents) can also cause acute duodenitis. It is associated with spasms and obstruction of the digestive tract. Toxic substances and foreign objects provoke chemical or mechanical trauma to the mucous membrane, which as a result also turns into acute inflammation.

Pathogenesis

The duodenum is the initial section of the intestine, which is actively involved in the digestive process. The bile duct and pancreatic duct open into the intestinal lumen. The duodenum is responsible for neutralizing gastric juice, regulating the production of enzymes and bile, as well as the reflex opening or closing of sphincters in the stomach and small intestine. Its mucous membrane is able to withstand the aggressive effects of hydrochloric acid and other compounds.

Any disturbances in the functioning of this part of the digestive system lead to significant disruptions in the entire functioning of the gastrointestinal tract and the appearance of characteristic symptoms.

Symptoms of acute duodenitis

Acute duodenitis occurs with pronounced periodic pain that occurs after eating or at night (hunger pain). In addition, body temperature increases to 38 degrees, general weakness and fatigue develop. Indigestion leads to fermentation of food and its rotting, so the patient complains of nausea, vomiting, rumbling in the stomach, flatulence and diarrhea. If the intestinal lumen becomes full, then bitter belching and vomiting mixed with bile appears due to the reflux of contents into the stomach. Adequate and timely treatment of acute duodenitis leads to relief of symptoms within 7-10 days, otherwise acute duodenitis becomes chronic.

Diagnosis of acute duodenitis

Acute duodenitis can be suspected based on patient complaints and external examination. Upon palpation, the gastroenterologist determines pain in the projection of the duodenum, rumbling and bloating. To clarify the diagnosis, additional examination methods are carried out: blood and stool tests, FGDS, ultrasound of the abdominal organs, radiography, a breath test for the presence of Helicobacter pylori.

A general and biochemical blood test in acute duodenitis allows one to determine the concentration of enzymes and the presence of signs of inflammation; stool analysis (coprogram) is necessary to assess digestive function and identify blood impurities. FGDS (fibrogastroduodenoscopy) is the most informative way to study the condition of the mucous membrane; it is often combined with intestinal biopsy. X-ray of the abdominal organs with a contrast agent is prescribed if it is impossible to carry out a previous study; it allows one to assess the degree of damage, since the X-ray contrast agent actively settles in the defective areas. Ultrasound is performed to exclude other pathologies.

Treatment of acute duodenitis

Therapy for acute duodenitis is aimed at eliminating the cause, eliminating inflammation, preventing chronicity of the process, restoring intestinal functions and normalizing digestion. Therapeutic measures are carried out at home, subject to a regimen, diet and regular physical activity. Hospitalization to the gastroenterology department is carried out in case of suspicion of intestinal neoplasms, severe general condition, or risk of bleeding.

Diet is the main element of therapy for acute duodenitis. It consists of limiting the consumption of certain foods and following a few simple rules. It is necessary to eat food in small portions 4-6 times a day, excluding fried, salted, smoked, fatty foods, carbonated drinks, coffee, alcohol, and seasonings. It is recommended to give preference to stewed and boiled dishes, soups, and dairy products.

If the cause of acute duodenitis was microorganisms, then patients are prescribed detoxification therapy (drinking plenty of fluids, intravenous solutions) and antibiotics with subsequent restoration of the microflora (taking prebiotics). After poisoning with toxins, a 1-2 day fast, the appointment of proton pump inhibitors and H2-histamine blockers (drugs that suppress the production of hydrochloric acid), and coating agents (antacids) are necessary.

If acute duodenitis has developed as a result of endocrine disorders, enzyme replacement therapy is prescribed, which improves digestion processes (pancreatin preparations), as well as prokinetics, normalizing the movement of chyme (intestinal contents) and antispasmodics to relieve pain. If the inflammation is caused by adhesions or tumor processes, surgery is prescribed.

Forecast and prevention of acute duodenitis

In general, the prognosis of acute duodenitis with adequate therapy is favorable. Rational treatment leads to complete restoration of all functions of the duodenum. Prevention of acute duodenitis should be carried out not only to prevent the disease, but also to prevent relapses of the pathology. To do this, you need to adhere to the right lifestyle, eat well, normalize your daily routine, give up spicy and fried foods, alcohol, and smoking. Regular exercise is helpful, as is annual preventative examinations with a gastroenterologist.

The inflammatory process of the mucous membrane of the duodenum, which can lead to problems throughout the entire body of adults, is referred to in medicine as duodenitis. Affecting the upper parts of the intestine, the symptoms resemble an ulcer, and the lower parts resemble pancreatitis. It affects men much more often than women. The code in the medical reference book is K29.

Accompanied by weakness of the body, pain in the stomach area, unpleasant belching, gagging and other manifestations. Acute types of duodenitis are treated with hunger and disappear after a couple of days, secondary types become chronic with complications.

Inflammation of the duodenal mucosa in its infancy stage is accompanied by unpleasant belching, vomiting, and abdominal pain.

Classification

Duodenitis is a disease that has a clear classification that helps determine an accurate diagnosis and prescribe the correct course of treatment. All types of mucosal lesions can be combined according to several classification criteria:

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Acute, occurring in combination with gastric manifestations. It is divided into several types, one of which is phlegmonous duodenitis.
Chronic, accompanying a person throughout his life and requiring careful monitoring and moderately targeted preventive treatment.

Based on the causes of occurrence, there are the following types of disease:

Duodenitis is classified according to its causes, which include poor nutrition, the consequences of drug therapy, and the presence of diseases in other organs of the gastrointestinal tract.

Primary, the causes of which are poor nutrition and bad habits (smoking, alcoholism).
Secondary, its fertile soil is existing inflammation (gastritis, ulcers) and improper treatment of this type, such as acute inflammation. Secondary duodenitis is the most common subtype.
Reactive duodenitis appears after the use of certain medications and is extremely rare; it occurs against the background of gastritis.

The degree of structural changes in the duodenum implies division into:

Superficial, involving the upper layers of the duodenum.
Atrophic duodenitis contributes to the thinning of the duodenal villi.
Hypertrophic, occurring with excessive tissue growth. The hypertrophic type is difficult to influence if it is started or if doctors refuse to intervene.
Follicular duodenitis is an increase in the papillae in the proximal layer.
Erythematous with erosive-ulcerative signs on the walls.

Inflammation in the duodenum can be minor or affect the entire organ.

According to the type of distribution in adults, it occurs:

diffuse affects the entire duodenum;
focal affects the major papilla;
distal duodenitis does not change the bulb;
proximal, involving the duodenal bulb.

The classification in expanded form will illustrate the causes of manifestation, development options, symptoms, necessary tests and acceptable measures for the disease, be it hypertrophic, erythematous or other.

Etiology

The causes of the primary disease look like this:

poor nutrition;
dry food, which leads to damage to the intestines with hard, difficult-to-digest particles;
eating large amounts of spicy, smoked, fried and fatty foods, which irritate the gastrointestinal mucosa;
vitamin and protein starvation, which is acute during pregnancy, when a double dose is required;
smoking;
abuse of coffee and alcohol.

Inflammation of the duodenum is rarely a separate disease, accompanying other disruptions in the functioning of the stomach and intestines, such as:

Most often, duodenitis occurs due to untreated gastritis, ulcers, hepatitis and other gastrointestinal ailments.

dyspepsia;
gastritis;
cholecystitis;
Crohn's disease;
ulcer;
acute form of hepatitis;
ischemic intestinal disease.

The causes of secondary duodenitis, which develops as a result of another disease, may be as follows:

infection with the bacterium Helicobacter pylori;
stress associated with surgical interventions or infectious diseases;
impaired blood flow to the duodenum;
taking non-steroidal drugs in the treatment of inflammatory processes;
duodenostasis – functional disorders of the digestive system, adhesions, duodenal obstruction, insufficient peristalsis;
pathological processes of the bile ducts (for example, congestion);
chronic diseases of the liver, pancreas, gall bladder, causing imbalance in the totality of enzymes, changing the homeostasis of the internal environment of the intestine, which can lead to a deterioration in the protective functions of the mucosa.

Most people ignore these signs of a developing disease, which can lead to irreparable consequences.

Symptoms of duodenitis

Like any disease, the described process has some symptoms, the main of which are the following:

disturbance of well-being and digestion;
partial or complete loss of appetite;
general weakness;
focal attack of pain in the navel area;
dyspepsia due to inflammation of the mucous membrane of the duodenum: belching, diarrhea, flatulence;
nausea, vomiting;
pain occurs on an empty stomach, at night or 3 hours after eating;
bloody impurities may be observed in feces and vomit;
signs of abdominal discomfort;
due to internal bleeding, anemia may develop, which is very dangerous during pregnancy;
slightly increased body temperature;
the tongue is dry and has a moderate white coating;
An acute attack is characterized by some tension in the abdominal muscles.

Owners of chronic duodenitis, both hypertrophic or erythematous, and any other, can also observe:

constant dull pain in the upper abdomen;
increased salivation;
heartburn;
bitter taste in the mouth;
during exacerbations, headache, irritability, sleep disturbance occur;
increased heart rate after eating;
weight loss or, conversely, weight gain does not occur moderately;
disorders of the cardiovascular and neuropsychic nature.

These symptoms will give you reason to think about your health and consult a specialist, because such diseases should not be neglected.

Diagnosis

Duodenitis has a nonspecific clinical picture and, as a rule, is combined with many other diseases of the gastrointestinal tract (for example, ulcers, chronic gastritis). Taking this fact into account, reliable diagnosis is only possible using instrumental methods:

fibrogastroduodenoscopy with biopsy of the intestinal mucosa;
pH-metry;
duodenoscopy;
impedancemetry.

In some cases, additional recognition methods are required, such as:

x-ray of certain areas of the esophagus;
stool examination;
blood chemistry;
recording indicators such as body temperature;
ultrasound examination, etc.

Analyzes will help reveal the picture more fully.

It should be remembered that the option of fibrogastroduodenoscopy is dangerous for patients with certain subtypes and during pregnancy. It is also recommended to simultaneously conduct an examination of the associated digestive organs.

Treatment methods

After receiving the test results and diagnostic conclusions, an individual course of treatment is prescribed. There are several generally accepted directions for treating duodenitis.

Developing a nutritional regimen with a special diet

First of all, gastric lavage is carried out; it may be necessary to fast for several days, and then strict adherence to a therapeutic diet will follow, the main principle of which is a gentle effect on the mucous membrane of the stomach and intestines, which includes:

five meals a day throughout the day;
small portions;
steaming or boiling;
avoiding cold and hot foods;
consistency – liquid, mushy;
exclusion of spicy, sour, canned, smoked and fried;
complete cessation of smoking and alcohol.

But the cure by hunger should not turn into an obsession, which will only aggravate the situation rather than cure it. After 10-12 days, the strict diet should be replaced by a lifelong one:

table No. 5p – pancreatitis-like type;
table No. 2 – if the gastric type of illness manifests itself;
table No. 5 for people with pathologies of the liver, gallbladder and bile ducts.

Of course, there are other options, since the disease progresses differently for everyone, and it also needs to be corrected.

Pharmacotherapy

An acute syndrome or exacerbation of a chronic syndrome requires the prescription of symptomatic therapy:

If the diagnosis of chronic duodenitis is confirmed, the gastroenterologist prescribes a long course:

anticholinergics to reduce pain;
antacids with enterosorbents that protect the intestinal lining from negative factors;
dopamine blockers to combat DGR, nausea and vomiting;
anti-inflammatory, healing agents for tissue regeneration and preventing the spread of the inflammatory process, which can lead to a phenomenon such as reflux duodenitis;
soothing infusions aimed at combating neurasthenia that accompanies duodenitis disorder.

is an inflammation of the mucous membrane of the duodenum. With lesions in the upper sections, the symptoms of the disease resemble gastric ulcers; duodenitis in the lower sections causes symptoms similar to pancreatitis or cholecystitis. The disease is accompanied by general weakness, pain in the stomach, heartburn, belching, nausea, and vomiting. Acute inflammation, when following a gentle diet (sometimes fasting), usually ends within a few days. Repeated diseases become chronic, complicated by intestinal bleeding, perforation of the intestinal wall, and the development of acute pancreatitis.

General information

Duodenitis is an inflammatory disease of the mucous membrane of the wall of the duodenum (duodenum). There are acute and chronic forms. Acute duodenitis is characterized by severe symptoms of inflammation, which completely subside after therapy and do not leave noticeable structural changes in the mucosa. Chronic duodenitis is a disease with a long, relapsing course, characterized by the development of foci of inflammation in the mucosa followed by pathological restructuring of its structure. It is the most common lesion of the duodenum. 94% of all inflammatory processes in the duodenum become chronic. Chronic duodenitis occurs more than twice as often in men than in women.

Causes of duodenitis

Experts in the field of modern gastroenterology believe that the causes of primary inflammation are nutritional 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 processes (developed as a result of another pathology).

The causes of secondary duodenitis are considered to be infection of the duodenum by Helicobacter Pylori, chronic gastritis of various etiologies, peptic ulcer of the duodenum, impaired blood supply to the duodenum, deterioration of trophism, innervation and tissue respiration in the intestinal wall. Pathology can be provoked by chronic diseases of the intestines and digestive organs: liver, pancreas (colitis, hepatitis and cirrhosis of the liver, acute and chronic pancreatitis of various etiologies, inflammatory diseases of the mesentery, etc.).

Pathogenesis

The mechanism of development of inflammation of the duodenum is associated with damage to the intestinal mucosa by hyperacid juice coming from the stomach. Increased acidity, combined with a decrease in the protective properties of the intestinal wall, leads to irritation and then inflammation of the mucous membrane. If acute inflammation occurs without pronounced symptoms, then it develops into a chronic process, acquires a cyclic recurrent course, and degenerative and atrophic processes begin in the intestinal wall.

In the case of secondary duodenitis, the main pathogenetic link in the development of the disease is duodenostasis - a consequence of functional digestive disorders, insufficient peristalsis, adhesions, compression obstruction of the duodenum. Chronic diseases of the liver, gallbladder and pancreas cause enzyme imbalances, which provoke a change in the homeostasis of the internal environment of the intestine, reduce the protective properties of the mucosal epithelium, and become the basis of chronic inflammation. Damage to the duodenal papilla is usually the result of pathological processes in the bile ducts.

Classification

Chronic duodenitis is classified according to several criteria. Based on their origin, they distinguish between primary and secondary processes, and based on the localization of foci of inflammation - bulbar, postbulbar, local or diffuse variants of the pathology. According to the endoscopic picture, erythematous, hemorrhagic, atrophic, erosive, and nodular duodenitis are distinguished. Based on the degree of structural changes, superficial, interstitial, and atrophic types of the disease are considered. There are also special forms (specific duodenitis: tuberculous, Whipple's disease, immunodeficiency, fungal, intestinal amyloidosis, Crohn's disease, etc.). Clinical classification includes:

Chronic acidopeptic bulbitis, usually combined with type B gastritis.
Chronic duodenitis in combination with enteritis and various types of enteropathies.
Duodenitis, as a result of duodenostasis.
Local process (peripapillary diverticulitis, inflammation of the papilla).

Symptoms of duodenitis

Symptoms vary for different clinical forms of the disease. Acidopeptic duodenitis associated with antral bacterial gastritis is often accompanied by peptic ulcer of the stomach and duodenum, which causes the presence of an ulcer-like syndrome - severe pain in the epigastrium on an empty stomach, at night or a couple of hours after eating.

Duodenitis combined with enteritis is manifested primarily by intestinal symptoms (digestive disorders, dyspepsia, malabsorption syndrome). Duodenostasis is characterized by a pronounced pain syndrome - paroxysmal, bursting and twisting pain in the epigastric region or in the right half of the abdomen, a feeling of bloating, rumbling in the abdomen, bitter belching, nausea and vomiting with bile.

With local damage, the outflow of bile is disrupted, resulting in symptoms of biliary dyskinesia. Pain in the area of duodenal projection can radiate to the right or left hypochondrium and become encircling. Characteristic is the development of signs of jaundice, slight yellowness of the skin (cholestatic jaundice is characterized by a brownish tint) and sclera, lightened to white (with complete obstruction of the biliary tract) stool. There is bilirubinemia in the blood.

A long-term chronic process is characterized by impaired synthesis of secretin, enkephalins and other gastrointerstitial enzymes. This is due to a decrease in the secretory properties of the mucosal epithelium due to its degeneration. These peptides are extremely important in digestive activity, and their deficiency leads to profound disorders not only of the digestive tract, but also of other body systems, including disorders of the autonomic and central nervous systems.

There are several clinical forms of the disease. In the ulcer-like form, there is a “night” and “hungry” pain in the epigastrium or in the area of the projection of the duodenum of a pulling nature without irradiation. It is controlled by eating and taking antacids and gastroprotectors. Heartburn and bitter belching often occur. With a gastritis-like form, there is pain almost 15-20 minutes after eating, dyspeptic syndrome - nausea, vomiting, belching, rumbling in the stomach, diarrhea, flatulence, lack of appetite.

In cholecyst-like and pancreatic-like forms, the pain is acute, severe, located in the right or left hypochondrium, prone to irradiation, proceeds as biliary colic, there are signs of cholestasis and dyspeptic disorders. In patients with the neuro-vegetative form, autonomic asthenoneurotic disorders and deping syndrome come to the fore - consequences of duodenal hormonal insufficiency. The mixed form combines the features of different clinical forms of duodenitis. The asymptomatic form is detected using functional diagnostic methods during examination for other pathologies.

Diagnostics

Duodenitis can be diagnosed based on the endoscopic picture during gastroscopy. Additional diagnostic methods are radiography of the stomach and duodenum; study of gastric juice - biochemical and pH determination. In addition, duodenal intubation, biochemical blood testing, and coprogram are indicated. If malignancy of the affected areas of the mucosa is suspected, a biopsy specimen is examined.

Treatment of duodenitis

Treatment of chronic duodenitis is carried out by a gastroenterologist and varies depending on its clinical form. For acidopeptic chronic duodenitis, treatment involves a complex action in three areas: eradication of Helicobacter; mucosal protection: reduction of hydrochloric acid secretion (proton pump blockers, H2 blockers, antacids) and gastroprotection (enveloping drugs); restoration of digestion with the help of enzyme preparations.

In case of duodenitis with enteritis, treatment of exacerbation is primarily aimed at eliminating from the diet foods that are poorly digested (primarily milk, cereals), using enzyme preparations to restore the digestive function of the intestine, and normalizing the intestinal flora. During periods of remission, proper balanced nutrition is indicated. Treatment and preventive measures should be carried out taking into account the clinical variant of chronic duodenitis and the nature of concomitant diseases.

In case of duodenitis against the background of duodenostasis, the aim is always to eradicate the cause of duodenal obstruction. Functional duodenostasis is treated conservatively - frequent meals in small portions with the exclusion of foods that promote bile secretion, drugs that bind bile, drugs that help regulate intestinal motility. Duodenal intubation with duodenal lavage is effective.

In cases of persistent obstructions as a result of pronounced adhesions, mechanical obstructions, as well as in functional obstruction that is not amenable to therapeutic treatment, surgery is indicated. Treatment of duodenal obstruction is always carried out in a hospital setting to prevent possible severe complications.

Prognosis and prevention

Primary prevention of duodenitis is a proper balanced diet, quitting smoking and moderation in alcohol consumption. Timely detection and treatment of gastrointestinal diseases, use of medications strictly as prescribed. Prevention of relapse consists of regular monitoring and annual outpatient examination, sanatorium treatment. The prognosis with regular observation and timely treatment is favorable; in case of duodenitis caused by duodenostasis, after measures aimed at eliminating stagnation, inflammatory symptoms subside and, as a rule, a cure occurs.

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