Duodenitis causes symptoms treatment. Duodenitis: treatment

Inflammation of the duodenum, or duodenitis, is rare in isolation - in most cases, this disease is combined with other diseases of the gastrointestinal tract (gastritis, ...). This pathology is diagnosed in people of different age groups, and affects both men and women equally.

Classification

According to the generally accepted classification, duodenitis occurs:

• by etiology - acute and chronic; acute, in turn, is divided into catarrhal, ulcerative and phlegmonous, and chronic is divided into primary (an independent disease) and secondary (a disease accompanying another pathology of the digestive tract);
• by localization of foci - local, diffuse, bulbar, postbulbar;
• according to the level of structural changes - superficial (affects only the superficial layer of the mucous membrane), interstitial (the inflammatory process spreads to the deeper layers of the intestine) and atrophic (thinning of areas of the mucosa, absence of glands in the affected areas);
• according to the endoscopy picture - erythematous, erosive, hemorrhagic, atrophic, hypertrophic, nodular;
• special forms of duodenitis - fungal, immunodeficiency, tuberculosis, Crohn's disease...

Etiology of duodenitis

Alcohol abuse quite often leads to duodenitis.

The most common causes of acute duodenitis are:

• food poisoning;
• excessive consumption of spicy foods and alcoholic beverages;
• mechanical damage to the intestinal mucosa by a foreign body.

Chronic duodenitis is often the result of irrational and irregular nutrition.

Factors provoking the onset of the disease are the presence of the Helicobacter pylori bacterium in the stomach cavity and duodenostasis (impaired movement of food through the duodenum). In addition to the above factors, the development of duodenitis is promoted by:

• ascariasis;
• giardiasis;
• foci of chronic infection in the oral cavity, in the genital area.

Pathogenesis

Acute and primary duodenitis occur as a result of damage to the mucous membrane of the duodenum by gastric contents of high acidity. If the number of protective factors in the duodenum is reduced, hyperacid juices have an irritating effect on the intestinal mucosa, causing inflammation in it.

Secondary duodenitis is a consequence of duodenostasis: the contents of the stomach, falling into the duodenum, remain in it for a longer period than necessary, which means it irritates the mucous membrane for a longer time, which leads to inflammation.

Symptoms of inflammation of the duodenum

Acute duodenitis is characterized by patient complaints of:

• severe pain in the epigastric region 1.5–2 hours after eating, night pain;
• nausea and vomiting;
• general weakness.

The symptoms of chronic duodenitis are more smoothed out and vary greatly in different forms of the disease. Patients are usually concerned about:

• constant aching, dull pain in the epigastric region;
• feeling of fullness, heaviness in the upper abdomen after eating;
• and belching;
• nausea, in some cases – vomiting;
• decreased appetite;
• general weakness, irritability, headaches and other so-called general symptoms.

With duodenostasis, pain in the epigastrium or in the right hypochondrium is pronounced, twisting, bursting, and paroxysmal in nature; Patients also complain of rumbling in the stomach, a feeling of bloating, bitterness in the mouth and vomiting bile.

If duodenitis is combined with duodenal ulcer, the symptoms of the above disease come to the fore, namely, intense pain in the epigastric region on an empty stomach.

In cases where duodenitis is combined with another intestinal disease, it is manifested primarily by intestinal symptoms (pain along the intestines, bloating, frequent loose stools).

If the disease lasts for a long time, the mucous membrane of the duodenum atrophies and the synthesis of enzymes that contribute to normal digestion is disrupted. As a result, profound disorders arise not only in the gastrointestinal tract, but also in many other systems of our body, including the central and autonomic nervous systems.

Diagnosis of duodenitis

The patient's complaints, medical history and objective examination will help the doctor suspect duodenitis. On palpation, you will notice varying degrees of pain in the epigastric area. To clarify the diagnosis of duodenitis and differentiate it from other gastrointestinal pathologies, the patient may be prescribed:

• EGDS (esophagogastroduodenoscopy) – examination of the upper part of the digestive organs through a probe; may be performed with or without biopsy;
• Ultrasound of the abdominal organs;
• study of gastric juice (determination of its acidity and composition);
• X-ray of the stomach and duodenum;
• coprogram;
• biochemical blood test (liver tests, amylase and other indicators).

Duodenitis: treatment

The food of a patient with duodenitis should be mechanically and thermally gentle, and it is recommended to prepare it by steaming, boiling or baking.

The main point in the treatment of duodenitis is diet.

• Food should be as thermally, chemically and mechanically gentle as possible; therefore, sour, spicy, fried, cold and hot foods, as well as alcohol, canned food and smoked foods are completely excluded for 10–12 days.
• Grinded food prepared by boiling or steaming should form the basis of the diet, and it should be taken in small portions 5-6 times during the day.
• Recommended for consumption: day-old wheat bread, porridge cooked in water or milk (rice, buckwheat, semolina, rolled oats), small pasta, cereal puddings or casseroles, lean meats and fish, soft-boiled eggs or in the form of a steam omelet no more than 2 in day, fermented milk products, whole milk, dry biscuit, vegetables (potatoes, beets, broccoli, cauliflower, zucchini, carrots).
• Excluded from the diet: legumes, millet, barley, large pasta, fresh bread, muffins, pancakes, fried or hard-boiled eggs, fatty dairy products, salty or sharp cheeses, overcooked butter, fatty meat and fish, sweets, carbonated and strong drinks .

The diet must be followed throughout life, but during the acute period of the disease it should be as strict as possible, and as the signs of exacerbation fade, the patient should gradually expand the diet (of course, within the limits of what is permitted).

The phlegmonous form of acute duodenitis is an indication for surgical treatment followed by antibiotic therapy.

Duodenitis is an inflammation of the mucous (inner) lining of the duodenum. The duodenum follows immediately after the stomach - they are separated by the pylorus - and is the initial section of the human small intestine.

The mechanisms of development of duodenitis are not fully understood. As a rule, the inflammatory process in the duodenum develops as a result of exposure to factors on the body that have an irritating and damaging effect on the mucous membrane of the digestive tract or that disrupt the relationship between aggressive factors and protective factors of the gastroduodenal zone.

According to the clinical course, there are acute and chronic forms of duodenitis. Accordingly, symptoms and treatment will also differ depending on the form of the disease.

Causes

Why does duodenitis develop, and what is it? Duodenitis means a systemic inflammatory disease of 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 of the digestive organs - smoked, spicy, fried, fatty, coffee, alcohol;
• food poisoning;
• damage to the mucous membrane by 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 due to poor diet (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 of acute duodenitis.

A major role in the development of secondary duodenitis is played by duodenostasis - insufficient mobility of the duodenum as a result of obstruction or poor peristalsis.

Classification

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. Qualified diagnostics will help establish an accurate diagnosis.

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, the general condition of the patient worsens sharply, fever, and neutrophilic leukocytosis are observed. 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.

The severity and nature of other concomitant diseases of the gastrointestinal tract largely determines the clinical symptoms of chronic duodenitis. Depending on the clinical manifestations, several main forms of chronic duodenitis are distinguished: 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 of gastric juice and pH determination;

In the case of secondary duodenitis, individual patients may additionally be prescribed 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 and other 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.

In case of chronic 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 secondary duodenitis is diagnosed with gastritis, then 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, proper nutrition plays a very important role, because the functioning of the gastrointestinal tract directly depends on what a person eats. The therapeutic diet in this case consists of 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, sausages, 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, it is necessary to carefully adhere to a balanced diet. Frequent consumption of hot, fried, spicy foods and dry food should be avoided. 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 disease that manifests itself as inflammation of the duodenum and is accompanied by significant thinning of the mucosa. In most cases, to treat such a disorder, gastroenterologists prescribe conservative therapy, which consists of following a diet, taking medications and using traditional medicine. However, it is worth considering that if the patient continues to lead an unhealthy lifestyle, then the positive effect of treatment may not occur.

Depending on the type of illness, different groups of medications will be prescribed. For example, the phlegmonous form requires quite long and serious therapy with antibiotics; for catarrhal form, antisecretory and antacid substances are required. But in most cases, treatment of duodenitis with medications requires an integrated approach and involves the simultaneous use of several groups of drugs, which are rarely prescribed individually.

Often the course of their use does not exceed three weeks, but depending on the form of the disease, the duration may vary. So, in cases, lifelong medication is indicated, but only during periods of exacerbation.

Treatment with tablets is mandatory in a hospital setting, under the supervision of a specialist. For duodenitis, patients may be prescribed:

• antacids;
• antimicrobial agents;
• antibiotics;
• anti-inflammatory drugs;
• painkillers and antisecretory drugs;
• vitamin complexes and enzymes.

If the disease occurs in a chronic form or is accompanied by symptoms from the vegetative-vascular system, then the above group of drugs is supplemented with sedatives.

Treatment regimens

Gastroenterologists have developed several treatment regimens that are used only in cases where the pathological influence of the Helicobacter pylori bacterium has been detected. There are several options:

When diagnosing secondary forms of duodenitis, i.e. formed against the background of other gastrointestinal diseases, it is first necessary to eliminate the underlying disease, which caused destructive changes in the duodenum area.

Also, drug therapy for duodenitis consists of several areas:

• etiotropic treatment– aimed at eliminating pathogens of the disease. Depending on the reasons, various substances are prescribed;
• pathogenetic– used against the inflammatory process;
• symptomatic– relieves other symptoms of this disorder.

Antibiotic therapy

Treatment with antibiotics is only necessary in cases where a pathogenic bacterium has been identified. The optimal course of eliminating inflammation of the duodenum must necessarily consist of a combination of two or three antimicrobial medications. For duodenitis, drugs such as:

• Amoxicillin;
• Clarithromycin;
• Metronidazole;
• Furazolidone.

In addition, the elimination of duodenitis is facilitated by:

• Klacid;
• Alpha Normix;
• Amoxicar;
• Omephesis;
• Promez.

The approved course duration is no more than two weeks. Since Helicobacter pylori can adapt to certain drugs, in cases where such a microorganism is detected after the specified period, the doctor prescribes analogues of antibiotics.

Such drugs can only be prescribed by the attending physician, since some of them have a destructive effect on the intestinal walls. It is for this reason that, after taking antibiotics, it is imperative to use probiotics and prebiotics to restore the intestinal microflora. These products include Linex, Bifiform, Probifor and Hilak-Forte.

Antispasmodics for duodenitis

The use of this group of drugs relaxes the smooth muscles of the walls, reduces the manifestation of painful spasms and discomfort, which very often accompany the inflammatory process of the duodenum.

The most effective drug is considered Platyfillin, aimed at eliminating pain in the organs of the digestive system, which is why it is widely used not only for duodenitis, but also for other gastrointestinal disorders.

No less popular and effective medicine is No-Shpa, which eliminates spasms. In addition, patients may be prescribed:

• Papaverine;
• Duspatalin;
• Drotaverine is an analogue of No-Shpa.

You can take these tablets, regardless of food intake, three times a day. However, they have several contraindications, the main ones being asthma and kidney failure. It is for this reason that medications are prescribed only by the attending physician, and the entire course of treatment takes place in a hospital.

Antacids

This group of drugs, thanks to several active ingredients, has a beneficial effect on acidity in the gastrointestinal tract, i.e., reduces it. In addition, it has an enveloping and mild antispasmodic effect. Can be used both for duodenitis and other ailments of the gastrointestinal tract.

The most effective medicine of this group is Almagel. It not only neutralizes the effect of hydrochloric acid, but helps restore injured tissues of the duodenum.

Other such substances include:

• Omez;
• Rutacid - in addition to the main effect, protects the mucous membrane from aggressive irritants;
• De-Nol - used for almost all gastrointestinal diseases, envelops and heals the membrane of the affected organ. Doctors often prescribe a well-known analogue of this drug – Vis-Nol;
• Maalox;
• Gaviscon;
• Phosphalugel;
• Altacid.

The main contraindications to the use of the above drugs are the presence of renal failure, the period of gestation, and the patient’s age under three years.

Antisecretory substances

Proton pump inhibitors are considered the most effective means for reducing secretion. This group differs from other drugs in its harmlessness and therapeutic effect.

For inflammation of the duodenum, the following is recommended:

• Omeprazole;
• Rabeprazole;
• Lansoprazole;
• Esomeprazole is eliminated from the body most slowly, which is why its dosage will be slightly smaller. This medicine is considered the most effective PPI and lasts for fourteen hours.

However, in addition to such medications, for the treatment of duodenitis, medications will be required to improve the functioning of the gastrointestinal tract. They are often prescribed for exacerbation of the chronic course of the disease. They not only promote motor skills, but also speed up the passage of food masses, but do not affect gastrin levels. Among these means the most famous are:

• Motilak;
• Motilium;
• Ganaton;
• Itomed;
• Passengers.

Vitamin complex

The administration of vitamins is indicated for inflammation of the duodenum to normalize or maintain the level of the immune system. Vitamin complexes A, B and C are considered the most valuable for the digestive system.

They can enter the body with food, but it is recommended to take them in tablet form, so they will be of greater benefit. Some products may take the form of a vaccine - Beplex is considered the best multivitamin product.

Some of the above medications can be used to prevent this disorder. Such drugs include:

• Omez;
• Pantoprazole;
• Misoprostol;
• Famotidine;
• Alpha Normix;
• Rofecoxib;
• Celecoxib.

Only the attending physician can prescribe certain medications and set their dosage. Only a specialist will be able to determine the nature of the course and causes of such a disease, as well as find out the content of hydrochloric acid. Self-administration of medications can only aggravate the course of the disease and cause undesirable consequences.

Similar materials

Erosive duodenitis is an inflammatory process that leads to the formation of erosions and ulcers on the surface of the mucous membrane of the duodenum. This gastroenterological pathology can lead to the development of peptic ulcer disease, which explains the second name of the disease - erosive-ulcerative duodenitis. The disease has no restrictions regarding age and gender. At the initial stage of development, it responds well to conservative methods of therapy. Be sure to follow a strict diet.

Duodenitis– inflammation of the mucous membrane of the duodenum (duodenum). The disease manifests itself as acute or nagging pain in the upper abdomen, nausea, vomiting, and upset stool.

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.

According to the stages of the disease and the duration of the course, acute and chronic duodenitis are distinguished.

Acute duodenitis develops quickly due to poisoning or ingestion of spicy food. It causes superficial inflammation of the mucous membrane, the appearance of ulcers and erosions, and rarely phlegmon (cavities filled with pus). The disease manifests itself with acute pain and digestive disorders. With proper treatment and diet, acute duodenitis goes away within a few days. With repeated inflammation, the risk of developing chronic duodenitis is 90%.

Chronic duodenitis often occurs against the background of other chronic diseases of the gastrointestinal tract (gastritis, peptic ulcer, pancreatitis), as well as due to poor nutrition. The disease can cause deep erosions and atrophy (thinning) of the upper layer of the duodenum. Periodically, chronic duodenitis worsens - severe pain and indigestion occur. This form of the disease requires long-term drug treatment and diet.

Anatomy of the duodenum

Duodenum (duodenum)- the initial section of the small intestine. It starts from the pylorus of the stomach, goes around the head of the pancreas and passes into the jejunum. The length of the duodenum in adults is 25-30 cm, capacity is 150-250 ml. The duodenum is fixed to the walls of the abdominal cavity with the help of connective tissue fibers.

The main pancreatic duct and the common bile duct open into the lumen of the duodenum. At the site of their exit, a major duodenal papilla (papilla of Vater) is formed. It is a cone-shaped formation equipped with a sphincter. With its help, the flow of bile and pancreatic secretions into the intestines is dosed. At the exit site of the accessory pancreatic duct there is a minor papilla.

Functions

• Neutralization of gastric juice. In the duodenum, food gruel mixed with acidic gastric juice acquires an alkaline reaction. Such contents do not irritate the intestinal mucosa.
• Regulating the production of digestive enzymes, bile, pancreatic juice. The duodenum “analyzes” the composition of food and sends the appropriate command to the digestive glands.
• Feedback from the stomach. The duodenum ensures the reflex opening and closing of the pylorus of the stomach and the passage of food into the small intestine

Shape and location. The duodenum is located at the level of the 12th thoracic – 3rd lumbar vertebra. The duodenum is partially covered by the peritoneum, and part of it is located behind the peritoneal space. It is shaped like a loop or a horseshoe and can be vertical or horizontal.

Parts

• The upper part - the ampulla or bulb - is a continuation of the pylorus of the stomach and, unlike the other parts, has longitudinal folds.
• Descending part
• Horizontal part
• Rising part

The last three sections have transverse folding and differ only in the direction of bending. By contracting, they promote the movement of food masses into the jejunum. Inflammation can occur along the entire length of the duodenum or in a separate area (usually in the upper part).

Blood supply The duodenum is supplied by 4 pancreatic-duodenal arteries and veins of the same name. The intestine also has its own lymphatic vessels and 15-25 lymph nodes.

Innervation. The nerve branches of the superior mesenteric, celiac, hepatic and renal plexuses approach the wall of the duodenum.

Histological structure. The mucous membrane of the duodenum has a special structure, as it must withstand the effects of hydrochloric acid, pepsin, bile and pancreatic enzymes. Its cells have fairly dense membranes and are quickly restored.

In the submucosal layer are located the Brunner's glands, which secrete a thick mucous secretion that neutralizes the aggressive effects of gastric juice and protects the mucous membrane of the duodenum. Causes of inflammation of the duodenum

Causes of acute duodenitis

1. Consumption of foods that irritate the digestive mucosa
   • roast
   • bold
   • smoked
   • acute
   In order to cope with such food, more hydrochloric acid is produced in the stomach. At the same time, the protective properties of the duodenal mucosa decrease, and it becomes more sensitive to negative influences.
2. Foodborne illnesses caused by:
   • Helicobacter pylori, which causes peptic ulcers
   • enterococci
   • clostridia
   Bacteria, when multiplying, damage duodenal cells and cause their death. This is accompanied by inflammation and swelling of the intestinal wall, as well as the release of a large amount of fluid into its lumen. The latter is the cause of diarrhea.
3. Diseases of the digestive organs
   • pancreatitis
   • peptic ulcer
   These diseases lead to impaired blood circulation and tissue nutrition in the duodenum. In addition, inflammation of nearby organs can spread to the small intestine, which negatively affects the protective properties of its mucosa. Diseases of the liver and pancreas disrupt the synthesis of bile and pancreatic juice, without which normal functioning of the duodenum is impossible.
4. Reverse reflux of small intestinal contents into the duodenum (reflux). It may be associated with spasm of the lower intestines or obstruction. Thus, bacteria are introduced from the lower intestines that cause inflammation.


5. Ingestion of toxic substances, which cause burns to the gastrointestinal mucosa. These can be acids, alkalis, chlorine compounds or other household chemicals.


6. Ingestion of foreign bodies or indigestible parts of food products leads to mechanical damage to the duodenum.

Causes of chronic duodenitis

1. Intestinal dysfunction
   • chronic constipation
   • poor peristalsis
   • adhesions
   • innervation disorder
   These pathologies lead to a slowdown in contractions - a deterioration in duodenal peristalsis. Stagnation of the contents causes stretching and atrophy of its walls, and also has a bad effect on the condition of the mucosa.
2. Chronic stomach diseases. Chronic gastritis with high acidity leads to the fact that hydrochloric acid gradually damages the intestinal cells, leading to thinning of the mucous membrane.


3. Chronic diseases of the pancreas, liver, gall bladder lead to disruption of the flow of enzymes into the duodenum. As a result, the stability of the intestines is disrupted and its protective properties are reduced.

Predisposing factors

• unhealthy or irregular diet
• chronic constipation
• disruption of hormone production
• taking a lot of medications
• bad habits

If these factors affect the body for a long time, they disrupt blood circulation in the digestive organs. As a result, local immunity is reduced, which contributes to the development of inflammation.

Symptoms of duodenitis

Symptoms of duodenitis depend on the cause of the disease and concomitant pathologies of the digestive organs. The disease is often “masked” as a stomach ulcer, gastritis, or hepatic (biliary) colic, which makes diagnosis difficult.

Symptoms of duodenitis

1. Pain in the epigastric region. The pain intensifies with palpation (palpation) of the abdominal wall.
   • At chronic duodenitis the pain is constant, dull in nature, which is associated with inflammation and swelling of the wall of the duodenum. The pain intensifies 1-2 hours after eating and on an empty stomach.
   • If duodenitis is associated with impaired patency of the duodenum, then the pain appears when the intestines are full and is of a paroxysmal nature: acute bursting or twisting.
   • Local inflammation in the area of ​​the papilla of Vater disrupts the flow of bile from the gallbladder, which is accompanied by symptoms of “renal colic”. There is acute pain in the right or left hypochondrium, girdle pain.
   • Ulcerative duodenitis, caused by the bacteria Helicobacter pylori. Severe pain occurs on an empty stomach or at night.
   • If duodenitis is caused gastritis with high acidity, then the pain occurs after eating 10-20 minutes. It is associated with the entry into the intestines of a portion of food mixed with acidic gastric juice.
2. General weakness and rapid fatigue are signs of intoxication of the body caused by inflammatory products. In acute duodenitis, body temperature may rise to 38 degrees.
3. Indigestion. Violation of the synthesis of digestive enzymes leads to fermentation of food in the intestines and its rotting. This is accompanied by:
   • decreased appetite
   • nausea
   • rumbling in the stomach
   • increased gas formation
   • diarrhea
4. Bitter belching, vomiting with bile associated with duodenal overflow. Its contents do not pass into the intestines, but are thrown into the stomach - duodenogastric reflux.
5. Jaundice of the skin and sclera with duodenitis it is explained by stagnation of bile and increased levels of bilirubin in the blood. This occurs when the papilla of Vater becomes inflamed and the bile duct narrows. Bile does not exit into the intestines, but overflows the gallbladder and enters the blood.
6. Disorders of the nervous system. Prolonged duodenitis causes atrophy of the mucous membrane and glands that produce digestive enzymes. This negatively affects the absorption of food. The body experiences a nutritional deficiency. To improve digestion, blood flow to the stomach and intestines is increased, while the brain and lower extremities are “robbed.” Dumping syndrome develops, the symptoms of which appear after eating:
   • fullness in the stomach
   • feeling of heat in the upper half of the body
   • dizziness, weakness, drowsiness
   • trembling hands, ringing in the ears.
   • hormonal deficiency develops, which negatively affects the functioning of the autonomic nervous system.
   In older people, duodenitis may be asymptomatic. In this case, the disease is diagnosed accidentally during gastroduodenoscopy.

Diagnosis of duodenitis

Signs of duodenitis:

• areas of narrowing of the duodenum - indicating a tumor, the formation of adhesions, developmental abnormalities
• enlarged areas - consequences of mucosal atrophy, motility disorders, blockage of the underlying sections of the intestine, decreased tone of the intestinal wall due to impaired innervation
• a “niche” in the wall of the duodenum may be a sign of erosion, ulcer, diverticulum
• gas accumulations are a sign of mechanical intestinal obstruction
• with swelling, immobility and inflammation, the folds can be smoothed out
• reflux of food mass from the duodenum into the stomach

Radiography is better tolerated by patients, it is accessible and painless. However, x-rays are not able to detect changes in the mucous membrane, but only indicate gross disturbances in the functioning of the organ.

Laboratory tests for duodenitis:

• a blood test reveals anemia and increased ESR;
• in stool analysis - hidden blood in bleeding erosions and ulcers.

Treatment of duodenitis

Treatment of duodenitis includes several areas:

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

Mostly treatment is carried out at home. For a speedy recovery, proper sleep, rest, diet, walks, and light physical activity in the absence of pain are necessary. It is necessary to avoid stress, quit smoking and alcohol. Such measures help normalize blood circulation in the duodenum and restore the protective properties of its mucosa.

Indications for hospitalization for duodenitis:

• exacerbation of duodenitis
• suspected tumor of the small intestine
• severe general condition of the patient, advanced cases of the disease
• inflammation of the serous covering of the duodenum (periduodenitis) and nearby organs
• presence or threat of bleeding (erosive or ulcerative form of duodenitis)

Treatment of duodenitis with medications

Group of drugs	Mechanism of therapeutic action	Representatives	Mode of application
Proton pump inhibitors	Suppresses the secretion of gastric juice. The drugs block the functioning of the glands that secrete hydrochloric acid and reduce the irritating effect on the duodenal mucosa.	Omeprazole 20 mg Lansoprazole 30 mg Pantoprazole 40 mg Esomeprazole 20 mg	Apply 2 times a day in the morning and evening 20 minutes before meals. Duration of treatment is 7-10 days.
Antibiotics	Prescribed in the presence of an infection caused by the bacterium Helicobacter pylori.	Tetracycline 500 mg	4 times a day, for 7-10 days.
		Clarithromycin 500 mg Amoxicillin 1000 mg Metronidazole 500 mg	2 times a day for 7-14 days. Take regardless of food intake.
H2-histamine blockers	Prescribed for the treatment of ulcer-like duodenitis. They inhibit the secretion of hydrochloric acid and reduce its irritating effect on the duodenum.	Ranitidine	0.15 g 2 times a day. Course 45 days.
		Famotidine	0.02 g 2 times a day in the morning and evening before bed.
Antacids	They have an enveloping and local anesthetic effect. Neutralize hydrochloric acid.	Almagel Maalox	Use as needed: for diet disorders, pain. 1 dose of the drug is taken an hour after meals 1-3 times a day.
Prokinetics	Prescribed for gastritis-like form of duodenitis. Regulate contractions of the gastrointestinal tract, promote gastric emptying and the movement of food masses through the intestines. They have antiemetic and local antiedematous effects.	Itomed Ganaton	1 tablet (150 mg) 3 times a day before meals.
Multienzyme drugs	Contains pancreatic enzymes. Normalize digestion, promote the absorption of nutrients and the disappearance of symptoms of the disease.	Creon 10000	One capsule is taken before meals, the other during or after meals. The capsule is not chewed. The drug is taken with every meal.
Antispasmodics	They relax the smooth muscles of the intestinal wall, relieve spasms and eliminate pain.	No-shpa (Drotaverine) Papaverine	2 tablets 3 times a day, regardless of meals.

Individual therapy is selected for each patient depending on the manifestations of the disease and the form of duodenitis. Self-medication can be dangerous to health.

Nutrition for duodenitis

Proper nutrition plays a key role in the treatment of duodenitis. In case of acute inflammation or exacerbation of chronic duodenitis, for the first 3-5 days you must adhere to a strict diet 1a. Its basis is slimy decoctions of cereals (rice, rolled oats), pureed soups, liquid milk porridges (semolina, buckwheat flour) and baby food products. Chicken or lean fish (pike perch) in the form of puree or steam soufflé are allowed once a day. Meals are fractional: 6 times a day, in small portions.

• ulcerative-like duodenitis - diet No. 1
• gastritis-like duodenitis (with reduced gastric secretion) - diet No. 2
• cholecysto- and pancreatitis-like duodenitis diet – No. 5

General recommendations

• Eat small meals 4-6 times a day. The feeling of hunger should not arise, otherwise “hunger pains” may appear.
• Food is served warm at 40-50°C.
• Dishes should be prepared in such a way as not to irritate the gastrointestinal mucosa. Preference is given to pureed soups with the addition of sour cream or cream and semi-liquid porridges (oatmeal, rice, semolina).
• Boiled lean meat with a minimum amount of connective tissue, removed from skin and tendons. Before use, it is advisable to mince it or grind it in a blender.
• Dairy products: milk, cream, steamed curd soufflé, yogurt, kefir, yogurt.
• Boiled vegetables, fruits without peels and seeds, baked or in the form of jelly. You can use canned baby food.
• Soft-boiled eggs or as a steam omelet. 2-3 per day.
• Fats: highly refined butter, olive and sunflower oil.
• Juices are a source of vitamins and improve digestion.
• Dried bread and crackers. They are better tolerated than fresh baked goods.
• Sweets - honey, jam, mousse, jelly, hard cookies, caramel in limited quantities.

Prohibited for duodenitis foods that stimulate gastric secretion and foods 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

Consequences of duodenitis

• Intestinal obstruction– a condition in which the movement of food through the intestines is partially or completely stopped. It is accompanied by sharp pain in the upper abdomen, 15 minutes after eating, and repeated vomiting mixed with bile. This phenomenon can be caused by the proliferation of connective tissue and the formation of adhesions at the site of the inflammatory process.


• Peptic ulcer of the duodenum. A deep defect forms on the wall of the duodenum - an ulcer. Its appearance is associated with the effect of hydrochloric acid and pepsin on the weakened mucous membrane. It manifests itself as pain in the upper abdomen during long breaks between meals, when drinking alcohol and exercising. Digestion is also disturbed: bloating, alternating diarrhea and constipation.


• Maldigestion/malabsorption syndrome– impaired absorption of nutrients through the intestinal mucosa due to enzyme deficiency. The development of a complex of symptoms is associated with disruption of the glands of the digestive tract. This condition manifests itself in the early stages as diarrhea. Subsequently, exhaustion appears, changes in the composition of the blood - anemia, immunodeficiency - a decrease in the body's resistance to infections. Children have noticeable delays in physical development.


• Intestinal bleeding may be a consequence of erosive duodenitis. It is manifested by weakness, dizziness, drop in blood pressure, blood in the stool (discharge turns black).

Duodenitis is a fairly common disease, but highly treatable. If symptoms appear, consult a doctor and strictly follow his instructions! You should not self-medicate to prevent the disease from becoming chronic.

Duodenitis is an inflammatory disease of the duodenum, in which its mucous membrane is most severely affected.

The duodenum is one of the most important digestive organs. In it, food is processed by the digestive juices of the pancreas, and cavity digestion occurs - a stage that prepares food for absorption. The duodenum also produces some hormones that regulate the functioning of the digestive system and metabolism in the body. Therefore, despite the prevalence of this disease, duodenitis is a very serious problem.

Causes

The reasons for the development of duodenitis are quite varied. Most often it develops in childhood, as a result of weakness of the hormonal apparatus of the duodenum and its incorrect location. One of the reasons for the development is the bacterium Helicobacter Pylori, which is the main cause of gastritis.

The risk of developing duodenitis exists in people of all age groups. There are acute and chronic forms of duodenitis. The acute form of duodenitis can be catarrhal, erosive-ulcerative and phlegmonous.

Chronic duodenitis

Chronic duodenitis can be primary or secondary. Primary chronic duodenitis occurs due to poor diet (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 of acute duodenitis.

A major role in the development of secondary duodenitis is played by duodenostasis - insufficient mobility of the duodenum as a result of obstruction or poor peristalsis.

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

• superficial (the inflammatory process affects only the upper layers of the mucous membrane);
• atrophic (thinning of the mucous membrane of the duodenum with the extinction of its secretory function);
• interstitial (without damage to the glands); erosive-ulcerative (characterized by the appearance of small erosions and ulcers on the mucous membrane);
• hyperplastic (with excessive tissue growth).

Symptoms of chronic duodenitis

• feeling of fullness in the upper abdomen,
• loss of appetite,
• heartburn,
• belching,
• sometimes nausea or vomiting of bile,

During periods of exacerbation - constant pain in the stomach, intensifying during fasting or 1.5-2 hours after eating. Night pain appears.

Some patients complain of headaches, weakness, irritability, shortness of breath and rapid heartbeat, which is associated with impaired hormonal function of the duodenum.

Treatment

Treatment of chronic duodenitis during periods of exacerbation of the disease is carried out in a hospital. Treatment is prescribed depending on the cause of the disease.

• In the presence of giardiasis and helminthiasis, appropriate chemotherapy is prescribed (flagyl, furazolidone, hloxin).
• When a Helicobacter pylori infection is detected, antibiotics are used.
• For increased acidity, drugs that reduce the secretion of hydrochloric acid (omeprazole, ranitidine) and antacids that neutralize the acidity of gastric juice (Almagel, Maalox, phosphalugel).
• To protect the mucous membrane, enveloping drugs (de-nol, sulfacrate) are prescribed. For anti-inflammatory purposes, it is recommended to use decoctions of chamomile and yarrow. Enzyme preparations are prescribed to restore digestion.

If the cause of duodenitis is impaired motility of the duodenum (duodenostasis), for example, obstruction, it is necessary to establish its cause. If it is associated with a violation of any functions of the digestive organs, treatment of duodenitis is conservative. Frequent meals in small portions, drugs that bind bile and promote its secretion (choleretic) are indicated. Duodenal intubation with duodenal lavage is effective.

In the presence of adhesions, mechanical barriers and other types of obstruction that are not amenable to therapeutic treatment, surgical treatment of duodenitis is indicated.

With secondary duodenitis, treatment of the underlying disease is necessary.

Acute duodenitis

Symptoms

• pain in the stomach area,
• nausea,
• vomit,
• weakness.

Acute duodenitis usually occurs against the background of acute inflammation of the stomach and intestines.

Treatment of acute form

Acute catarrhal and erosive-ulcerative duodenitis usually do not require special treatment and, if the correct regimen is followed, disappear within a few days, but in case of repeated manifestations, the disease can become chronic.

The patient is prescribed bed rest and fasting for 1-2 days. Sometimes it is recommended to rinse the stomach with a weak solution of potassium permanganate. After rinsing, to cleanse the intestines, drink 25-30 grams of magnesium sulfate diluted in a glass of water. Starting from the third day, the patient is prescribed therapeutic diet No. 1 (food that irritates the intestinal walls is limited, dishes are prepared pureed, boiled in water or steamed, very cold and hot dishes are excluded). Astringent and enveloping drugs are prescribed, and in case of pain - antispasmodics (No-shpa, drotaverine, papaverine).

For phlegmonous duodenitis, surgical treatment and antibiotic treatment are indicated. Possible complications are intestinal bleeding, perforation of the intestinal wall, acute pancreatitis.

Diet for duodenitis

One of the most important components of proper treatment of duodenitis is a properly formulated diet.

For 10-12 days, you must adhere to the most gentle diet possible. Food should be taken 4-5 times a day in small portions. All foods that irritate the mucous membrane (spicy and fried foods, spices, pickles, fresh bread and bakery products, vegetables) are excluded from the diet. Slimy soups made from oatmeal, rice and semolina, liquid porridges, soft-boiled eggs (no more than 3 per day), steam omelettes, jelly from sweet fruits and berries are allowed.

After 10-12 days, steamed meat and fish cutlets and pureed soups are allowed. If you feel well and with the permission of a doctor, the diet can be expanded, but spicy and irritating foods should be excluded for a long time. Alcohol is strictly contraindicated.
Physiotherapy is also prescribed, and sanatorium treatment is recommended.

Read more about nutrition for duodenitis in our separate article.

Diagnostics

Because The nature of the course of duodenitis is varied and similar to many diseases of the gastrointestinal tract; its diagnosis is based on instrumental research methods:

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

In case of phlegmonous duodenitis, fibrogastroduodenoscopy is contraindicated.