Duodenogastric reflux. Symptoms and treatment. How to treat duodenogastric bile reflux

The abbreviation GHD hides a chronic condition. digestive tract duodeno gastric reflux. It is rarely an independent pathology, being a symptom of other disorders in the gastrointestinal tract, such as gastritis and ulcers. GHD is accompanied by vomiting, abdominal pain, stool instability and other unpleasant symptoms. The diagnosis of pathology is carried out by a therapist and a gastroenterologist. In this article you will learn about gastric dysplasia: what is it?

Duodenogastric reflux is a disorder in which the contents of the duodenum are thrown into the gastric cavity. A similar condition without serious impact on the body is detected in 15% of patients, and they never complain about the gastrointestinal tract or other discomfort.

We are talking about disruption of the functioning of the digestive tract if the level of daily acidity of the stomach contents rises above 5 and there is a clear cyclical nature of such an increase. GHD is considered as a separate disease only in 25-30% of all diagnosed cases.

The symptoms of the pathology intensify after sports activities, as well as at night, when all muscles relax and the gastrointestinal tract straightens. The risk group for DGR includes inactive people who have sedentary jobs and also consume large amounts of food; its quality does not matter in this case.

Attention! The disease does not have a specific gender. Duodenogastric reflux is registered equally in men and women.

Causes of duodenogastric reflux

Several factors can trigger the disease, which should be avoided if possible.

• Unhealthy eating. Particularly dangerous is an addiction to fast foods rich in fats and simple carbohydrates.
• Unbalanced diet, in which the patient consumes large portions of food at one time.
• Long breaks between meals.
• Lack of physical activity or a large amount of it immediately after eating.

• Sleep after eating. At the same time, even simple things are dangerous horizontal position within the first 30 minutes after leaving the table. At this time, it is better to take a leisurely walk or sit.
• Development of chronic, previous operations on the gastrointestinal tract.
• Often, GHD is provoked under the influence of duodenitis and gastroduodenitis.
• Insufficient tone of the food sphincters, which causes intestinal contents to be thrown back into the stomach cavity.
• Diagnosis of a hernia in the diaphragmatic region.
• Use alcoholic drinks, including beer. Chronic alcoholics, as well as those who have previously abused large quantities, are at risk.
• Use of any medicines without medical supervision. Pregnant women are at risk, as they have weakness of the gastrointestinal tract due to pressure on the digestive tract of the growing fetus.
• Smoking. Most often, patients who smoke a cigarette immediately after eating or more than 10-15 per day suffer from GHD.

Attention! If before the diagnosis of duodenogastric reflux the patients had no other chronic diseases Gastrointestinal tract, there is a high probability of their appearance in the future. They develop due to the constant exposure of the stomach walls to pancreatic enzymes, bile and its salts. Most often, patients experience ulcers and reflux gastritis because of this.

Symptoms of duodenogastric reflux

The symptoms of the disease are vague, as they are similar to the signs of other pathologies of the digestive tract. But after diagnostic manipulations, the doctor will be able to make an accurate diagnosis. The characteristic signs of DGR are the following:

• heartburn, it occurs in almost 90% of cases immediately after eating or in the first two hours after that;
• periodic appearance of belching with a large amount of air, after which an acidic taste may remain;
• frequent bloating and flatulence, appearing in the first hour after eating;
• sharp and spasmodic pain in the abdominal area;
• periodically a bitter taste appears in the mouth;
• sometimes patients complain of attacks of nausea, which can turn into vomiting interspersed with bile;
• the language has a large number of yellow plaque.

Depending on which area of ​​the tongue the plaque is located in, one can judge about problems with a specific internal organ.

Attention! Duodenogastric reflux should be suspected if the symptoms described above appear at night and after physical labor. In other cases, the disease can be diagnosed only after it enters the acute stage and requires use. large quantities medicines.

Stages of gastric dysplasia

Experts distinguish three stages of disease development.

Types of duodenogastric reflux

Taking into account damage to the gastric mucosa, four types of duodenogastric reflux are distinguished:

• with superficial DGR, only a small part of the mucosa is damaged, glandular epithelium not touched by alkali;
• with catarrhal GHD, an inflammatory process of the mucous membrane with severe swelling and redness is noted;
• with erosive GHD, atrophy of a small or large area of ​​the stomach lining is noted;
• with biliary GHD, not only is there severe inflammation of the mucous walls of the stomach, but there is also a disruption in the flow of bile into the duodenum.

Attention! The exact type of duodenogastric reflux can be determined only after passing instrumental methods examinations. This is impossible to do with a regular survey.

Diagnosis of duodenogastric reflux

In addition to in-person examination of the patient and collecting anamnesis after the interview, the doctor may refer the patient for a functional examination.

Tables 1. Types of functionalsurveys

Survey	His character
Abdominal ultrasound	It is necessary to determine the degree of functioning of the gastrointestinal tract, pancreas and gall bladder.
Esophagogastroduodenoscopy	It is carried out using an endoscope. Provides an opportunity to confirm the diagnosis, as well as obtain materials for cystological and histological studies. This is required to identify the degree of inflammation and possible cancer.
Chemical analysis of digestive juice	Necessary to confirm the presence of pancreatic enzymes and bile acids in the stomach.
Daily measurement of gastric alkalinity level	Makes it possible to determine the cyclicity of DGR and its causes.
X-ray with contrast	Reveals the degree of damage to the mucosal walls.

Treatment methods for GHD

Diet for gastric dysplasia

The success of therapy depends on how well the patient adheres to the rules of nutrition for duodenogastric reflux. You need to eat often and in small portions; ideally, the size of one serving should be slightly larger than your palm. You should completely avoid spicy, salty, fatty and smoked foods. The same rule applies to alcoholic beverages and cigarettes.

Foods that are harmful to patients suffering from GHD include garlic seasoning, tomatoes, green onions, sweet desserts, rich pastries and bread, strong coffee and tea, citrus fruits. They negatively affect the sphincter connecting the stomach and 12 duodenum. It becomes weak, causing intestinal contents to leak into the stomach.

Useful mineral water, rich in magnesium. It is enough to drink 100-200 ml of this water daily, including after the exacerbation stage has passed. Be sure to include bran in your diet; they are added to soups, salads, and eaten with yogurt.

Fish and meat are healthy high content fat They can be baked and made into soups. It is required to include curd products, kefir, low-fat milk and sour cream in the menu. You should not eat sour berries and fruits; sour juices or those with a high sugar content are also harmful. Packaged juice products are completely excluded.

Traditional therapy for gastric dysplasia

Medicines are used to relieve irritation from the gastric mucosa and direct the gastrointestinal tract in the right direction, that is, to strengthen the sphincter tone and prevent intestinal contents from being thrown into the gastric cavity.

The drug allows you to get rid of heartburn, a feeling of fullness in the stomach, flatulence and bloating. For treatment, you need to take 10-20 mg up to four times a day. The tablets are taken 20 minutes before meals.

The duration of treatment depends on the patient's condition. Motilium should not be taken if you have severe or moderate liver damage.

A drug for complex effects, prescribed in the form of chewable tablets. It can relieve pain, irritation of the mucous membranes, heartburn, and improve bowel movements. Take Passazhik no later than 10 minutes before meals.

A single dose cannot exceed 20 mg; 80 mg of the active substance can be taken per day. The duration of treatment is determined taking into account the patient's medical history.

The tablets are aimed at restoring the natural acidity of the stomach and eliminating the consequences of poor diet and consumption of alcoholic beverages. Protects mucous membranes from erosive lesions. The tablets must be chewed thoroughly in the mouth and washed down with plenty of water.

Single dose – no more than two tablets 30 minutes before meals. You can take 6 doses of Gastrofarm per day.

The drug restores normal stomach acidity, relieves heartburn and relieves pain syndrome. Omeprazole is taken daily at a dose of 40-80 mg, it is recommended to do this in morning time on empty stomach.

The duration of treatment is 21 days. Omez and Omitox are taken according to the same scheme.

Almagel

An enveloping medication that protects the mucous membrane from further erosive destruction. The product comes with a spoon for dosing the active substance. Adult patients need to take 1-3 parts of Almagel no more than four times in 24 hours.

You can drink a maximum of 16 doses per day. At maximum dosage therapy lasts no more than 14 days; in other cases, its duration is determined by the doctor.

The complex drug allows you to get rid of heartburn and abdominal pain. Gastal normalizes the microflora of the stomach and relieves acute symptoms. You need to take the medication 1-2 tablets 45-60 minutes after eating.

Three doses of Gastal are taken per day. Treatment is continued for no more than 14 days.

The tablets relieve pain, most often caused by spasm of smooth muscles. Taking into account the degree of pain, the patient can take 1-2 Spazmalgon tablets.

You should not take more than 6 doses of the drug per day. Since the medication is quite strong, you should not drink it for more than five days.

The drug improves the functioning of the pancreas and also protects the stomach from negative impact organ enzymes.

A single dose of Somilase is no more than two tablets, taken 45-60 minutes after a meal. The duration of therapy is selected separately for each patient.

This drug prevents harmful bile acids from destroying the epithelium of the stomach, healing erosions and relieving pain.

For duodenogastric reflux, you need to take 300 mg of Choludexan an hour before going to bed. The minimum duration of therapy is 10 days, the maximum is six months.

No-Shpa

This is an anesthetic drug that helps with any type of pain, not just spasms. It is recommended to take No-Shpu in a single dose of 40-80 mg of the drug, but not more than 0.24 g per day.

For best effectiveness, administration should be rescheduled for a time after a meal or an hour before it. Duration of treatment is 1-7 days.

Home treatment for duodenogastric reflux

Home treatment can be used as an aid. Also, non-traditional recipes allow you to carry out therapy after using traditional drugs in order to consolidate the results.

To prepare the medicine, you should mix herbs such as St. John's wort, chamomile, and yarrow in equal amounts. It is recommended to grind them first in order to get more when steaming. useful substances. Pour 250 ml of boiling water over a teaspoon of raw material and wait 15 minutes. As soon as the infusion has reached a pleasant drinking temperature, it should be drunk.

Drink herbal tea morning and evening for two weeks. It eliminates heartburn, prevents the development of dysbiosis, and relieves abdominal pain.

Flax seeds

To prepare, take one tablespoon of seeds and add 100 ml of cold water. Flax should be kept in liquid until it releases mucus. It is necessary to eat the seeds without straining, a tablespoon every morning before breakfast.

The course of treatment is 7 days. Flax mucus envelops the walls of the stomach, protecting against the harmful effects of alkali thrown from the intestines.

For GHD treatment you need to take two tablespoons of the smoky infusion and combine it with 0.5 liters of boiling water. The product must be infused for six hours. Store the solution in the refrigerator. Treatment involves taking 50 ml of infusion every two hours. The course of treatment is no more than three days. Used to prevent vomiting with bile impurities. As soon as nausea and vomiting go away, treatment is stopped.

Using the same scheme, you can take marshmallow rhizomes. An infusion of fume and the second ingredient can be bought at any pharmacy.

It is used in fresh immediately after eating. To avoid heartburn, abdominal pain, vomiting, diarrhea and other unpleasant symptoms, it is recommended to slowly chew 1-2 leaves 10 minutes after eating.

Treatment can be continued for two weeks.

Sage and calamus rhizomes

To prepare the medicine, mix 50 g of chopped sage and calamus rhizomes. To enhance their effect, you can also add 25 g of angelica root to the mixture. After thoroughly mixing the ingredients, pour one teaspoon of the substance into 250 ml of boiling water. The product should be infused for an hour.

Take 30 minutes after meals, 50-100 ml three times a day. The duration of therapy is 10 days.

Prevention of gastric dysplasia

To reduce the risk of relapse in the future after an exacerbation of duodenogastric reflux and to prevent its occurrence in healthy people, the following recommendations must be followed:

• eat small portions every 3-4 hours;
• give preference healthy food, with a minimum amount of fast food, fatty and fried foods;
• avoid physical activity for the first 1-2 hours after eating;
• prevent exacerbation of chronic gastrointestinal diseases, especially ulcers and gastritis;
• try not to eat before going to bed;
• support optimal weight body and engage in feasible sports activities;
• give up fresh bread, it is better to eat a product made 1-2 days ago, bread or crackers.

Attention! All described preventive methods mandatory for people with chronic gastrointestinal pathologies. This will avoid complications and reduce the risk of duodenogastric reflux in the future.

GHD of the stomach requires the patient to constantly follow a diet. If exacerbation cannot be avoided, symptomatic therapy is mandatory, including several drugs. Treatment requires constant medical supervision and strict adherence to the prescribed regimen, which is developed individually for each patient.

Video - Duodenogastric reflux of the stomach

Characteristic symptoms are diffuse pain and dyspeptic disorders in the form of heartburn, belching, nausea with vomiting, and the formation of a yellow coating on the tongue. For diagnosis, EGDS, electrogastroenterography, and 24-hour intragastric pH-metry are used. Treatment is complex with the use of prokinetics, acid-lowering agents, and antacids.

Description of the pathology

Duodeno-gastric gastric reflux means painful condition an organ in which the intestinal alkaline environment is thrown into the stomach containing digestive juice with hydrochloric acid. As a result, a conflict between different environments develops, against which unpleasant symptoms arise. The clinical picture is usually blurred and intensifies with active physical activity or at night when all muscle structures in the body are relaxed and the gastrointestinal tract is straightened.

Gastro-duodenal reflux through the pyloric zone of the stomach worries every 9th adult. At high risk are office workers whose lives are inactive, and people who consume large portions of food at one time. Duodeno-reflux aggravates the addiction to fast foods and quick snacks. If gastro-duodenal reflux occurs constantly, inflammation of the mucous membrane on the walls of the stomach develops.

Reasons for appearance

There are external and internal factors influencing the development of duodeno-gastric reflux into the stomach:

1. Exogenous causes:
   • poor nutrition – addiction to fast foods, unhealthy, fatty foods;
   • quick snacks, one-time consumption of large portions of food;
   • a sedentary lifestyle or, conversely, intense work immediately after eating;
   • sleep immediately after a meal.
2. Endogenous causes:
   • gastrointestinal pathologies - chronic ulcer, duodenitis, gastritis or gastroduodenitis;
   • muscle weakness of the sphincters;
   • diaphragmatic hernia.
3. Other provoking factors:
   • frequent alcohol abuse;
   • uncontrolled use of medications, especially during pregnancy;
   • frequent smoking, particularly immediately after meals.

Degrees and varieties

There are 3 degrees of development of duodenogastric reflux:

• I degree - minor violations, when only a small amount of duodenal contents is thrown into the stomach and causes irritation. This degree is typical for 49% of patients.
• II degree, when a large portion of an alkaline environment from the intestines is thrown into the stomach, causing inflammation and the development of other pathologies. This degree develops in 10% of patients.
• III degree, when the gastric mucosa suffers significantly due to alkalization of intestinal contents. A vivid clinical picture develops with vomiting, heaviness in the stomach, and bad breath, which often resemble the stage of exacerbation of gastroduodenitis. This degree occurs in 1 patient out of 10. Symptoms often develop that are identical to gastritis, when diarrhea, flatulence, decreased appetite, and increased belching are observed.

According to the nature of destruction, there are 4 types of duodenogastric reflux:

1. Superficial, when destruction concerns only the cells of the mucous layer, and the integrity of the glandular exocrine epithelium is preserved.
2. Catarrhal, when inflammation, swelling and redness of the mucous membrane joins the process.
3. Erosive, when a focal form of atrophy is observed.
4. Biliary, when inflammation of the mucous membrane is accompanied by a disruption in the supply of bile from the gallbladder to the duodenum.

Symptoms of duodeno-gastro reflux

A feature of the clinical picture of duodenogastric reflux of the stomach is its similarity with other gastrointestinal pathologies. The characteristic signs of DGR are:

• severe, sharp pain in the epigastrium caused by the processes of digestion of food;
• chronic severe heartburn;
• pronounced flatulence;
• belching with a bitter taste, provoked by the reflux of bile from the duodenum into the stomach and esophagus;
• a dense mass of yellow coating on the tongue;
• bad odor from the mouth due to the predominance of carbohydrate foods in the diet.

Indirect signs of gastroduodenal reflux are:

• brittle nails and dry hair;
• unhealthy skin tone;
• presence of swelling and hyperemia in the corners of the lips.

Diagnostics

Duodeno-gastric reflux is discovered accidentally - during fibrigastroduodenoscopy for the diagnosis of another pathology. It is possible to determine the presence of GDR in the stomach through a comprehensive examination of a person. For these purposes the following is carried out:

1. Visual examination of the patient, assessment of the collected anamnesis.
2. Ultrasound of the abdominal area. The method allows you to determine the nature and source of dysfunction of the stomach, duodenum, pancreas, and gall bladder.
3. Esophagogastroduodenoscopy. An endoscopic examination allows you to obtain accurate information about reflux, identify its cyclicity, check the cytology and histology of the affected mucosa, the type of its damage (to differentiate malignancy from benignity).
4. Chemical analysis of digestive juices. It is carried out to detect even minimal concentrations of pancreatic enzymes and bile acids in gastric juice by titration.
5. Daily measurement of gastric pH, subject to familiar image. This is necessary to determine the exact cause and timing of reflux.

Additional techniques are:

• radiography;
• acoustic contrast of the stomach.

Treatment

The therapeutic regimen for DRG is comprehensive and complex, aimed at eliminating the cause of the development of the pathology using medicinal, physiotherapeutic approaches and the basics of proper nutrition. As an auxiliary measure it is prescribed traditional treatment. The goal of complex physiotherapy is to restore the elasticity of the anterior abdominal muscles through special physical training and the use of electromyostimulation procedures.

Drugs

Basics of drug treatment:

• relieving irritation from the gastric mucosa resulting from the effects of pancreatic juice;
• restoration of intestinal peristaltic ability in one direction.

The following medications are used for this:

1. Prokinetics, such as Motilium, Passazhiks, which are necessary to correct the conditions for the gradual movement of food in the right direction, ensuring the tone of the circular sphincter of the gastrointestinal tract.
2. Tablet form and suspension "Ovenson", "Choludexan" - for eliminating harmful influence bile acids on the stomach.
3. "Omeprazole" - to correct the level of acid in gastric juice, creating a barrier against the active effects of bile acids in the main digestive organ.
4. "Almagel", "Pylorid" - for treatment erosive form reflux.

Traditional treatment

In combination with drug therapy, folk remedies give high positive result. For the treatment of gastro-disorders caused by reflux, the following recipes are recommended:

• Infusion herbal collection, consisting of equal quantities of St. John's wort, chamomile, yarrow, taken without reference to proportion and poured with boiling water. This tea should be drunk twice a day to relieve heartburn, alleviate the symptoms of gastritis and GHD, and eliminate dysbiosis.
• Slime infusion of flax seeds. Prepared in proportion - 1 tbsp. l. in 100 ml of cool water and infuse until mucus is released. Used on an empty stomach.
• Infusion of 2 tbsp. l. fumes/marshmallow rhizomes in 500 ml of boiling water (infused for an hour/5.5 hours, respectively). Take 50 ml every 2 hours. These medications help prevent bilious vomiting.
• Rue leaves for chewing after meals, 1–2 pcs. help improve intestinal motility.
• A mixture of sage and calamus root (50 g each), angelica rhizome (25 g) in the amount of 1 tsp. pour 200 ml of boiling water. Take 1 hour after meals three times a day.

Diet

The success of treatment depends on proper nutrition and regimen. The principles are as follows:

• food – frequent, but in small portions;
• refusal of hard, unhealthy, spicy foods;
• avoiding alcohol and smoking;
• refusal of foods that reduce the tone of the pyloric sphincter, such as garlic, tomatoes, onions, sweets, fresh baked goods, coffee, citrus fruits;
• exclusion from the menu of cabbage and apples, which provoke an increase in acidity in the stomach;
• enriching the menu with magnesium-containing mineral water;
• inclusion of bran in the diet.

If GHD is accompanied by complications, the principles of slightly different diet therapy are applied:

• low-fat fish and meat varieties are allowed;
• cottage cheese, yogurt, milk, non-acidic sour cream are included in the diet;
• Sour berries and fruits and juices from them are prohibited;
• pureed porridges and pureed soups are consumed.

Any food should be steamed, baked in the oven or boiled in water. Dishes should be at room temperature.

Prevention

To prevent the development of GHD in the stomach? It is recommended to constantly eat right, monitor your health and lifestyle. For this it is important:

Forecast

The outcome of treatment with timely detection of GHD is favorable. To prevent relapse, it is important to follow your doctor’s recommendations and preventive measures.

What is reflux gastroduodenitis?

When is gastroduodenitis reflux diagnosed? The gastrointestinal tract consists of separate sections through which food moves. In them it is digested and absorbed, and waste products are then eliminated from the body naturally. When this process is disrupted and food backflows, reflux occurs. If food from the stomach flows back into the esophagus, a diagnosis of reflux gastritis or gastroesophageal reflux disease (GERD) is made; if the contents of the duodenum flow back into the stomach, reflux gastroduodenitis occurs.

Clinical picture of duodeno-gastric reflux

Until recently, reflux gastroduodenitis was perceived by official medicine only as a symptom accompanying other diseases. gastrointestinal tract. And only in 30% of patients does it occur independently, without showing any clinical signs. In such cases, pathology does not have any effect negative influence on the gastrointestinal tract. Therefore, few people know what gastroduodenitis DGR (duodeno-gastric reflux) is; its symptoms are similar to those of other pathological conditions that occur in the stomach or duodenum. Here are the most common ones:

• Cramping pain that appears an hour after eating.
• Constant feeling of fullness in the stomach, bloating after eating.
• Heartburn.
• Sour belching.
• Bitter taste in the mouth, reminiscent of the taste of metal.
• Yellow coating on the tongue.

Gastritis and duodenitis have similar signs. Only fibrogastroduodenoscopy helps to detect gastroduodenitis reflux. If the described phenomenon occurs on its own, its treatment comes down to following a strict, gentle diet. It is built on the basis of several rules, which are worth discussing separately.

Treatment of reflux gastroduodenitis

There are diseases that are easy to treat. One of them is gastroduodenitis reflux, its treatment is a long process. The patient will need to change his lifestyle, learn to eat right, eat five or six times a day in small portions, completely give up alcohol, and forget about gastronomic excesses.

The menu for DGR and GERD will have to include only easily digestible dishes. The main volume of food should be divided into three parts; it is important to organize snacks between them. They will prevent starvation - the main provocateur. For snacks, it is better to choose foods that help eliminate bile. These are crackers, rye crackers, bran and oatmeal livers.

If a patient has gastroduodenitis of the DGR, all food must be thoroughly chewed during meals and ensure that the food on the table is warm.

• You should not take a horizontal position for an hour after the main meal.
• You cannot exercise or perform heavy physical activity for an hour after lunch and dinner.
• You should not wear clothes for a long time that can create high intrauterine pressure (clothes with wide, tight belts).
• It is necessary to lead an active lifestyle, walk more in the fresh air.
• Fans of alcohol and smoking will need to forget about their bad habits in the chronic form of the disease.

What can you eat if you have reflux gastroduodenitis?

When choosing products, you need to understand that gastroduodenitis, duodenogastric reflux is a pathology that combines two diseases: gastritis and duodenitis. Therefore, when following a diet, you need to take into account the characteristics of the two ailments and look for the points that unite them.

So, for example, in both places you can eat only lean varieties of meat and fish; they need to be steamed. Fermented milk products and sour juices are prohibited. Dairy products allowed: milk, skim cheese and curdled milk. You can create a menu by studying the “Table No. 1” and “Table No. 2” diets, and coordinate all unclear points with a gastroenterologist.

It is important to understand that diet will not help if the causes of the disease have not been eliminated. Almost all symptoms will return immediately after it ends. This is why it is so important not to self-medicate. You should always remember that the first mild stages of pathology, such as superficial reflux-gastroduodenitis, are easy to treat. If you do not take any steps towards recovery, the superficial form of the disease quickly develops into a chronic form, which is characterized by a protracted course.

Dealing with them will be much more difficult. You will have to call for drug therapy to help. It is complex in nature. The doctor will advise you to take prokinetics, antacids, histamine receptor blockers. Physiotherapy and traditional medicine help well. But they must be paired with medications.

Duodeno gastric reflux: what is it, symptoms, treatment

Duodenogastric reflux (DGR) is a disorder digestive system, which is accompanied by the entry of the contents of the small intestine into the stomach. As a rule, the disease indicates a pathological condition of one or more organs of the digestive system, but it is also diagnosed as an independent disease.

The spellings found: duodeno-gastric, duodenal-gastric or gastric reflux are not correct.

DGR - what is it?

The disease occurs independently quite rarely - in 30% of cases. As a rule, DGR is accompanying symptom gastrointestinal pathologies: chronic gastritis, ulcerative lesions of the stomach and duodenum (DPC), gastroduodenitis, duodenitis.

Pathology can also develop as a result surgical intervention- after excision of the gallbladder, suturing of perforated ulcers of the stomach or duodenum.

Signs of duodenogastric reflux disease are also observed in healthy people. In 15% of the population, food from the upper intestines can return to the stomach, which does not always mean an abnormal condition of the gastrointestinal tract.

Most often, reflux occurs at night and during physical exertion, without causing an increase in the acidity level of the gastric environment and without causing discomfort.

However, prolonged occurrence of gastroduodenal reflux is dangerous for the condition of the digestive system. Active enzymes contained in bile aggressively act on the walls of the stomach, injuring the protective lining. Over time, something like this chemical exposure leads to reflux gastritis - “corrosion” of the protective layer and inflammation of the walls of internal organs.

In addition, pressure in the stomach increases, and intestinal contents can be pushed even further. Unlike conventional GHD (1st degree), when food does not rise above the stomach, GHD of 2nd degree is characterized by the reflux of duodenal contents into the esophagus (duodeno-gastro-esophageal) or into oral cavity(duodeno-gastro-esophago-oral reflux).

Why does the disease occur and how does it progress? Among the leading causes of pathology are:

• gastroduodenal stenosis - low patency of the pyloric part of the stomach, narrowing of the outlet leading to the duodenum;
• increased pressure in the upper region of the small intestine;
• disorder of motor activity of the stomach and duodenum;
• chronic inflammatory processes occurring in the gastrointestinal tract (gastritis, stomach ulcers, cancer), as well as long-term exposure to unfavorable factors on the mucous membrane (smoking, alcohol abuse, prolonged use of medications);
• poor nutrition;
• consequences of surgery;
• Pregnancy can contribute to weakening of the esophageal muscles.

Often, several factors influence the development of pathology.

What are the signs of duodenogastric reflux?

It is not easy to identify clear symptoms of the disease, since they are similar to the manifestations of other pathologies in the functioning of the digestive system. Sometimes a person does not feel any discomfort, and the disease is diagnosed randomly when complaining of other problems.

Signals indicating retrograde reflux of duodenal contents into the stomach are:

• cramping pain in the upper abdomen following meals;
• feeling of bloating, fullness of the stomach, increased gas formation;
• heartburn and regurgitation with a sour taste;
• belching air;
• bitterness in the mouth;
• nausea, vomiting (food debris with bile);
• thick yellow coating on the tongue.

The danger of GHD is that, while asymptomatic, it can provoke complications: gastroesophageal form, reflux gastritis, intestinal metaplasia of the stomach or esophagus, and the growth of cancerous tumors.

The respiratory system is also negatively affected: as a result of DGR, some patients develop asthma, bronchitis, and lung damage.

All these serious changes are associated with the aggressive effect of intestinal enzymes and bile on the mucous membrane of the stomach and esophagus, which are subject to chemical burns.

Diagnosis of the disease

Determine DGR by external signs and patient complaints are not always possible. To exclude similar disorders in the gastrointestinal tract, it is necessary to undergo an esophagogastroduodenoscopy (EGD) procedure - examination of the stomach and small intestine with a probe with a special camera. This study helps to establish the condition of the mucous membrane, but it itself can provoke GHD.

The most accurate diagnostic method for verifying pathology is daily pH-metry of the gastric environment. Fluctuations in the acidity of gastric juice during the night are carefully analyzed, since they are not associated with meals and physical activity.

The diagnosis of GHD is made if the gastric pH rises above 3. And when examining the gastric juice, bile impurities should be detected in it.

Electrogastroenterography and antroduodenal manometry provide information about the motor function of the stomach and duodenum.

Treatment of duodenal gastric reflux

First of all, it is necessary to eliminate accompanying illnesses, resulting in DGR: gastritis, gastroduodenitis, ulcers, duodenitis.

Normalization of the functioning of the gastrointestinal tract is possible only with an integrated approach: the use of medications, lifestyle changes, and giving up bad habits.

Drug therapy

How to treat gastroduodenal reflux depends on the cause of its occurrence. Commonly prescribed drugs include:

• medications that normalize peristalsis of the upper gastrointestinal tract (Trimedat);
• prokinetics, stimulants motor activity stomach and duodenum and promote better movement of food through the digestive tract (Cerual);
• drugs that neutralize the effect of bile in the stomach (Rabeprazole, Nexium, Omez);
• drugs that reduce the acidity of gastric juice, as well as relieve unpleasant symptoms, such as heartburn (Almagel, Maalox).

Duodeno-gastric reflux will have to be treated with both pills and diet:

• it is important to follow a diet - you should eat at the same time 4-6 times a day, if possible, reduce portions so as not to get used to overeating;
• food must be steamed or boiled; Baking in the oven is allowed. Fried foods should be completely excluded from your diet;
• optimal temperature for prepared food degrees. Too hot or too cold can harm your mucous membranes;
• It is better to eat crushed food or chew it well;
• After eating you can’t lie down, it’s better to take a half-hour to an hour walking while avoiding heavy loads;
• you need to avoid foods that irritate the mucous membrane - salty, spicy, sour, pickled foods, smoked and canned foods, yeast bread, citrus fruits, tomatoes, onions and garlic, soda, coffee;
• the diet should be dominated by pureed soups and cereals, lean meat and fish, as well as low-fat milk; The use of bran, fresh vegetables (except cabbage, cucumbers, green beans) and fruits (not sour) helps the movement of duodenal contents through the intestines.

Giving up bad habits - alcohol, smoking - will be an effective step on the path to recovery.

You should also stop taking medications unsystematically (especially choleretic and non-steroidal anti-inflammatory drugs - aspirin, ibuprofen, diclofenac) or consult a doctor about replacing them.

Folk recipes

Traditional medicine can provide additional assistance in the treatment of GDR:

Herbal tea: St. John's wort, chamomile, yarrow. Proportions are chosen according to taste. Take twice daily. This infusion also helps with inflammatory processes in the digestive tract.

Soaked flax seeds. Pour flax seed with water at room temperature (half a glass of water for 1 tablespoon). Take on an empty stomach after the flax releases mucus, which protects the walls of the internal organs.

Smoke leaves help against vomiting (2 tablespoons per half liter of boiling water). Leave for an hour. Take 50 ml every two hours.

Rue leaves, which can be chewed or added to tea, help restore motor function of the gastrointestinal tract.

Please note that folk remedies are not the basis of treatment! First of all, you need to visit a gastroenterologist or therapist!

Prevention of duodenogastric reflux

Poor nutrition and its consequence, obesity, provoke the development of GHD. Therefore, keeping your body in good shape and paying attention to the food you eat are the main preventive measures in maintaining your health.

In addition, you should promptly apply for professional help in case of unpleasant symptoms, treat diagnosed diseases of the digestive system, listen to the advice of doctors, following their recommendations.

Duodeno-gastric reflux

Duodeno-gastric reflux is the reflux of the contents of the duodenum into the stomach cavity. As an independent disease, it is rare; much more often it is a symptom of another gastrointestinal pathology. It manifests itself as pain and dyspeptic syndromes: with duodenogastric reflux, vague diffuse abdominal pain, heartburn, belching, nausea, vomiting, and a yellowish coating on the tongue occur. Diagnosis is not difficult: EGDS, electrogastroenterography, and 24-hour intragastric pH-metry are used for this. The treatment complex includes prokinetics, drugs to reduce stomach acidity, and antacids.

Duodeno-gastric reflux

Duodeno-gastric reflux is a condition that is not always a sign of pathology of the digestive tract - the reflux of duodenal contents into the stomach is detected in approximately 15% of the healthy population, mainly at night. Duodeno-gastric reflux is considered pathological if, during daily intragastric pH-metry, there is an increase in the acidity of gastric juice above 5, not associated with food intake and persisting more than 10% of the time. Duodeno-gastric reflux accompanies many diseases of the initial parts of the digestive tract, but in approximately 30% of patients it can be considered an isolated pathology. This condition accompanies functional and organic diseases of the gastrointestinal tract, and also quite often develops in postoperative period cholecystectomy, suturing duodenal ulcer. Some authors note that duodenogastric reflux occurs in all chronic diseases of the stomach and duodenum. Men and women suffer from duodenogastric reflux to the same extent.

Causes of duodeno-gastric reflux

Several factors are important in the development of duodenogastric reflux: insufficiency of the pyloric part of the stomach with gaping of the pylorus, impaired motility of the stomach and duodenum, increased pressure in the initial parts small intestine, aggressive effect of duodenal contents on the gastric mucosa. Bile acids and pancreatic enzymes damage the protective barrier of the gastric mucosa; provoke reverse diffusion of hydrogen ions into the deep layers of the stomach wall (this leads to increased acidity); stimulate the production of gastrin by the antral glands and damage the lipid membranes of cells, increasing their sensitivity to the components of gastric juice. In addition, due to the retrograde reflux of duodenal contents, the pressure in the stomach cavity increases, which can lead to the occurrence of gastroesophageal reflux.

Duodeno-gastric reflux often accompanies diseases such as chronic gastritis, peptic ulcer stomach and duodenum, stomach cancer, impaired sphincter of Oddi tone, duodenostasis. Often, duodenogastric reflux occurs in patients who have undergone surgery to remove the gallbladder or suturing a duodenal ulcer. Impaired motility of the stomach and initial parts of the small intestine is the root cause of duodeno-gastric reflux in functional diseases of the gastrointestinal tract, and in organic pathology, impaired motility is secondary.

Discoordination of motility leads to impaired evacuation of the contents of the stomach and duodenum, which leads to gastro- and duodenostasis, reverse peristalsis, and reflux of duodenal masses into the stomach cavity. Dysmotor disorders can be observed in various parts of the digestive tract, combined with pylorus pathology: normal gastric tone, accompanied by pylorospasm and duodenostasis, or gastric hypotension in combination with pylorus gaping, duodenal hypertension.

Previously, it was believed that duodenogastric reflux is a protective reaction to the inflammatory process in the stomach and the increased acidity of gastric juice entering the duodenum: supposedly, duodenal juice, when it enters the stomach, alkalizes its contents, which prevents further damage to the duodenal mucosa. However, today it has been proven that bile acids contained in duodenal juice, as mentioned above, not only damage the mucous barrier of the stomach, but also provoke reverse diffusion of hydrogen ions into the submucosal layer and stimulate the secretion of gastrin by the antral glands, which ultimately leads to further greater increase in acidity in the stomach. Thus, the ulcerogenic effect of duodeno-gastric reflux was substantiated and the theory of its protective nature was refuted.

Symptoms of duodeno-gastric reflux

Symptoms of duodenogastric reflux are nonspecific and are characteristic of many diseases of the gastrointestinal tract. First of all, these are diffuse, vague pains in the upper abdomen, most often spasmodic, occurring some time after eating. Patients complain of increased flatulence, heartburn (with any acidity of the stomach), regurgitation of acid and food, belching of air, vomiting with bile. Mandatory for duodeno-gastric reflux is a feeling of bitterness in the mouth, a yellowish coating on the tongue.

Long-term duodenogastric reflux can cause serious changes in the stomach and esophagus. Initially, an increase in pressure in the stomach cavity leads to the development of gastroesophageal reflux disease. Subsequently, bile acids and pancreatic enzymes cause specific changes in the esophageal mucosa, intestinal metaplasia, which can lead to the development of adenocarcinoma - one of the most malignant tumors esophagus.

The most likely outcome of duodeno-gastric reflux if not timely diagnosis and lack of rational treatment - toxic-chemical gastritis type C. To the occurrence of this disease predisposes to constant reflux of bile into the stomach and chemical damage to the mucous barrier.

Diagnosis of duodeno-gastric reflux

It can be difficult to make a diagnosis of duodenogastric reflux during a consultation with a gastroenterologist, since this disease does not have specific symptoms. Quite often, duodeno-gastric reflux is discovered by chance, during examinations for other diseases of the digestive tract.

To verify the diagnosis, a consultation with an endoscopist is required: only he will be able to determine the required scope of examination, conduct differential diagnosis with other pathology of the stomach and duodenum (gastritis with high acidity, erosive gastritis, duodenitis, gastric ulcer). It should be remembered that esophagogastroduodenoscopy itself can cause duodeno-gastric reflux. Distinctive feature induced by endoscopy and pathological reflux will be the presence of bile in the stomach in the second case.

The most reliable method for diagnosing duodenogastric reflux is round-the-clock intragastric pH-metry. During the study, all fluctuations in the acidity of gastric juice are recorded, especially those not related to meals. To obtain more accurate results, the study of fluctuations in the pH of gastric juice is carried out over a night period of time, when the patient does not eat or experience physical activity.

Electrogastrography and antroduodenal manometry will help confirm the diagnosis - when conducting these studies, discoordination of gastric and duodenal motility, hypotension of the initial parts of the digestive tract can be detected. Gastric juice is also examined to identify pancreatic digestive enzymes and bile acids. Exclude other diseases of the digestive system that have symptoms similar to duodenogastric reflux ( acute cholecystitis, pancreatitis, cholangitis, cholelithiasis etc.), an ultrasound of the abdominal organs will help.

Treatment of duodeno-gastric reflux

Typically, patients with duodenogastric reflux do not require hospitalization, however, to conduct a full examination, a short stay of the patient in the gastroenterology department may be necessary. To date, clear clinical guidelines for the treatment of duodeno-gastric reflux. They include the prescription of drugs that normalize the motility of the initial parts of the digestive tract, modern selective prokinetics (increase the peristalsis of the stomach and duodenum, improving the evacuation of their contents), bile acid inhibitors, proton pump blockers and antacids.

However, drug treatment of duodenogastric reflux alone is not enough; the patient must be warned about the need for a radical change in lifestyle. You should stop smoking, drinking alcohol and coffee. Uncontrolled use of medications is also a predisposing factor in the development of duodenogastric reflux, so the patient must be warned against unauthorized use of NSAIDs, choleretic drugs and other medicines.

Malnutrition and the resulting obesity are of great importance in the development of duodenogastric reflux. To achieve the desired therapeutic effect, body weight should be normalized and obesity should be prevented in the future. You need to give up spicy, fried and extractive foods. IN acute period The disease requires a special diet: food should be consumed in small portions, at least 4-5 times a day. After each meal, you should maintain an upright position for at least an hour and avoid heavy physical activity. Diet preference low-fat varieties meat, cereals, dairy products, vegetables and sweet fruits.

The prognosis with timely diagnosis and careful adherence to all recommendations of the gastroenterologist is favorable. Prevention of duodeno-gastric reflux consists of following a proper diet that ensures normal motility of the gastrointestinal tract. Avoiding alcohol and cigarettes is of great importance in preventing this disease.

With duodenogastric reflux, the contents of the duodenum are thrown into the gastric space.

This diagnosis is independent only in 30% of all cases. In some patients, the disease occurs in outbreaks - it occurs suddenly during sleep or as a result of excessive physical exertion. At the same time, there are no visible symptoms, and the condition does not have a negative effect on the digestive system.

Therefore, in such cases, GHD is not regarded as a disease.

What it is?

Duodeno-gastric reflux is a condition that is not always a sign of pathology of the digestive tract - the reflux of duodenal contents into the stomach is detected in approximately 15% of the healthy population, mainly at night.

The disease is considered pathological if, during daily intragastric pH-metry, there is an increase in the acidity of gastric juice above 5, not associated with food intake and persisting more than 10% of the time. This disease accompanies many ailments of the initial parts of the digestive tract, but in approximately 30% of patients it can be considered an isolated pathology.

Reasons for development

The causes of duodenogastric reflux can be divided into external and internal. By external we mean factors that directly depend on a person’s behavior and living conditions. For example, statistically, GHD is more common in people with:

• physical inactivity;
• poor nutrition;
• smoking;
• alcoholism;
• taking medications during pregnancy;
• other factors that contribute to tissue damage, despite the gastric mucous barrier protecting them.

The symptom is also found in the clinical picture of the following pathologies:

• decreased tone of the muscles of the gastric openings;
• hiatal hernia;
• increased duodenal pressure;
• cholecystitis;
• pancreatitis;
• Botkin's disease.

Sometimes the release of the contents of the small intestine back into the stomach cavity occurs after surgical operations on the organs of the gastrointestinal tract.

Stages and types

With the typology of the course destructive processes There are 4 types of reflux:

1. superficial, only the cells of the mucous membrane are affected;
2. catarrhal, accompanied by an inflammatory process;
3. erosive, foci of atrophy form on the mucosa;
4. biliary, when the outflow of bile from the gallbladder into the duodenum is impaired.

There are 3 degrees of development of duodenogastric reflux:

1. The first degree of GHD is a moderate process. This phase is characterized by the discharge of a small amount of the contents of the duodenum. Irritation of the gastric mucosa manifests itself in an unexpressed way. About 50% of people may experience this problem.
2. The second degree is characterized by the introduction of a large amount of alkaline medium. At this stage, the development of an inflammatory process is often observed, which leads to new gastrointestinal diseases. This degree of disease occurs in 10% of people.
3. The third degree is a pronounced process, which is accompanied by pain, nausea, and vomiting. Appears bad smell from the mouth, the patient complains of heaviness in the stomach. An examination by a specialist gives the opportunity to record bright clinical picture development of pathology.

The danger of duodenal gastric reflux is that the disease can cause ulcers to appear on the gastric mucosa. This occurs as a result of mixing bile and pancreatic juice, which form an aggressive environment, destroying the mucous membrane.

If duodenal gastric reflux is neglected, it can lead to serious consequences (peptic ulcer, digestive system disorders).

Symptoms of duodeno-gastric reflux

In most cases, the symptoms of duodenogastric reflux are nonspecific and are characteristic of many diseases of the gastrointestinal tract. First of all, these are diffuse, vague pains in the upper abdomen, most often spasmodic, occurring some time after eating. Patients complain of increased flatulence, heartburn (with any acidity of the stomach), regurgitation of acid and food, belching of air, vomiting with bile. Mandatory for duodeno-gastric reflux is a feeling of bitterness in the mouth, a yellowish coating on the tongue.

Long-term duodenogastric reflux can cause serious changes in the stomach and esophagus. Initially, an increase in pressure in the stomach cavity leads to the development of gastroesophageal reflux disease. Subsequently, bile acids and pancreatic enzymes cause specific changes in the esophageal mucosa, intestinal metaplasia, which can lead to the development of adenocarcinoma - one of the most malignant tumors of the esophagus.

The most likely outcome of duodenogastric reflux in case of untimely diagnosis and lack of rational treatment is toxic-chemical gastritis type C. The occurrence of this disease is predisposed by the constant reflux of bile into the stomach and chemical damage to the mucous barrier.

Complications

More pronounced Negative consequences can provoke complications of duodenogastric reflux - primarily these are:

• gastroesophageal reflux disease - the reflux into the esophagus of not only the acidic contents of the stomach, but also the alkaline duodenum, which is actively thrown into the stomach;
• adenocarcinoma is one of the most malignant neoplasms esophagus, which develops from its glandular cells. The mechanism of tumor occurrence is as follows. The contents of the duodenum, entering the stomach, increase the pressure in it. Because of this, the contents of the stomach rush into the esophagus, causing changes in its mucosa, resulting in metaplasia - the proliferation of the mucosa and the degeneration of its cells, which ultimately develops into adenocarcinoma;
• toxic-chemical gastritis C is a constantly maintained inflammation of the gastric mucosa due to chronic exposure to bile and pancreatic juice, which are components of the contents of the duodenum. Most often occurs when improper treatment duodenogastric reflux.

Diagnostics

The doctor initially probes the patient's abdomen. Palpation of different areas of the abdomen helps to find out the cause of the pain syndrome and determine the source of inflammation of the digestive tract. Special attention is given to the epigastric zone, which is located below the sternum and just above the navel. At inflammatory process caused by reflux, the patient feels pain in this area.

For a more accurate diagnosis, instrumental examination is prescribed:

1. FGDS. The examination uses a probe equipped with video equipment. During the study, symptoms of the disease are identified and the degree of pathology is clarified.
2. Radiography. Allows you to identify inflammation and changes in the size of the digestive organs, as well as determine the reflux of food mass from the duodenum into the stomach, narrowing or expansion of the intestines, and the presence of edema of the esophagus.
3. Manometry. Used to obtain data on organ motility.
4. Ultrasound of the abdominal organs. Helps to find out the nature and sources of malfunction in the stomach, gallbladder, pancreas or duodenum.
5. Biopsy. During the examination, a tissue scraping sample is taken to determine the presence of malignant neoplasms in the organs.

Laboratory tests are also important:

1. pH – metric. Gives the opportunity to determine the level of secretion. The procedure is carried out using a rubber probe, with which gastric juice is taken for analysis.
2. Blood analysis. Helps identify increased ESR and anemia.
3. Stool analysis. Necessary to identify possible internal hemorrhages that indicate ulcers or erosions.

How to treat duodeno-gastric reflux?

The treatment regimen for DRG is complex and only a qualified physician can do it. Problem discovered during diagnostic examinations can be eliminated in a short time using correct selection treatment regimens that will include drug treatment, physiotherapeutic procedures and normalization of diet. The influence of traditional medicine cannot be ruled out.

The goal of complex physiotherapeutic treatment is to restore the elastic state of the abdominal muscles. This direction includes not only physical exercises, but also procedures (electric myostimulator for the abdominal muscles).

Drug treatment has several objectives: to reduce the irritation of pancreatic juice on the gastric mucosa and restore intestinal motility to pass food unilaterally.

Drug treatment

Treatment is focused on reducing the severity of symptoms and improving the patient's condition.

The therapeutic regimen contains several groups of drugs:

1. Selective prokinetics - Motilium, Ondansetron accelerate the removal of gastric contents into small intestine, which prevents harmful effects on the gastric mucosa and reflux into the esophagus. Take a quarter of an hour before meals 3 times a day. The maximum course is 28 days.
2. Non-absorbable antacids Maalox, Almagel, Phosphalugel act for 2.5–3 hours and adsorb not only hydrochloric acid, but also the components of duodenal juice: 96% of bile acids and lysolecithin. They have an adsorbing, enveloping and gastroprotective effect. Quickly relieve pain. Drink three times a day after meals.
3. Proton pump inhibitors (PPIs) have an antisecretory effect: Rabeprazole, Esomeprazole. PPIs are used in average therapeutic dose 1 time per day for 4-8 weeks. If an effect is observed from the treatment of gastritis reflux, the dose is gradually reduced until the drug is discontinued. If relapses occur, the minimum effective dose is prescribed.
4. Gastroprotectors: Venter, Ulgastran, De-nol, Rebapimide. They participate in the formation of a protective layer on the surface of the mucosa and inactivate bile acids. Take 4 times a day an hour before meals and before bedtime. The course is 4-6 weeks, if necessary extended to 3 months.
5. Adsorbents for absorbing bile: Smecta, Polysorb, Lactofiltrum, Polyphepan. Drink between meals. Do not combine with other medications.
6. Ursofalk is a drug that changes the properties of bile acids, making them soluble and less toxic. Use 1 capsule in the evening for 10-14 days, according to indications - up to 6 months.

Physiotherapy

Numerous physiotherapeutic methods help eliminate the symptoms of the disease, restore muscle tissue and the gastric mucosa. For the treatment of GHD the following are used:

1. Impact of dynamic currents. Helps restore stomach muscle tone, accelerates the healing process of the mucous membrane, and normalizes the nutrition of stomach tissue.
2. Ultrasound. Removes discomfort, pain, inflammation of the mucous membrane
3. UHF reduces the acidity of gastric juice, regulates the process of its production
4. Exposure to microwaves. This method is shown when severe pain. The procedure helps normalize gastric motility, reduces the amount of gastric juice produced, and eliminates inflammatory processes.

Diet and nutrition

Almost all diseases of the gastrointestinal tract can be treated with proper nutrition. And DGR is no exception. When suffering from duodeno-gastric reflux, a strict diet is required. The food you eat must be thoroughly chopped. It is recommended to eat little by little, but 5-6 times a day.

Folk remedies

Treatment of GHD folk remedies often gives the same positive effect as medication. In addition, the frequency of manifestations side effects when it is carried out - significantly lower.

The most well-known folk remedies for the treatment of this disease are the following:

• Brew St. John's wort, chamomile and yarrow, taken in any proportion, with boiling water and add to tea. You need to drink the decoction 2 times a day. It will relieve heartburn, alleviate the symptoms of gastritis, minimize duodenogastric reflux, and eliminate dysbacteriosis;
• 1 tbsp. l. flaxseed, pour 100 ml of cool water, infuse until the seeds secrete mucus. Consume on an empty stomach;
• 2 tbsp. l. smoke herbs per 500 ml of boiling water. Leave for an hour, take 50 ml every 2 hours. Infusion of 2 tbsp. l. marshmallow roots in 500 ml of water, steeped for 5–6 hours, taken in small portions throughout the day. Using these folk remedies, you can prevent bilious vomiting;
• Rue leaves are effective folk remedies for improving intestinal motility. They need to be chewed after meals, 1–2 leaves;
• Mix 50 g of sage and calamus root with 25 g of angelica root; 1 tsp. mixture pour 1 tbsp. boiling water, stand for 20 minutes. Drink 1 hour after eating 3 times a day.

Operation

Surgical treatment is used when conservative methods interventions do not have the desired effect or are ineffective due to the characteristics of the disease. So, when the gatekeeper gapes, it is used Plastic surgery, the purpose of which is to reduce it plastically.

Using laparoscopic equipment, the anterior part of the pylorus is placed deep into the duodenal bulb, thus forming a functionally active prepyloric pocket. This pocket takes over the contractile and peristaltic functions of the damaged pylorus.

Forecast

The prognosis is favorable in the vast majority of cases.

The unfavorable development of duodenogastric reflux occurs due to its neglect and the occurrence of complications. In severe long-term cases, gross violations in the motility of the gastrointestinal tract, which is fraught with the “loss” of the stomach and duodenum from the normal act of digestion.

In such cases, the patient is forced to be fed parenterally (by administering nutrients through the bloodstream).

Prevention

Prevention of the disease is based primarily on rational nutrition and treatment of chronic diseases of the digestive tract.

Taking medications only on the recommendation of a doctor in appropriate dosages and prescribed courses, and the absence of self-medication is also one of the preventive measures to prevent reflux.

Duodenogastric reflux is a disease in which retrograde reflux into the stomach occurs from. Most often, the pathological process is classified as a syndrome that accompanies other diseases of the digestive tract.

Duodenogastric reflux is the reflux of the contents of the duodenum into the stomach cavity.

Duodenogastric reflux can occur due to various causes. In most cases, the occurrence of a pathological condition is diagnosed as a motor disorder.

Bile acids and pancreatic enzymes damage the protective barrier in the gastric mucosa. As a result, hydrogen ions flow back into the stomach wall.

Against this background, stimulation of the production of gastrin by the antral glands and damage to the lipid membranes of cells is observed. This leads to an increase in their sensitivity to.

Retrograde reflux leads to increased pressure in the stomach, which leads to the onset of the disease. Duodenogastric reflux is quite often observed against the background of:

1. Gastric ulcer;
2. Stomach cancer;
3. Duodenostasis;
4. Violations of the sphincter of Oddi tone;

The occurrence of a pathological condition is quite often observed after surgical removal. People who have impaired gastric motility are at risk for this disease.

The cause of the pathological condition is quite often systemic diseases digestive tract. The development of the disease is most common in smokers. It can also be diagnosed in pregnant females.

A fairly common cause of duodenogastric reflux is a hernia of the diaphragm. With inflammation, which is observed in the area of ​​the gallbladder and pancreas, a pathological process can also develop.

If a patient loses the tone of the esophageal muscles that separate the duodenum and the duodenum, this leads to the onset of the disease. During the period of taking medications, the action of which is aimed at reducing muscle tone smooth muscles, the development of this disease may occur. The causes of duodenogastric reflux can be quite varied.

Most often, the pathological process occurs against the background of diseases of the digestive tract or an unhealthy lifestyle.

Symptoms of the disease

Belching air indicates indigestion.

Duodenogastric reflux is accompanied by pronounced symptoms, which allows the patient to independently determine the course of this disease.

Most often, patients complain of heartburn, which appears after. Some patients experience belching of air. Sometimes she has. During the course of the disease, a yellow coating may be observed on the patient's tongue.

Patients with duodenogastric reflux complain of a bitter taste in the mouth. Very often the patient feels sick when the disease appears. Some patients experience vomiting of bile. Enough common symptom pathological condition occurs after eating.

Patients complain of gastric distension. After eating, patients experience cramping and spasmodic pain in the epigastric area. In everyday life, the disease manifests itself in rare cases.

Most often it is diagnosed accidentally during examination of the patient's digestive tract. That is why he is recommended to be as attentive to his health as possible, which will allow him to identify the disease in a timely manner.

Diagnostic methods

Ultrasound examination as a diagnostic method.

Duodenogastric reflux can be detected by visual examination of the patient. Also, to make a preliminary diagnosis, the doctor collects an anamnesis.

To confirm the doctor’s diagnosis, he prescribes additional methods examinations. For determining pathological process carry out organs in the abdominal region.

This allows us to determine not only the nature, but also the source of dysfunction of such organs as gallbladder, stomach, duodenum.

A fairly effective diagnostic method is esophagogastroduodenoscopy, which makes it possible to obtain the most accurate picture of the disease. With the help of this examination, it is possible to give a cytological and histological assessment of the degree of damage to the mucous membranes of the stomach and the nature of their damage, since benign and malignant processes are possible.

Most patients are prescribed a chemical analysis of gastric juice. It is used to determine small concentrations of enzymes in the pancreas by titration. Also during the diagnostic period, gastric juice is measured throughout the day. For this purpose, a special pH indicator is used.

Thanks to the wide variety diagnostic methods provides the opportunity to determine the development of the disease in the shortest possible time.

Features of treatment of the disease

Omeprazole treats diseases of the gastrointestinal tract.

Treatment of the disease must be carried out comprehensively, which will allow achieving a successful result. First of all, the patient is recommended to normalize.

Treatment of the disease is carried out using medications and physiotherapeutic procedures. Physiotherapeutic treatment is aimed at restoring the elasticity of the abdominal muscles.

The patient must perform a certain complex daily physical exercise. An electrical stimulator can also be used for this purpose.

With the help of drug treatment, irritation of pancreatic juice on the mucous membranes of the stomach should be relieved. With its help you can restore .

To perform these tasks, in most cases, patients are prescribed prokinetics - Passazhix. With their help, food movement is restored in the order in which it was received. The action of medications is aimed at ensuring muscle tone of the circular muscles in the gastrointestinal tract.

Doctors prescribe Choludexan and Ovenson for duodenogastric reflux. Thanks to these drugs, it decreases harmful effects bile acids on the mucous membranes of the digestive system.

In order to reduce stomach acidity, patients are prescribed. This makes it possible to create a barrier to the negative effects of bile acids on the stomach. If a patient is diagnosed with erosive reflux, then he is recommended to take Pilorida.

And medications will be effective only if the patient normalizes nutrition. To ensure the success of treatment of the pathological process, physiotherapeutic methods are often prescribed.

Before meals, patients are advised to take one teaspoon of celery root juice. You can also prepare a syrup based on dandelion roots for this purpose. Treatment of duodenogastric reflux should be carried out comprehensively and taking into account the individual characteristics of the patient.

Watch the video about gastroduodenal reflux:

Chronic gastritis, ulcers and other pathological conditions of the gastrointestinal tract can provoke a secondary illness - duodenogastric reflux. This pathology is characterized by the reflux of duodenal contents into the gastric region. Symptoms are pronounced: painful sensations in the peritoneum, nausea, which can cause heartburn, constant belching.

Attention! One of the characteristic signs of duodenogastric reflux is a yellow coating on the tongue.

For diagnostic purposes, electrogastroenterography and endoscopy are used. Additionally, 24-hour intragastric pH monitoring may be required. Then, once the diagnosis is confirmed, the course of treatment is determined. Acid-lowering drugs, prokinetics, and antacids are mainly used.

Medical statistics provide data that almost 15% of adults experience reflux of duodenal contents into the gastric cavity at night. However, such a process does not apply to pathological condition. The acidity level in the stomach is considered critical - 5 (if it persists for 15% of the time and is absolutely independent of food intake).

GHD is characteristic of most ailments of the digestive tract. But in some patients it is detected as an isolated pathology (the patient rate is equal to 30%).

Note! GHD may occur after surgical treatment- duodenal ulcers (in the period after suturing) and cholecystectomy.

Some experts claim that duodenogastric reflux accompanies all gastrointestinal diseases chronic(from 45% to 100% of cases). It is worth noting that the pathology does not have gender differences, that is, men and women are equally affected by GHD.

Root causes of pathology

There are several factors associated with GDR, these include:

1. Disturbance of the process of gastric motility.
2. If there is increased pressure in the small intestine.
3. When the gastric mucosa is adversely affected by the contents of the duodenum.
4. Insufficiency was diagnosed in the stomach area (namely in the pyloric region).

What happens when bile acids affect the gastric cavity?

1. The protective barrier of the gastric mucosa layer is damaged.
2. A diffuse process of hydrogen ions is provoked into the deep layers of the gastric walls.
3. The antral glands begin to actively produce gastrin.
4. Lipid membranes of cells are damaged.
5. In the gastric cavity, pressure increases under the influence of reflux of the contents of the duodenum.

Reference! With increased pressure in the stomach, gastroesophageal reflux occurs.

GHD can be diagnosed:

• as an accompanying illness with duodenostasis, stomach cancer, chronic gastritis, peptic ulcers;
• when the tone of the sphincter of Oddi is impaired;
• after removal of the gallbladder;
• surgical treatment of ulcers.

Previously, experts believed that DGR was just defensive reaction for inflammation in the stomach, as well as for increased acidity. Thus, when thrown into the stomach, dual juice stimulates the alkalization process, as a result of which it acts preventive measure damage to the duodenal mucosa. This theory has been completely refuted. Since studies have confirmed the ulcerogenic effects of DGR, therefore protective function This process is completely eliminated.

Video - Duodenogastric bile reflux from the inside

Symptoms of GHD

There are no specific symptoms for GHD. Consequently, non-specific symptoms are characteristic of most diseases of the gastrointestinal tract and the digestive system as a whole.

Typical general symptoms, warning about DGR:

• after eating, abdominal pain of a spastic nature (less often diffuse) is observed;
• increased flatulence;
• despite the level of acidity, a feeling of heartburn occurs that persists for several days in a row;
• often patients complain of belching air;
• nausea, which ends with vomiting (there are bile impurities);
• regurgitation may be periodically observed not only with food, but also with acid;
• yellow coating on the surface of the tongue;
• a feeling of bitterness in the mouth.

If GHD is observed in a patient over a long period of time, then pathological changes in the esophagus and gastric cavity. As a result, they begin to develop various ailments digestive system. For a long time, the patient may not attach any importance to secondary symptoms.

Carefully! High blood pressure in the stomach leads to gastroesophageal reflux disease. Therefore, under the influence of stomach acids, intestinal metaplasia develops (one of the most dangerous malignant pathologies of the esophagus).

What is the outcome if the symptoms are not eliminated and GHD is not treated?

In the absence of timely diagnosis of pathology, and, consequently, a course effective therapy, toxic-chemical gastritis develops (in this case, type C). The provoking factor is the regular reflux of duodenal bile into the gastric cavity. As a result, the mechanical barrier of the gastric mucosa is damaged. Therefore, when identifying primary characteristic– yellow coating on the surface of the tongue, consultation with a doctor is recommended.

Diagnosis of GHD

GHD is not an independent disease, so diagnosis by examination by a specialist is impossible. In particular, pathology is detected during examination for gastrointestinal diseases.

Stages of diagnosis	Brief description of the examination method
Consultation with a gastroenterologist	The patient is initially examined by a gastroenterologist, then if GHD is suspected, the patient is redirected to an endoscopist
Esophagogastroduodenoscopy	This study is carried out with caution as it may lead to the development of GHD. Therefore it is used extremely rarely
Intragastric pH-metry	It is considered one of the most reliable methods for studying DGR. This is a 24-hour study, which shows fluctuations in acidity levels. Often, the acidity level of gastric juice is monitored at night, when there are no meals and the body is at rest.
Antroduodenal manometry and electrogastrography	These are two studies confirming the diagnosis. They also help to detect incoordination of gastric motility and hypotension of the gastrointestinal tract.
Gastric juice analysis	The laboratory detects the presence of bile acids, as well as digestive enzymes
Ultrasound of the abdominal organs	Helps eliminate diseases of the digestive system, which are very similar in symptoms to signs of GHD

Attention! The symptoms of GHD are typical for pancreatitis, as well as cholelithiasis and cholecystitis. For a reliable diagnosis, a comprehensive study is necessary.

Treatment methods for GHD

After diagnosis in gastroenterology and confirmation of the diagnosis of GHD, the patient does not need inpatient treatment. Therapy includes clinical recommendations (taking selective prokinetics, proton pump blockers, inhibitors, antacids, as well as drugs to stabilize gastric motility).

It is important! All medications are selected by a specialist based on the diagnosis, so self-medication is strictly contraindicated. Uncontrolled use of medications will only worsen the clinical picture.

Despite drug treatment, its effect on the pathology is insufficient. Additionally, the patient is recommended to adjust their lifestyle, namely:

1. Completely give up bad habits (no alcohol or smoking).
2. The consumption of coffee drinks is contraindicated.
3. Take with caution choleretic agents(Only as prescribed by a doctor).
4. Go to the correct one balanced diet.
5. Monitor your body weight to avoid obesity.
6. Eat food in small portions (up to 6 times a day in small portions).

What is the prognosis if all prescriptions and therapy are followed?

With timely diagnosis and effective treatment Doctors give fairly favorable prognoses. However, we should not forget about prevention methods, which include a balanced diet consistent with the daily routine (thus, gastric motility is normal and digestive function is carried out correctly). At the same time, the state of digestion can be directly affected bad habits, in particular smoking. Quitting alcohol consumption and smoking will significantly improve the patient's condition.