home Thyroid How to recognize and treat exacerbation of duodenitis. Chronic duodenitis: causes, symptoms and treatment in adults, diet

How to recognize and treat exacerbation of duodenitis. Chronic duodenitis: causes, symptoms and treatment in adults, diet

Duodenitis - inflammation of the mucous layer twelve duodenum. The overall prevalence of the pathology among the population is 5-10%; the disease is found 2 times more often in men, which is associated with a greater commitment to addictions.

There are acute and chronic forms of the disease. Acute duodenitis most often occurs due to poisoning and consumption of spicy foods, and is manifested by inflammation of the mucous membrane, the development of erosions (a superficial defect of the epithelium that heals without scarring) and, less commonly, phlegmonous cavities filled with pus. The disease manifests itself as digestive disorders and pain. If you follow the diet and doctor's instructions, you can be cured in 1-2 weeks. If o occurs again. duodenitis, the risk of chronicity is 90%.

Chronic duodenitis develops against the background chronic pathology digestive tract (gastritis, gastric ulcers, pancreatitis), with prolonged diet violations. Atrophy of the mucosa (atrophic duodenitis) or its erosion (erosive duodenitis) gradually develops. Under the influence of provoking factors, an exacerbation of the disease occurs. Treatment is longer than with acute form.

Structure

After the pylorus of the stomach comes the duodenum. It, like a horseshoe, goes around the head of the pancreas (PG), continuing into the jejunum. Its length is 25-30 cm. Fixation to the walls abdominal cavity carried out by connective tissue fibers. The duodenum is located in the projection of the XII thoracic – III lumbar vertebrae.

Divisions: superior (bulb or ampulla), descending, horizontal, ascending. The mucous membrane of the bulb is equipped with longitudinal folds, the remaining sections - transverse. When they contract, a bolus of food moves into the jejunum.

The greater or Vater's nipple opens into the duodenum cavity. It is formed by the fusion of the main pancreatic duct and the common bile duct. The papilla of Vater has a sphincter, with the help of which the flow of bile and pancreatic juice into the intestines is regulated. The minor nipple is located in the area where the accessory duct of the pancreas exits.

Functions

The duodenum performs several functions:

Neutralization of acidic gastric contents. The bolus of food mixed with acidic gastric juice is neutralized in an alkaline environment. Due to this, irritation of the intestinal epithelium does not occur.
Regulation of the formation of digestive enzymes, bile, pancreatic juice. In the duodenum, the contents are analyzed and the appropriate command is transmitted to the digestive glands.
Relationship with the stomach: the duodenum ensures the opening and closing of the pylorus of the stomach, the entry of a new portion of the bolus of food into the small intestine. This occurs as the next amount of gastric contents is neutralized in the cavity of the duodenum.

What causes acute duodenitis

The reasons leading to the development of o. duodenitis:

Dry food, eating food that has an irritating effect on the epithelium of the digestive tract: coffee, smoked foods, fried, fatty, spicy. To process such food, the stomach produces increased amount of hydrochloric acid, which reduces protective properties epithelium duodenum.
Foodborne toxic infections caused by the bacterium Helicobacter pylori (which causes ulcers), staphylococci, enterococci, clostridia, as well as giardiasis, helminthiases. Pathogenic bacteria lead to the development of inflammatory phenomena in the duodenal mucosa, damage to epithelial cells and their death. A large amount of fluid leaks into the intestinal lumen, which manifests itself as diarrhea.
Diseases of the digestive system: colitis, hepatitis, cirrhosis, pancreatitis, ulcers, gastritis. Inflammation of nearby organs leads to transition inflammatory process and the development of duodenitis (pancreatitis-duodenitis, gastritis-duodenitis). Another mechanism causing inflammation The duodenum is a violation of the production of bile and pancreatic juice, without which it is impossible to normal functioning this organ.
Reflux or backflow of the contents of underlying intestinal segments into the duodenum. This may occur due to spasm or obstruction (due to a tumor or other reasons) of the jejunum. Bacteria from the lower parts small intestine enter the duodenum, causing reflux duodenitis.
Alcohol consumption.
Ingestion chemical substances(acids, alkalis, chlorine-containing compounds), leading to burns of the intestinal epithelium.
Mechanical damage to the duodenal mucosa due to ingestion of foreign bodies.

What causes chronic duodenitis

Reasons leading to the appearance of chronic duodenitis:

Intestinal pathology leading to deterioration of peristalsis, stagnation of intestinal contents, stretching of the walls and atrophy of the duodenum mucosa: prolonged constipation, intestinal adhesions, impaired blood supply and nervous regulation intestines.
Chronic gastritis with high acidity causes acid damage to the intestinal epithelium with the gradual development of its atrophy. Gastritis-duodenitis is formed.
An abnormality of the liver, gallbladder and pancreas leads to disruption of the release of enzymes into the lumen of the duodenum, which impairs its functioning.
Regular violation of diet and nutrition.
Food allergies.
Prolonged stress.
Use large quantity medicines.
Availability bad habits(drinking alcohol, smoking, substance abuse).

Clinic

Manifestations of duodenitis depend on the cause of its occurrence and the presence of concomitant pathology. Often the disease is hidden under the guise of other ailments: stomach ulcers, gastritis, cholecystitis.

Symptoms of duodenitis in adults:

Painful sensations in the epigastric region, aggravated by palpation (palpation) of the abdomen. Pain has its own characteristics various forms duodenitis:
- at chronic form- constant, aching, worsening on an empty stomach and 1-2 hours after eating;
- with duodenitis caused by intestinal obstruction, the pain is bursting, paroxysmal, and occurs when the intestines are full;
- with gastritis-duodenitis with high acidity - develops 10-20 minutes after eating, which is explained by the entry of acidic gastric contents into the intestines;
- the ulcer-like form caused by Helicobacter pylori is characterized by fasting pain;
- with local inflammation around the nipple of Vater, the outflow of bile from the gallbladder is disrupted, resulting in a clinical picture similar to an attack of hepatic colic: pain in the right hypochondrium.
Increased fatigue, weakness. This is due to the action of toxic substances formed during inflammation.
Maybe slight increase body temperature (up to 37-38 0).
Digestive disorders (dyspepsia):
- nausea;
- decreased appetite;
- increased gas formation (flatulence);
- belching, vomiting with a bitter taste (due to bile) - throwing food back into the stomach;
- bowel disorder (diarrhea or constipation).
Yellowing of the skin and mucous membranes. Swelling of the papilla of Vater leads to a decrease in the lumen of the bile duct, stagnation of bile and its release into the blood.
Dumping is a syndrome. Occurs after a heavy meal. When the duodenum is overfilled, a redistribution of the bloodstream occurs (blood flow to the digestive organs, outflow from the head). Manifested by dizziness, drowsiness, a feeling of fullness in the stomach, heat in the upper body.

At asymptomatic Disease complaints may be absent; detection of pathology is an accidental finding during gastroduodenoscopy.

Diagnostics

The diagnosis of duodenitis is made if there is a combination of data:

The presence of characteristic complaints described above.
Inspection. When palpating (feeling) the abdomen, pain is noted in the projection of the duodenum.
Instrumental examination data:

FGDS (fibrogastroduodenoscopy) – scopic examination of the stomach cavity, duodenum. If duodenitis is present, it is determined characteristic features: (swelling of the mucous membrane, redness). Each form of duodenitis has its own characteristics of FGDS - pictures:
- a) with catarrhal (or superficial) duodenitis - uniform redness of the epithelium;
- b) the presence of erosions - with an erosive form;
- c) smoothness of the folds indicates a decrease in intestinal tone;
- d) nodules on the mucous membrane – about the nodular form;
- e) hemorrhages – hemorrhagic;
- f) atrophy of the epithelium - about atrophic.
X-ray contrast study - performing fluoroscopy or graphy after consumption by the patient contrast agent(barium sulfate). With such a study it is possible to identify gross violations in the structure and functioning of the organ, the restructuring of the mucous membrane cannot be detected in this way. In case of duodenum pathology, a number of signs are found:
- a) areas of narrowing indicate a tumor, adhesions, developmental anomalies;
- b) areas of expansion indicate a decrease in tone, blockage of the lower parts of the intestine, disruption of food passage, and nervous regulation;
- c) a niche symptom is observed with erosion, ulcer;
- d) with mechanical obstruction, an accumulation of gases is detected;
- e) smoothness of folds - with swelling, inflammation;
- f) reflux - the reflux of contents from the duodenum back into the stomach.

Laboratory data:

a general blood test can determine an increase in ESR, indicating inflammation and anemia, as a sign of internal bleeding;
biochemical blood test: for initial stages duodenitis, there will be an increase in enzymes (esterokinase and alkaline phosphatase), their activity subsequently decreases;
stool analysis occult blood(will be positive in the presence of bleeding, maybe in the erosive form).

Features in children

Small children cannot correctly localize pain; they most often simply point to their stomach and say that it hurts. Among the symptoms, the most common are malaise, weakness, abdominal pain, nausea, belching, heartburn, and constipation. Exacerbation of duodenitis occurs more often in autumn and spring. In older children (10 years or more), the clinical picture does not differ significantly from adults.

The treatment is complex. If the cause of duodenitis is helminthiasis, deworming is a mandatory component.

Treatment

The main tasks in the treatment of duodenitis:

elimination of inflammation;
prevention of process chronization;
normalization of duodenum function;
restoration of normal digestion.

Most often, treatment is carried out in a clinic. For recovery, a number of conditions must be met:

stick to a diet;
observe the work and rest schedule;
avoid stress;
give up bad habits (smoking, alcohol).

Indications for inpatient treatment:

exacerbation of the disease;
suspicion of tumor formation;
danger of bleeding (with erosive form);
severe general condition.

Treatment components:

therapeutic nutrition;
folk remedies;
medicines;
physiotherapy;
use of mineral waters.

Nutrition

The menu for duodenitis plays a primary role in therapy. If you do not adjust your diet, relapses of the disease will occur again and again.

During exacerbation of the chronic form or o. duodenitis for the first 3-5 days, you should follow table 1a according to Pevzner. The same diet is used to treat exacerbation of stomach ulcers. It is allowed to eat slimy cereal decoctions (rice, oatmeal), pureed soups, liquid porridge with half-and-half milk (first the cereal is boiled in water, so it swells faster and becomes more slimy, then add milk, the ratio of water and milk is 1/1).

Basic principles of nutrition:

food should be: pureed, not hot, steamed

frequent meals - 6 times a day, in small portions

Avoid overeating and long breaks in meals

For example, let's look at diet 1a, scheduled for one day.

Eating	Recommended dishes
1st breakfast	Buckwheat porridge cooked with half-and-half milk (buckwheat - 50, milk and water - ½ cup each, butter - 10), milk - 1 cup
2nd breakfast	Milk – 1 glass
Dinner	Milk cereal soup (oat flakes - 40, milk - ¾ cup, eggs - ¼ pcs, butter - 10, sugar 2, water - 1¾ cups), meat puree (boiled lean beef - 100, milk - 1/4 cup, butter – 10), dried apple compote (water – 200, dried apples – 20, sugar – 15)
Afternoon snack	Milk – 1 glass, soft-boiled egg
Dinner	Rice porridge cooked with half-and-half milk (rice – 50, milk and water – ½ cup each, butter – 10), egg “in a bag”, milk – 1 cup.
2nd dinner	Milk – 1 glass

Then the diet is gradually expanded.

ulcer-like form – table No. 1;

gastritis-like variant – table No. 2;

Pancreatito- and cholecysto - similar form - table No. 5.

boiled lean meat, minced through a meat grinder or chopped with a blender;
dairy and lactic acid products (milk, kefir, fermented baked milk, yogurt);
boiled or baked vegetables, peeled, vegetable puree;
eggs, boiled soft-boiled or prepared as an omelet;
fats (butter, vegetable oil);
juices;
yesterday's bread and crackers (easier to digest than fresh baked goods);
natural sweets (honey, mousse, jelly).

Products that stimulate gastric secretion and contain difficult-to-digest fibers are prohibited:

raw fruits and vegetables;
canned food, smoked meats;
spicy dishes, seasonings, onions, garlic;
rich fish, meat, mushroom broths;
fatty varieties meat and fish (duck, pork, carp, mackerel);
ice cream;
carbonated drinks;
alcohol.

You should eat in small portions, 4-6 times a day. You should not wait until you are hungry to eat, otherwise you may experience “hunger pains.”
Food should be warm, but not hot or cold.
A gentle preparation method is preferable to avoid irritation of the duodenum mucosa. These are soups, porridges, steam dishes.
Avoid overeating and eating at night.

Traditional methods

Treatment with folk remedies is of auxiliary value. The main goal is to suppress the aggressive effects of hydrochloric acid and protect the duodenum epithelium.

Medicinal plants that are suitable for this purpose are: coltsfoot, sage, nettle, St. John's wort, peppermint, oregano, plantain, strawberry leaves, chamomile inflorescences, fennel seeds, eucalyptus leaves.

During the period of remission, the following herbs are used: lingonberry leaves, St. John's wort herb, licorice root, flax seed, oregano herb, nettle herb, chamomile root.

Recipes for preparing medicinal potions for duodenitis:

2 tbsp. spoons of St. John's wort raw material are poured into 200 ml of boiling water, heated in a water bath for 0.5 hours, left for 15 minutes, filtered, drunk 1/3 cup 3 times a day 0.5 hours before meals;
3 tbsp. spoons of plantain juice are mixed with 1 teaspoon of honey, take 1 tbsp. spoon 3 times a day before meals;
50g of propolis is poured with 2 glasses of alcohol, the resulting mixture is placed in a dark place to infuse for 3 weeks, taken outside of exacerbation, before meals, 1 tbsp. spoon, pre-mixing with 1 tbsp. a spoonful of milk;
2 tbsp. spoons of Hercules are boiled in 2 liters of water, filtered, and ¼ cup of aloe juice is added to the broth. Drink ½ glass 3 times a day;
1 teaspoon of flax seeds is poured into 1 glass of boiling water, left for 15 minutes, consumed on an empty stomach for a month.
0.5 kg of sea buckthorn is ground, poured with unrefined sunflower oil and infused for a week in glass jar, take 1 tbsp. spoon on an empty stomach.

Drug therapy

How to treat duodenitis? Depending on the form of the disease, various combinations of drug groups are used:

Drug group	Mechanism of action	Representatives	How to use
PPIs – proton pump inhibitors	Blocks the production of hydrochloric acid (HCl), thereby reducing irritation of the duodenum mucosa.	Emanera 20 mg Omeprazole 20 mg Ultop 20 mg Zulbex 20 mg	20 mg 1-2 times a day, for 7-10 days.
Antibiotics, antibacterial agents	In case of infection, Helicobacter pylori is detected.	Doxycyline	2 times a day, 7-10 days.
Antibiotics, antibacterial agents	In case of infection, Helicobacter pylori is detected.	Clarithromycin 500 mg Amoxicillin 1000 mg Metronidazole 500 mg	2 times a day, 7-14 days.
H2 - histamine blockers	Suppress the release of HCl.	Ranitidine	0.15 - 2 times a day, course 1 - 1.5 months.
H2 - histamine blockers	Suppress the release of HCl.	famotidine	0.02 g – 2 times
Antacids	Neutralize with HCl. Envelop the mucous membrane and have a local analgesic effect.	Almagel Maalox Gastal	For heartburn, up to 3 times a day.
Prokinetics	Regulate peristalsis, help promote bolus movement	Itomed Ganaton	1 tablet 3 times a day.
Enzyme products	Contain pancreatic enzymes, help better digestion of food	Pancreatin Creon 10000	After every meal.
Antispasmodics	Remove spasms, relieve pain	No-shpa (drotaverine) Platyfillin Duspatalin	1 tablet – 3 times.
Sedatives	Calming effect	Valerian and motherwort tablets	Course 10-14 days.

Separately, it is worth mentioning the drug De-nol. It combines antacid, antibacterial (directed against Helicobacter pylori), anti-inflammatory, astringent action, protects the duodenum mucosa, and promotes its restoration. Adults take 1 tablet 4 times a day (3 times after meals, the 4th at night). Take the drug with water (you can’t take it with milk due to the formation of insoluble compounds). Children under 12 years of age are prescribed 1 tablet 2 times a day. The course of admission is up to 8 weeks.

In each case, the combination of drugs is selected individually. If Helicobacter pylori is present, antibiotics are mandatory. If the disease is triggered by stress, connect sedatives. When acidity increases, you cannot do without antacids, PPIs, and histamine blockers.

Physiotherapy

Magnetic therapy, ultrasound, and phonophoresis are used.

Application of mineral waters

Use low-mineralized waters alkaline reaction, not containing carbon dioxide: “Borjomi”, “Essentuki No. 4”, “Smirnovskaya No. 1”, “Slavyanovskaya”, “Luzhanskaya”, “Berezovskaya”. Before use mineral water Warm up slightly and release gases. Take 1-1.5 hours after meals.

All these treatment methods together help relieve inflammation and achieve stable remission of duodenitis.

The inflammatory process developing on the walls of the duodenum has recently been diagnosed very often. This pathology can affect any person, but men most often suffer from it. The most common form of the disease is chronic. Acute duodenitis is quite rare. Such a diagnosis is made only if the inflammatory process and the accompanying negative symptoms occur in a person for the first time and suddenly.

The pathology responds well to treatment, but if the therapeutic process is ignored, the exacerbation stage can provoke the development of quite serious complications, including perforation of the duodenal wall, as well as massive intestinal bleeding.

Factors provoking the development of the disease

The biggest risk of unexpected occurrence acute stage duodenitis occurs in those people who suffer from increased enzyme activity and acidity gastric juice. This is due to the fact that excess acid and pepsin produced by their stomachs enter the duodenum and corrode its mucosa, since alkaline environment, located in it, is not enough to neutralize aggressive substances.

Also, disruption of food digestion during achlo- and hyporhydria is also dangerous for the intestine, since large pieces of undigested food have an irritating effect on the walls of this organ.

These are internal, in some cases congenital, factors that provoke the development of an acute form of pathology, but there are also external, most various reasons, causing the development of this pathology. Of particular importance among them are the following:

the most common prerequisite for the development of the disease is damage digestive organs bacterium Helicobacter pylori;
The second most common reason, experts believe, is uncontrolled and long-term use medicines(Aspirin, Baralgin);
abuse is no less dangerous alcoholic drinks and constant smoking for many years.

Frequent stressful situations, systematic eating disorders, the use of substances that provoke the release of hydrochloric acid, and the use of hormonal drugs also have an impact.

Experts advise all people to be more attentive to their health, and if negative symptoms appear, indicating the development of an exacerbation of the disease, immediately seek advice from a gastroenterologist and undergo a diagnostic test.

The first warning signs of pathology

One of the first symptoms acute duodenitis is an attack of acute abdominal pain that occurs after overeating. It cannot be removed or reduced with medications. Consequently unpleasant sensation the person begins to sweat on the face, and may experience an attack of vomiting. All signs of this type of pathology depend on what specific cause provoked the disease, and whether the patient has a history of accompanying illnesses digestive organs. Very often, the acute form of duodenitis is “masked” as hepatic colic, gastritis or ulcer, which makes diagnosis difficult. But still, there are a number of symptoms that experts advise you to pay attention to:

painful sensations in the epigastric region, aggravated by palpation;
the appearance of a feeling of fullness in the stomach;
decreased appetite;
severe drooling;
dense white coating on the tongue;
nausea, which may be accompanied by vomiting.

In addition, a person who develops an acute form of the disease experiences general weakness, a significant increase in temperature, arterial hypotension, headache, fatigue. These manifestations are signs of intoxication of the body, which was caused by inflammatory products. The same symptoms can be observed when there is an exacerbation of chronic duodenitis.

Secondary signs

If, when the first alarming signs appear, a person does not turn to a specialist, but waits for everything to “go away on its own,” as, by the way, often happens, he will begin to develop a disorder in the synthesis of digestive enzymes. This, of course, in as soon as possible will provoke fermentation of food accumulated in the duodenum and its further rotting. Indigestion is always accompanied by the following symptoms:

complete loss of appetite by a person;
constant feeling of nausea;
increased gas formation;
rumbling in the stomach caused by fermentation processes;
diarrhea.

The fact that the duodenum is overcrowded with fermenting and rotting food masses is also evidenced by bitter belching, as well as vomiting, which contains impurities of bile. This symptomatology is associated with duodenogastric reflux. It occurs due to the fact that the contents of the duodenum are thrown back into the stomach, rather than passing further into the intestines.

In acute duodenitis, the first symptoms of which are ignored by the patient, work disturbances may also occur. nervous system. This is due to the fact that rotting food, firstly, causes severe intoxication, and secondly, the body, due to severely impaired digestion, begins to experience a shortage of necessary nutrients. To correct the situation and improve digestion, it increases blood flow to the duodenum and stomach, and the brain and lower limbs"being robbed." In this regard, a sick person develops dumping syndrome, the manifestations of which become noticeable immediately after eating food:

feeling of excessive stomach fullness;
heat appears in the upper half of the body;
drowsiness, weakness and dizziness;
there is noise in the ears, and hands begin to tremble.

A person develops hormonal deficiency, and this negatively affects the functioning of the autonomic nervous system. If the patient ignores this already obvious symptom of developing acute duodenitis, the next stage will be the onset of a chronic form of pathology, which is impossible to get rid of, since it has an irreversible course.

Diagnostic measures

In order to put accurate diagnosis In order to prescribe an effective treatment protocol, a reliable diagnosis of acute duodenitis is necessary. This pathology can also be suspected if initial examination, but due to the fact that the disease has many forms with similar symptoms, an instrumental diagnostic study is extremely necessary. Typically, if an acute form of pathology is suspected, the following diagnostic tactics are used:

Gastroscopy. With help this method the specialist has the opportunity to visually see the cavity of the duodenum and identify the exact location of the exacerbation of the inflammatory process. It will look red, hyperemic and swollen. Gastroscopy also allows for a biopsy of the inflamed area, which will help determine the degree of development of the negative process.
Ultrasonography. Thanks to it, the diagnostician has the opportunity to identify pathologies of internal organs and assess their condition.
General blood analysis.
Biochemical analysis of gastric juice to determine the level of acidity, which in case of primary acute duodenitis is necessary for prescribing medical therapeutic procedures.

Taking into account the fact that the acute form of duodenitis is often a consequence of other gastrointestinal diseases, a diagnostic examination of other organs of the digestive system may be prescribed.

Methods of treating the disease

Therapeutic measures for the first time acute duodenitis begin with cleansing the mucous membrane of the stomach and duodenum. For this purpose, a method of washing them with a weak solution of potassium permanganate is used. In order to remove remaining toxins from the intestines, patients are prescribed a saline laxative. Magnesia sulfate is usually used in an amount of 30 g.

In the first 3 days, the sick person will have to completely fast. You can only drink warm boiled water in minimal quantities. This measure is necessary in order to maximally relieve the duodenum of digestive products.

Without this, all therapeutic measures using medications will be useless, since the tablets simply cannot be absorbed. It is during this period that therapy is carried out using intramuscular infusions (antispasmodic injections of No-shpa, Platyfillin or Drotaverine).

From day 3, the patient is allowed to go on a strict diet, which implies greater restrictions in the diet. For now, he can eat liquid porridges, milk and slimy soups, as well as jelly. After a week, eggs (soft-boiled or cooked as a steam omelet without additives), boiled vegetables crushed to a puree, meatballs or meatballs are added to the menu. Categorically in acute inflammatory pathology duodenum the following products:

Gradually, a person’s diet will become less strict. Dairy products, vegetable casseroles, baked fruits, and compotes will be added to it. This table must be followed for approximately 2 months, until it is canceled by the attending physician.

In the event that a person has alarming symptoms and treatment was started in a timely manner and carried out without any errors, the prognosis for acute duodenitis is very favorable. The inflammatory process goes away within 7–10 days, and the functions of the duodenum are fully restored. This speaks of complete cure. The only thing that a formerly sick person needs to adhere to is a properly adjusted diet, avoiding frequent stressful situations and alcohol abuse. In this case, he will never again remember the severe symptoms of the disease in his life.

Duodenitis: what kind of disease is it?

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

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

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

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

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

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

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

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

Causes

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

Primary reasons:

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

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

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

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

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

Acute duodenitis: what is it?

The acute form of duodenitis appears suddenly. Often precisely after a violation of the diet. Characteristic symptoms is a painful sensation in the upper abdomen, nausea, turning into vomiting. These signs are accompanied by general weakness and fever.

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

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

Chronic duodenitis

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

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

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

By degree structural changes There are several variants of chronic duodenitis:

Superficial duodenitis

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

Symptoms:

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

Atrophic

Atrophic duodenitis is a chronic form of the disease, which is characterized by atrophy of the mucous membrane of the duodenum, as well as a sharp decrease in the number of goblet enterocytes. This diagnosis has practically nothing to do with atrophic gastritis.

Interstitial

No damage to the glands.

Erosive-ulcerative

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

Hyperplastic

Manifested by excessive tissue growth.

Patients with chronic duodenitis should be under dispensary observation, they are indicated for anti-relapse treatment.

Symptoms of duodenitis in adults

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

The main symptoms of duodenitis are:

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

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

Complications

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

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

Diagnostics

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

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

Diagnosis is based on instrumental methods research:

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

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

Treatment of duodenitis

In adults, treatment of duodenitis includes several areas:

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

How to treat acute duodenitis?

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

How to treat chronic duodenitis in adults?

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

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

Antispasmodic drugs to relieve spasms:

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

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

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

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

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

Nutrition and diet

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

The following foods are encouraged:

products that have an enveloping effect on the mucous membrane of the stomach and duodenum - flax-seed, oats, potato and corn starch,
cereal and pureed soups,
lean varieties of meat and fish, preferably in the form of cutlets, meatballs and meatballs,
omelette, dairy dishes,
baked fruits, stewed vegetables,
stale bread, crackers,
butter and vegetable oil in small quantities.

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

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

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

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

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

Menu for the day

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

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

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

Folk remedies

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

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

Prevention

Prevention of duodenitis includes the following preventive measures:

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

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

Duodenitis – inflammation of the mucous membrane of the duodenum

Causes and risk factors

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

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

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

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

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

Forms of the disease

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

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

Chronic forms of duodenitis are classified according to different criteria:

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

There are also special forms diseases (tuberculosis, fungal, immunodeficiency duodenitis).

By features clinical manifestations The following forms of duodenitis are distinguished:

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

Symptoms

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

Diagnostics

Basically, the diagnosis of duodenitis is carried out according to FEGDS. The following additional methods are used:

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

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

Treatment

The treatment regimen for duodenitis includes:

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

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

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

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

Possible complications and consequences

The main complications of duodenitis:

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

Forecast

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

Prevention

Prevention of duodenitis includes:

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

Video from YouTube on the topic of the article:

Gastrointestinal problems can be called one of the most common. Disorders in the functioning of the stomach and intestines have an extremely negative impact on a person’s quality of life.

Duodenitis of the 12 duodenum also belongs to the classification of these diseases. It refers to those ailments that affect the mucous membrane, namely, cause an inflammatory process. Over time, if left untreated, inflammation affects not only the stomach, but also affects the functioning of the intestines.

Acute and chronic form

Duodenitis of the 12 duodenum is a complex inflammatory process affecting its mucous membrane. Characterized by the disease frequent pain in the epigastric area, human weakness, malaise, as well as a number of other unpleasant symptoms.

Duodenitis 12 duodenum medical practice is divided into two types:

spicy;
chronic.

Acute duodenitis occurs due to the influence of such factors on the gastrointestinal tract:

poisoning by toxins and chemicals;
food poisoning;
poor nutrition;
drinking alcohol and smoking;
mechanical damage to the mucous membranes of the digestive organs.

Duodenitis of the duodenum 12 in acute form, as a rule, occurs very abruptly, but goes away quite quickly on its own. It usually takes 2-3 days to heal. If acute duodenitis of the duodenum occurs over and over again, the disease can become chronic.

Chronic duodenitis in medicine is divided into primary and secondary. The primary type of illness appears in those who do not comply proper nutrition and abuses alcohol and smoking. The secondary type is observed much more often. It occurs as a result of inflammation of other digestive organs and diseases, including:

chronic gastritis;
duodenal ulcer;
pancreatitis.

Also possible reason May be incorrect treatment or ignoring acute duodenitis of the duodenum.

Symptoms

Symptoms of duodenitis 12 depend on its type (acute, chronic), the causes that led to the disease, as well as on concomitant pathologies of the digestive system. Making a diagnosis is significantly complicated by the fact that duodenitis can masquerade as other diseases, including:

gastritis;
stomach ulcer;
hepatic colic and more.

The most frequent symptoms The conditions for which patients consult a doctor are the following:

Pain in the epigastrium, aggravated by palpation. If the patient has chronic duodenitis, 12 duodenal pain is constant. Blunt pain intensifies 1-3 hours after eating and in the morning, on an empty stomach.
General weakness. The symptom is accompanied by rapid fatigue and an increase in temperature to 38, which is typical for acute duodenitis of the 12 duodenum.
Disturbance in the functioning of the digestive system. The food in the intestines ferments and rots. This further causes the following symptoms - nausea, loss of appetite, diarrhea, rumbling in the stomach, increased gas production.
Bitter belching. This symptom is often associated with duodenal overflow and is accompanied by vomiting with bile. Thus, patients experience duodenogastric reflux, that is, the reflux of intestinal contents into the stomach.
Jaundice of the sclera and skin. This symptom is explained by the fact that the outflow of bile is impaired, which causes a similar manifestation of the disease.

Important: Symptoms of duodenitis are not always constant. Thus, in some cases, the disease may manifest itself in stages, which makes diagnosis and treatment difficult.

Causes of the disease

Duodenitis of the 12 duodenum can appear at absolutely any age. This disease is also quite often transmitted hereditarily. This indicates that the problem of duodenal duodenitis can affect both adults and children.

However, recently duodenitis of the 12 duodenum, like gastritis, has become more common in young and middle-aged people. It's connected with modern type life, as well as with the products that people eat.

Thus, the main causes of duodenitis include:

unhealthy and inappropriate nutrition;
food poisoning;
toxic poisoning;
injury to the mucous membrane by foreign objects;
abuse of strong drinks;
abuse of hot, salty, spicy foods;
abuse of sweet carbonated drinks;
drinking energy drinks;
lack of physical activity.

If multiple aspects are not met, it is optimal healthy life Duodenitis of the 12 duodenum acquires chronic forms. In this case, the patient is shown constant diet and abstaining from a number of foods, such as alcohol, soda, chocolate and coffee.

The disease can also appear as a result hormonal imbalance. Most often this problem occurs in childhood. Therefore, it is recommended that parents of children who suspect gastrointestinal problems undergo comprehensive examination at least once every six months.

Important: Duodenitis of the duodenum often appears due to infection with the pathogenic bacterium Helicobacter pylori, despite the fact that this bacterium is usually a companion to gastritis.

Diagnostics

Diagnosis of the disease is carried out by a gastroenterologist. It necessarily includes taking an anamnesis, examination, palpation, and familiarization with the patient’s medical history. Thus, the doctor, having received complete information about the disease, when the first symptoms began to appear and how actively it manifests itself.

After this, analyzes are collected, namely:

general blood test (biochemistry);
coprogram;
Analysis of urine.

Additionally, the patient may be prescribed probing if the cause cannot be found pain straightaway. If symptoms continue to worsen, the patient is scheduled for a biopsy.

Therapy

As data from the tests is received, the doctor prescribes to the patient necessary treatment. Therapy is selected strictly individually, based on the indications and characteristics of the human body. Taking into account all indicators, they are assigned separately - drug therapy, physiotherapy, as well as some traditional methods of treatment (if there is such a need).

Also, the patient must adhere to a diet. The diet is developed taking into account the patient’s personal needs, tolerance and intolerance to certain foods. It is worth noting that dietary nutrition is a key point in the patient’s recovery.

Important: To develop a balanced and useful dietary nutrition you need to visit a nutritionist. This way the diet will bring more tangible results.

Medication

Drug treatment of the duodenum is prescribed based on the cause that provoked the development of the inflammatory process. So the treatment might look like this:

For an anti-inflammatory effect, the patient is prescribed special enveloping drugs - de-nol, almagel, maalox, phosphalugel.
When helminths and giardiasis are detected, effective chemotherapy is necessary - Chloxin, Flagyl.
when identifying pathogenic bacteria the patient must undergo a course of antibiotics. At the same time, it is recommended to take drugs that restore the microflora.
with increased acidity, antacids and agents that reduce the production of hydrochloric acid - omeprazole, ranitidine - are recommended.

During your appointment medications Be sure to check the instructions for them. Increasing or decreasing the dose on your own may lead to not just a lack of effect, but also the possibility of developing complications.

Important: If there is no effect from taking the pills, you should consult your doctor again. In the future, he will replace the existing drugs with more suitable ones. A complete change in treatment tactics is also possible.

Traditional methods

In the treatment of duodenitis, the presence of traditional methods treatment. They are relatively safe for almost everyone with any health condition. In addition, they provide truly worthwhile and effective results.

Shows excellent results in the treatment of duodenitis:

Freshly squeezed vegetable juices perform well - potato, carrot. During the treatment period, it is strongly recommended to drink the required amount of water and green tea (without sugar).

Before using any folk remedies, it will not be superfluous to obtain a preliminary consultation with a doctor.

Prevention

Prevention of duodenitis is directly related to how a person arranges his lifestyle. Successful treatment disease and the guarantee of its non-recurrence are as follows:

proper and balanced nutrition;
presence of regular physical activity;
giving up alcohol and smoking;
absence of stressful situations and depression;
comfortable and loose clothing;
lack of excessive physical activity;
timely treatment of the first signs of the disease.

In the presence of a chronic form of duodenitis, a constant diet is necessary, as well as regular examinations by a doctor, which will help identify progression and promptly prevent the disease.