Duodenitis is an inflammation of the lining of the duodenum. Such a disease is one of the most common lesions of this organ, which has been observed at least once in almost every tenth person. The disease has no age restrictions, which is why it is often diagnosed in children. However, gastroenterologists noted that such a disease occurs several times more often in males.

Inflammation of the duodenum has several causes, depending on which the disease is divided into primary and secondary. In most cases, unhealthy lifestyles, as well as various gastrointestinal disorders, become predisposing factors.

As for the symptoms, its expression depends on the form of duodenitis, as well as the disorder that caused such an ailment. The main, and often one of the first signs, is a strong pain syndrome.

Only a gastroenterologist can establish the correct diagnosis, after performing a series of laboratory and instrumental tests. Therapy of such a disease also depends on the nature of its course, but preference is given to conservative methods. These include taking medications and maintaining a sparing diet. Surgical intervention is required only in extremely severe cases.

Etiology

The causes of duodenitis are quite diverse, but contribute to the appearance of such a disease in both adults and children. Primary duodenitis can be caused by factors such as:

• poor nutrition, in particular the consumption of large amounts of fatty and spicy foods. In addition, regular drinking of strong coffee is often a source of such an ailment;
• prolonged exposure to stressful situations;
• maintaining an unhealthy lifestyle, namely addiction to alcohol and nicotine;
• a person has an allergic reaction to any product;
• hormonal imbalance;
• chemical poisoning;
• regular intake of medications for no apparent reason or with non-compliance with the dosage prescribed by the doctor.

If the above factors affect the body for a long period of time, they lead to impaired blood circulation in the organs of the digestive system. Against this background, immunity decreases, which entails the development of inflammation of the duodenum.

Experts noted that primary duodenitis is several times less common than secondary, which develops due to the occurrence of another pathology of the gastrointestinal tract. The formation of secondary duodenitis is facilitated by:

• pathological influence of the bacterium Helicobacter pylori or other microorganisms;
• different nature;
• ulcerative lesions of the 12 duodenal ulcer;
• chronic forms of ailments of organs such as the liver and pancreas;
• cholelithiasis or inflammation of the gallbladder;
• hepatitis of viral etiology;
• malignant neoplasms or cancer metastasis to the gastrointestinal tract.

Duodenitis in children has several specific factors of occurrence. These include:

• incompletely formed duodenal apparatus;
• incorrect location of this organ;
• damage to the initial section of the intestine by a foreign object.

Classification

In the field of gastroenterology, there are several varieties of inflammation of the duodenum 12. The first of them distinguishes two forms of the course of the disease:

• sharp- is characterized by a sudden and vivid manifestation of symptoms, which, if detected in the early stages, can be eliminated within a few days, often thanks to dietary therapy. Acute duodenitis can be caused by bad habits and malnutrition;
• - is a consequence of untimely treatment of the previous form, and is also formed due to the chronic course of diseases associated with other organs of the gastrointestinal tract. The basis of therapy is the use of medications, and during the period of remission, compliance with a sparing menu.

Depending on the factors of occurrence, primary and secondary duodenitis are distinguished.

According to the endoscopic picture, inflammation of the duodenum is divided into:

• atrophic duodenitis- in which there is a thinning or death of the cells of the mucous membrane of the affected organ, which causes a violation of the secretion of digestive juices;
• hemorrhagic- characterized by the detection during the diagnosis of duodenal bleeding;
• erythematous- expressed by significant swelling and severe redness of the mucosa;
• or hypertrophic duodenitis- accompanied by the appearance of erosion, of various amounts and depths;
• nodular;
• hyperplastic duodenitis- characterized by increased division and proliferation of mucosal tissues. During endoscopic examination, a bumpy surface of the shell is noted;
• reflux duodenitis- during which there is a reverse reflux into the duodenum of the contents of the small intestine.

As the disease process spreads, such a disorder is divided into the following types:

• or catarrhal duodenitis- characterized by a slight inflammation of the upper layers of this organ;
• proximal duodenitis- the complete opposite of the previous form, since inflammation spreads to the deeper layers of this organ, and the bulb of the duodenum is also involved in the process;
• distal duodenitis- almost completely similar to the proximal one, the only difference is that the bulb is almost unchanged;
• total or diffuse- with damage to the entire surface of the mucosa;
• focal duodenitis or limited- during the diagnosis, it is expressed by one or more foci of inflammation in various parts of the duodenal membrane;
• papillitis- this condition is said when the inflammatory process affects the major duodenal papilla.

In addition, there are several specific and most rarely encountered types of inflammation of the duodenum 12. These include:

• tuberculous duodenitis;
• immunodeficient;
• caused by Whipple's or Crohn's disease;
• fungal;
• follicular duodenitis;
• consequence of intestinal amyloidosis.

Symptoms

Signs of duodenitis completely depend on the causes of such a disease, as well as the presence of concomitant ailments. Such a disorder can often be confused with, and hepatic colic, which is why only a specialist can make an accurate diagnosis.

One of the very first symptoms of the disease is pain, which, depending on the form of inflammation, can have a different character and location. Thus, pain in duodenitis differ in manifestation and causes of formation:

• with obstruction of the duodenum, they have a paroxysmal character, and can also be bursting, often expressed with intestinal overflow;
• in cases of involvement in the pathology of the papilla of the duodenum, the localization of acute pain will be the region of the left or right hypochondrium;
• in chronic course - dull pain spasms, aggravated after eating;
• if the cause of the formation was, then the pain is expressed about an hour after the meal;
• in cases where infection with bacteria has occurred, patients complain of arising on an empty stomach.

Other symptoms of inflammation of the duodenum include:

• severe weakness and rapid fatigue of the body;
• increase in body temperature;
• attacks of nausea, in the vomit there are impurities of bile;
• the appearance of a characteristic rumbling in the abdomen;
• increased gas emission;
• violation of the stool, which is manifested by diarrhea;
• decrease or complete lack of appetite, since it is after a meal that some symptoms are expressed;
• eructations with a bitter, sour and unpleasant smell;
• the acquisition of the skin and mucous membranes of a yellowish tint;
• severe headaches and dizziness;
• rapid pulse;
• an increase in the size of the abdomen.

In addition, children have increased moodiness, decreased mental abilities and severe irritability. Elderly patients often have an asymptomatic course of the disease, especially its mildest form - catarrhal duodenitis.

Diagnostics

Establishing the correct diagnosis requires a comprehensive examination and the implementation of laboratory and instrumental studies. But before their appointment, the specialist performs several manipulations:

• studies the patient's life history and medical history - this is necessary to find out possible predisposing factors for the occurrence of such a disorder;
• a thorough questioning and physical examination, which necessarily includes palpation of the entire surface of the anterior wall of the abdominal cavity - this will enable the doctor to preliminarily establish the form of duodenitis.

Laboratory methods for diagnosing include a complete blood count and microscopic examination of feces. Do this to detect anemia and other signs of bleeding.

However, the basis for the diagnosis of duodenitis is instrumental examinations, which include:

• FGDS - endoscopic examination of the inner surface of the digestive tract. Such a procedure with accuracy allows you to make a diagnosis and identify the nature of the course of the disease;
• biopsy - performed during a previous examination. It is a collection of a small piece of the affected organ for subsequent microscopic studies;
• radiography using a contrast agent;
• study of the acidity of gastric juice.

Only after such diagnostic methods can a gastroenterologist prescribe the most effective tactic for eliminating such a disease.

Treatment

Therapy of duodenitis is aimed at reducing the manifestation of symptoms, restoring the normal functioning of the affected organ and normalizing digestion.

In most cases, conservative treatment is indicated, which involves taking medications, such as:

• antibacterial drugs;
• antispasmodics;
• antacids;
• prokinetics.

Each patient is selected individually.

In addition, the main part of conservative therapy is the observance of a sparing diet. The use of the basic rules of the diet table No. 1 and 5 is shown. A complete list of allowed products, as well as an approximate menu, is provided only by the attending physician.

Surgical intervention is extremely rare. The main indications are:

• suspicion of a malignant tumor;
• serious condition of the patient;
• the presence of hemorrhages;
• exacerbation of the disease that caused the formation of duodenitis;
• inefficiency of conservative methods.

Complications

If symptoms are ignored, treatment is started late, or the course of inflammation of the duodenal membrane is chronic, there is a possibility of the formation of complications such as:

• inflammation of the serous membrane of this organ;
• extensive bleeding;
• ulcerative lesions of the stomach or duodenum;
• narrowing of the pylorus of the stomach;
• insufficiency of duodenal hormones;
• purulent inflammation of the tissues surrounding the duodenum.

But, despite the high likelihood of such complications, the prognosis of duodenitis is favorable. If the disease is detected in the early stages, a complete cure is achieved.

There is no specific prevention for this disorder. It is only necessary to lead a healthy lifestyle, eliminate gastrointestinal diseases in a timely manner, follow nutritional recommendations, and also undergo preventive examinations by a gastroenterologist several times a year.

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

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

Duodenitis: what is this disease?

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

• The secretory function is to mix the chyme with digestive juices that enter the intestine from the gallbladder and pancreas.
• The motor function is responsible for the movement of the food gruel.
• The principle of the evacuation function is to evacuate the chyme to the subsequent sections of the intestine.

As practice shows, acute inflammatory processes of the duodenum in 94% of cases acquire a chronic form of the course.

Duodenitis can be an independent disease or be 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, gallbladder, 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. Manifested by multiple clinical types:

• gastritis-like;
• ulcer-like;
• cholecystic;
• pancreatic;
• mixed and asymptomatic.

Causes

The main causes of duodenitis in most cases are the bacterium Helicobacter Pylori (Helicobacter pylori), improper 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, the use of products 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 disposing factors that, acting for a long 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 certain medicines.

Acute duodenitis: what is it?

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

In acute duodenitis, the pain is intense, sharp, occurring more often two to three hours after eating or at night (hungry pains). If duodenitis is combined with gastritis with high acidity of the stomach, pain may occur as early as 15-20 minutes after eating. Such clinical forms are called ulcerative and gastritis-like.

With proper therapy and diet, it is possible to get rid of it in a few weeks. If the inflammation occurs again, there is a high probability that the disease will become chronic. According to statistics, this happens in 90% of cases.

Chronic duodenitis

The course of chronic duodenitis (CD) is characterized by a variety of clinical symptoms that make it difficult to make a correct diagnosis. 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 is manifested by dyspeptic disorders, then it is initially misdiagnosed as gastritis.

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

1. During an exacerbation, the patient complains of headache, general malaise, irritability, and poor sleep.
2. After 2-2.5 hours after eating, some patients experience increased heart rate, sweating, shortness of breath, weakness and dizziness.
3. There is a significant weight loss or excessive fullness of the patient.
4. In addition, there are pronounced cardiovascular and neuropsychiatric disorders.

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

Superficial duodenitis

What it is? Superficial duodenitis is an inflammatory process that affects the duodenal mucosa, causing the intestinal wall to swell and thicken significantly. In addition to organic changes, the functional capabilities of the organ are violated, motor and enzymatic functions change. Sometimes edema 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. In advanced stages, the pain of the stomach and intestines may increase at night;
• general fatigue and apathy, may even develop;
• permanent violation of the stool: diarrhea or constipation.

atrophic

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

interstitial

No gland damage.

Erosive and ulcerative

It differs by a superficial defect of the intestinal mucosa due to erosive lesions. In addition to external factors, surgical interventions on internal organs, sepsis, thrombotic lesions of the veins, diseases of the central nervous system and blood can be a catalyst for development.

hyperplastic

Manifested by excessive growth of tissue.

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

Symptoms of duodenitis in adults

Duodenitis can begin both suddenly and gradually. Often it manifests itself after some kind of dietary excess, alcohol consumption, stress. Symptoms of duodenitis depend on the cause of the development of the disease and concomitant pathologies of the digestive system. The disease is often "disguised" as gastritis, hepatic (biliary) colic, which makes it difficult to make a diagnosis.

The main symptoms of duodenitis are:

• dull 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 eructation;
• heartburn;
• nausea, sometimes with vomiting;
• constipation;
• weakness, general malaise;
• increased body temperature;
• dyspepsia.

If symptoms appear, consult a doctor and strictly follow his instructions! Do not self-medicate to prevent the transition of the disease to the chronic stage.

Complications

If you do not seek medical help in time or do not follow the diet for chronic duodenitis, serious complications are possible. Inflammation can spread to all layers of the intestinal wall and even affect the peritoneum. In this case, periduodenitis develops, leading to severe violations of the digestive processes, pain becomes constant, and treatment is very difficult.

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

Diagnostics

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

If during the diagnosis the doctor suspects malignant tumors 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 research methods:

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

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

Treatment of duodenitis

In adults, the treatment of duodenitis includes several areas:

• elimination of acute inflammation
• preventing the transition of the disease to the chronic stage
• restoration of the functions of the duodenum 12
• normalization of digestion

How to treat acute duodenitis?

Treatment of duodenitis with gastritis in the acute phase in the early days involves gastric lavage, strict bed rest and hunger. After that, it is necessary to treat the disease with the help of anticholinergic and antispasmodic drugs, enveloping and astringent drugs. Be sure to follow the diet for duodenitis No. 1.

How to treat chronic duodenitis in adults?

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

• antibiotics (to fight Helicobacter pylori);
• enveloping preparations - means "Sulfakrat";
• enzymes;
• chemotherapy drugs (if any);
• drugs that reduce acidity (for example,);
• drugs that reduce the secretion of hydrochloric acid (tablets "Ranitidine").

Spasmolytic drugs to relieve spasms:

• Drotaverin (Bespa, No-shpa, Spazmoverin, Spazmol)
• Papaverine Hydrochloride (Papaverine)
• Antacids (decreased stomach acid)
• Diamond (Simagel)

An individual scheme of pharmacological therapy is selected for each patient, depending on the form and clinical features of the disease.

As a rule, all necessary activities are carried out at home. To speed up recovery, it is recommended to avoid stress, give up alcohol and smoking. The patient needs proper rest and sleep, light physical activity and walks. During the period of remission, patients with duodenitis are shown spa treatment.

The prognosis with regular monitoring and timely treatment is favorable, with duodenitis caused by duodenostasis, after measures aimed at eliminating stagnation, inflammatory symptoms subside and, as a rule, cure.

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

Nutrition and diet

With duodenitis, the patient is prescribed a diet, usually diet No. 1 (according to Pevzner), which excludes the use 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 they are transferred to 4B. During the period of remission, you can apply diet number 15.

The use of products such as:

• products that have an enveloping effect on the mucous membrane of the stomach and duodenum - flaxseed, oats, potato and corn starch,
• cereal and pureed soups,
• low-fat varieties of meat and fish, better in the form of cutlets, meatballs and meatballs,
• omelet, dairy dishes,
• baked fruits, stewed vegetables,
• stale bread, crackers,
• butter and vegetable oil in a small amount.

Boiled foods are allowed. They must necessarily be warm, as cold can aggravate spasm and motor disturbances (clinically, the patient will resume or increase pain).

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

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

Foods 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 diet for the day can be adjusted at your discretion, including more of your favorite allowed foods.

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

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

Folk remedies

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

1. Chamomile tea is best consumed more than twice a day. It is best to drink it chilled. The drink is distinguished by its ability to soothe the internal organs and reduce inflammation.
2. 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 in the amount of 3 large spoons 3 times a day. This remedy is especially effective for erosive duodenitis.
3. Pour 2 tablespoons of herbs St. John's wort perforated with 1 cup boiling water, close the lid, heat in a water bath for 30 minutes, leave for 15 minutes, strain. Drink 0.3 cups 3 times a day 30 minutes before meals with duodenitis.
4. For the treatment of the erosive form of the disease, it is recommended to use the following recipe: a teaspoon of flax seeds is poured with a glass of boiling water and infused for about 15 minutes. It is recommended to take the healing composition on an empty stomach one hour before breakfast. Flax treatment lasts about a month.
5. 30 g of peppermint leaves and lemon balm, 40 g of chamomile flowers. Insist. Drink a glass half an hour before meals.

Prevention

Prevention of duodenitis includes the following preventive measures:

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

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

There are acute and chronic forms of the disease. Acute duodenitis often occurs with poisoning and eating spicy foods, manifested by inflammation of the mucous membrane, the development of erosion (a superficial defect of the epithelium that heals without scarring) less often - phlegmonous cavities filled with pus. The disease is manifested by digestive disorders, pain syndrome. If you follow a diet and doctor's prescription, you can recover in 1-2 weeks. With the recurrence of duodenitis, the risk of chronicity is 90%.

Chronic duodenitis develops against the background of a chronic pathology of the digestive tract (gastritis, stomach ulcers, pancreatitis), with prolonged violation of the diet. Gradually, atrophy of the mucosa (atrophic duodenitis) or its erosion (erosive duodenitis) develops. Under the action of provoking factors, an exacerbation of the disease occurs. Treatment is longer than in the acute form.

Structure

After the pylorus, the duodenum follows. She, 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 of the abdominal cavity is carried out due to connective tissue fibers. The duodenum is located in the projection of the XII thoracic - III lumbar vertebrae.

Divisions: upper (bulb or ampulla), descending, horizontal, ascending. The mucosa of the bulb is provided with longitudinal folds, the rest of the departments are transverse. When they contract, a lump of food moves into the jejunum.

A large or Vater's nipple opens into the duodenum cavity. It is formed by the confluence of the main pancreatic duct and the common bile duct. The papilla of Vater has a sphincter that regulates the flow of bile and pancreatic juice into the intestine. The small nipple is located in the area of ​​the outlet of the accessory pancreatic duct.

Functions

The duodenum performs several functions:

1. Neutralization of acidic gastric contents. The food lump, mixed with acidic gastric juice, is neutralized in an alkaline environment. Due to this, there is no irritation of the intestinal epithelium.
2. Regulation of the formation of digestive enzymes, bile, pancreatic juice. In the duodenum, the contents are analyzed and the proper command is transmitted to the digestive glands.
3. Relationship with the stomach: the duodenum ensures the opening and closing of the pylorus, the entry of a new portion of the food bolus into the small intestine. This happens as the next amount of gastric contents is neutralized in the duodenal cavity.

What causes acute duodenitis

The reasons leading to the development of duodenitis:

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

What causes chronic duodenitis

Causes leading to the appearance of chronic duodenitis:

1. Pathology of the intestine, leading to a deterioration in 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 of the intestine.
2. Chronic gastritis with high acidity causes acid damage to the intestinal epithelium with the gradual development of its atrophy. Formed gastritis-duodenitis.
3. An anomaly of the liver, gallbladder and pancreas leads to a violation of the release of enzymes into the lumen of the duodenum 12, which impairs its functioning.
4. Regular violation of the diet and diet.
5. food allergy.
6. Prolonged stress.
7. The use of a large number of drugs.
8. The presence of 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:

• Pain in the epigastric region, aggravated by palpation (palpation) of the abdomen. The pain has its own characteristics in various forms of duodenitis:
  • in the chronic form - constant, aching, aggravated on an empty stomach and 1-2 hours after a meal;
  • with duodenitis caused by a violation of intestinal patency, the pain is arching, paroxysmal, 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 intestine;
  • for the ulcer-like form caused by Helicobacter pylori, fasting pains are characteristic;
  • with local inflammation around the Vater nipple, the outflow of bile from the gallbladder is disturbed, a clinic similar to an attack of hepatic colic occurs: pain in the right hypochondrium.
• Increased fatigue, weakness. This is due to the action of toxic substances formed in the process of inflammation.
• Perhaps a slight increase in body temperature (up to 37-38 0).
• Digestive disorders (dyspepsia):
  • nausea;
  • loss of appetite;
  • increased gas formation (flatulence);
  • belching, vomiting with a bitter taste (due to bile ingestion) - throwing food back into the stomach;
  • stool 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 entry into the blood.
• Dumping is a syndrome. Occurs after a large meal. When the duodenum overflows, 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, fever in the upper body.

With an asymptomatic course of the disease, there may be no complaints, the detection of pathology is an accidental finding during gastroduodenoscopy.

Diagnostics

The diagnosis of duodenitis is made in the presence of a combination of data:

1. Presence of characteristic complaints described above.
2. Inspection. On palpation (feeling) of the abdomen, there is pain in the projection of the duodenum.
3. Instrumental examination data:

• FGDS (fibrogastroduodenoscopy) - a scopic examination of the stomach cavity, duodenum. In the presence of duodenitis, characteristic signs are determined: (mucosal edema, redness). Each form of duodenitis is characterized by its own characteristics of FGDS - pictures:
  • a) with catarrhal (or superficial) duodenitis - uniform reddening of the epithelium;
  • b) the presence of erosion - with an erosive form;
  • c) the smoothness of the folds indicates a decrease in intestinal tone;
  • d) nodules on the mucosa - about the nodular form;
  • e) hemorrhages - about hemorrhagic;
  • f) atrophy of the epithelium - about atrophic.
• X-ray contrast study - conducting fluoroscopy or graphy after the patient has consumed a contrast agent (barium sulfate). With such a study, it is possible to identify gross violations in the structure and functioning of the organ; restructuring of the mucosa in this way cannot be detected. In the pathology of the duodenum, 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 intestines, a violation of the passage of food, nervous regulation;
  • c) a symptom of a niche is observed with erosion, ulcers;
  • d) with mechanical obstruction, an accumulation of gases is detected;
  • e) smoothness of folds - with edema, inflammation;
  • e) reflux - reflux of contents from the duodenum back into the stomach.

1. Laboratory data:

• in a general blood test, an increase in ESR can be determined, indicating inflammation and anemia, as a sign of internal bleeding;
• biochemical blood test: in the initial stages of duodenitis, an increase in enzymes (eterokinase and alkaline phosphatase) will be noted, in the future their activity decreases;
• analysis of feces for occult blood (will be positive in the presence of bleeding, may be with an erosive form).

Features in children

Young children cannot localize the pain correctly, they most often just point to the stomach and say that it hurts. The most common symptoms include malaise, weakness, abdominal pain, nausea, belching, heartburn, and constipation. Exacerbation of duodenitis is more common in autumn and spring. In older children (from 10 years of age or more), the clinical picture does not differ significantly from adults.

The treatment is complex. If helminthiasis has become the cause of duodenitis, deworming is an obligatory component.

Treatment

The main tasks in the treatment of duodenitis:

• elimination of inflammation;
• prevention of process chronization;
• normalization of the duodenum;
• 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 regime of work and rest;
• avoid stress;
• give up bad habits (smoking, alcohol).

Indications for inpatient treatment:

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

Treatment components:

• medical 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 the diet, relapses of the disease will occur again and again.

With an exacerbation of the chronic form or about. duodenitis for the first 3-5 days, table 1a according to Pevsner should be observed. The same diet is used to treat exacerbation of stomach ulcers. It is allowed to eat mucous cereal decoctions (rice, oatmeal), pureed soups, liquid cereals with half milk (first, the cereal is boiled in water, so it swells faster and becomes more mucous, 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 eating

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

meal	Recommended meals
1st breakfast	Buckwheat porridge cooked in half milk (buckwheat - 50, milk and water - ½ cup each, butter - 10), milk - 1 cup
2nd breakfast	Milk - 1 glass
Dinner	Milk cereal soup (oatmeal - 40, milk - ¾ cup, eggs - ¼ pieces, butter - 10, sugar 2, water - 1¾ cups), meat puree (lean boiled beef - 100, milk - 1/4 cup, butter - 10), dried apple compote (water - 200, dried apples - 20, sugar - 15)
afternoon tea	Milk - 1 cup, soft-boiled egg
Dinner	Rice porridge cooked in 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 number 1;

• gastritis-like option - table number 2;

• pancreatitis and cholecysto - a similar form - table number 5.

• boiled lean meat, scrolled 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 cooked in the form of an omelet;
• fats (butter, vegetable oil);
• juices;
• yesterday's bread and crackers (easier to digest than fresh pastries);
• natural sweets (honey, mousse, jelly).

Prohibited foods that stimulate gastric secretion containing indigestible fibers:

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

1. You should eat fractionally, in small portions, 4-6 times a day. You should not wait until hunger strikes to eat, otherwise "hunger pains" may occur.
2. Food should be warm, but not hot or cold.
3. A gentle method of preparation is preferable, in order to exclude irritation of the duodenum mucosa. These are soups, cereals, steam dishes.
4. Avoid overeating, eating at night.

Folk methods

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

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

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

Recipes for the preparation of medicinal potions for duodenitis:

• 2 tbsp. tablespoons of St. John's wort raw materials are poured into 200 ml of boiling water, heated in a water bath for 0.5 hours, insisted for 15 minutes, filtered, drunk 1/3 cup 3 times a day 0.5 hours before meals;
• 3 art. tablespoons of plantain juice are mixed with 1 teaspoon of honey, take 1 tbsp. spoon 3 times a day before meals;
• 50 g of propolis is poured with 2 cups of alcohol, the resulting mixture is put in a dark place for 3 weeks to infuse, taken without 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, ¼ cup of aloe juice is added to the broth. Drink ½ cup 3 times a day;
• 1 teaspoon of flax seeds is poured with 1 cup of boiling water, insisted 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 insisted for a week in a glass jar, take 1 tbsp. spoon on an empty stomach.

Medical therapy

How to treat duodenitis? In accordance with the form of the disease, various combinations of groups of drugs are used:

medicinal group	Mechanism of influence	Representatives	How to apply
PPI - 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	With infection, detection of Helicobacter pylori.	doxycillin	2 times a day, 7-10 days.
		Clarithromycin 500 mg Amoxicillin 1000 mg Metronidazole 500 mg	2 times a day, 7-14 days.
H2 - histamine blockers	Suppress release of HCl.	Ranitidine	0.15 - 2 times a day, course 1 - 1.5 months.
		famotidine	0.02 g - 2 times
Antacids	Neutralize with HCl. Envelop the mucosa, have a local anesthetic effect.	Almagel Maalox Gastal	For heartburn, up to 3 times a day.
Prokinetics	Regulate peristalsis, help promote the food bolus	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 spasm, relieve pain	No-shpa (drotaverine) Platifillin Duspatalin	1 tablet - 3 times.
Sedatives	Calming effect	Valerian tablets, motherwort	The course is 10-14 days.

Separately, it is worth touching on the drug De-nol. It combines antacid, antibacterial (directed against Helicobacter pylori), anti-inflammatory, astringent action, protects the duodenum mucosa, promotes its recovery. Adults take it 1 tablet 4 times a day (3 times after meals, 4th - at night). The drug is washed down with water (it is impossible to drink 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. In the presence of Helicobacter pylori, antibiotics are mandatory. If the disease is provoked by exposure to stress, sedatives are connected. With an increase in acidity, one cannot do without antacids, PPIs, histamine blockers.

Physiotherapy

Apply magnetotherapy, ultrasound, phonophoresis.

Application of mineral waters

Low-mineralized alkaline waters that do not contain carbon dioxide are used: Borjomi, Essentuki No. 4, Smirnovskaya No. 1, Slavyanovskaya, Luzhanskaya, Berezovskaya. Before use, mineral water is slightly heated, gases are released. Take 1-1.5 hours after eating.

All these methods of treatment together help to remove the manifestations of inflammation, to achieve a stable remission of duodenitis.

Good day, dear readers!

In today's article, we will consider with you such as - duodenitis, as well as its symptoms, causes, types, diagnosis, treatment, folk remedies, as well as the prevention of duodenitis. So…

What is duodenitis?

Duodenitis- an inflammatory disease of the duodenum, mainly its mucous membrane.

The danger of duodenitis is that the duodenum (Latin duodenum) is one of the most important organs in the digestive system, which immediately follows the stomach, and is the initial section of the small intestine. Food in the duodenum is processed by pancreatic juice and prepared for absorption. In addition, the duodenum is involved in the production of hormones that regulate the normal functioning of the digestive system and metabolism. Duodenal disease leads to a number of disorders of the entire digestive system, including deadly diseases, for example -.

Some doctors refer "duodenitis" to a group of diseases united by the name - "".

The main symptoms of duodenitis are - pain in the right side of the abdomen, grumbling in the abdomen, lack of appetite.

The main causes of duodenitis in most cases are the bacterium Helicobacter Pylori (Helicobacter pylori), improper location of the organ and a violation of the production of hormones by the intestine.

According to the form, acute and chronic duodenitis are distinguished, which in turn are also divided into various types of the disease. But the most dangerous thing is chronic duodenitis, because over time, if you do not take the necessary measures to treat this disease, it contributes to destructive changes in the structure, and, accordingly, the functionality of the duodenum.

Development of duodenitis

The development of inflammatory processes is due to two factors: the first is pathology in the intestine or its weakening due to various pathological processes (alcohol, unhealthy foods, stress, etc.), the second is the effect of an irritating or infectious factor on the weakened place of the intestine (gastric juice, bacteria, etc.).

Thus, when the duodenum is weakened, it is more susceptible to the negative effects of acidic gastric juice, bacteria, and other factors that, in the normal state of this organ, cannot harm it. The integrity of the mucosa is broken, the same gastric juice, which by its very nature of digesting food has high acidity, begins to “corrode” the mucous layer of the intestine. Toxins produced by the bacterium Helicobacter pylori can also increase the amount of acid in the intestine.

The combination of these processes, if they are not stopped at this stage, contribute to the complications of duodenitis, which can be expressed in dystrophic changes in the structure of the walls of this organ, and then, perforation of the intestinal walls, internal bleeding, etc.

Statistics

According to statistics, it is noted that most often, inflammatory disease of the duodenum duodenitis is observed in men, and it develops in many cases in childhood. In addition, as practice shows, acute inflammatory processes of the duodenum in 94% of cases become chronic.

Duodenitis - ICD

ICD-10: K29.8
ICD-9: 535.6

Symptoms of duodenitis

The main symptoms of duodenitis are:

• dull constant or in the right hypochondrium, which increases at night, with an empty stomach or palpation;
• lack of appetite;
• feeling of fullness in the abdomen, especially after eating;
• bitter eructation;
• , sometimes with ;
• , general malaise;
• dyspepsia.

Important! In the elderly, duodenitis often occurs in a secretive form, i.e. asymptomatic, so it causes all the same harm to human health.

Complications of duodenitis

Complications of duodenitis may be accompanied by the following symptoms:

• perforation of the wall of the duodenum 12;
• intestinal bleeding;
• acute pancreatitis;
• yellowing of the skin;
• dystrophy of the duodenum;
• disorders in the autonomic and central nervous systems.

Causes of duodenitis can be:

• Improper location of the duodenum in the body;
• Weakness of the hormonal apparatus of the duodenum;
• Violation of the motor function of the duodenum (duodenostasis);
• Infection of the organ with the bacterium Helicobacter Pylori;
• Violation of the diet;
• The use of spicy, sour, fried, fatty and smoked foods;
• Abuse of alcoholic and caffeinated drinks, smoking;
• Uncontrolled intake of certain medications, such as non-steroidal anti-inflammatory drugs (NSAIDs - "Aspirin", ""), antibiotics;
• Violations in the functionality of the intestine: violations of its blood supply, trophism, tissue respiration;
• Others - the liver (,), pancreas (), intestines (), gallbladder, mesentery.

Types of duodenitis

Duodenitis is classified as follows ...

By shape

Acute duodenitis. It usually proceeds in an acute form, with acute attacks of pain, especially with a long period of time between meals, as well as with the use of spicy, sour, fried, smoked. Often accompanied by inflammatory processes in the stomach and intestines. It often ends in self-healing, but with repeated attacks it usually becomes chronic.

Chronic duodenitis. A very diverse form of the disease, both in etiology and in symptoms. The main symptom is dull and dull pain, pursuing the patient throughout the entire period of inflammatory processes, sometimes intensifying. All the types of duodenitis listed below will more accurately characterize the chronic form of this disease.

According to the endoscopic picture:

Atrophic duodenitis. It is characterized by the suppression of activity, incl. motility of the duodenum 12, the mucous membrane of which becomes thinner in this form of the disease.

Hemorrhagic duodenitis. It is characterized by the appearance of bleeding in the intestine, which later can leave the body along with feces or vomit. The main causes of the development of the disease are considered to be the use of substances that strongly irritate the intestinal mucosa - drugs, alcohol, acids.

Interstitial duodenitis. It is characterized by the absence of processes of atrophy of the glandular part of the intestine.

Catarrhal duodenitis. It is characterized by severe acute pain in the abdomen, nausea and vomiting, general weakness and. The main reason is damage to the intestinal mucosa with coarse or irritating food - alcohol, spicy, salty, fried, sour, smoking. Treatment usually comes down to a sparing diet.

Superficial duodenitis. Inflammatory processes develop mainly on the surface layers of the mucous membrane of the duodenum 12.

Phlegmonous duodenitis. It is characterized by an acute purulent lesion of the lower part of the duodenum, in the region of the Vater (large) papilla, against the background of a weakened organism.

Erythematous duodenitis. It is characterized by general weakness, paroxysmal pain in the abdomen, sometimes the work of the respiratory and cardiovascular systems is inhibited. It usually develops against the background of a long course of inflammation of the intestinal mucosa and other organs of the gastrointestinal tract.

Erosive and ulcerative duodenitis. It is characterized by the appearance of ulcerative and erosive formations on the mucosa of the organ.

According to clinical manifestations:

Chronic bulbar duodenitis with acidopeptic genesis. It is characterized by damage to the mucous membrane of the duodenal bulb. It is often accompanied by peptic ulcers of the stomach and duodenum. Pain is usually paroxysmal, worse on an empty stomach or after eating junk food (spicy, smoked, etc.), at night, and also during palpation of the epigastric region of the abdomen.

Chronic duodenitis, which develops against the background of a violation of intestinal obstruction (duodenostasis). It is characterized by severe twisting paroxysmal pains, belching, flatulence, grumbling in the abdomen, nausea and in some cases, vomiting with bile;

Chronic duodenitis, accompanied by an atrophic form of gastritis and enteritis. It is characterized mainly by disorders of the digestive system - dyspepsia, pain after taking spicy or smoked food, nausea, heartburn.

Neuro-vegetative duodenitis. It is characterized with a predominance of symptoms, mainly disorders of the nervous system.

Local duodenitis (diffuse), accompanied by the development of peripapillary diverticulitis and / or papillitis. This form of the disease is usually accompanied by a violation of the outflow of bile, which is expressed by yellowing of the skin and whites of the eyes (). The stool is clarified, in severe cases almost white. There are also pains in the epigastric region, with a return to the right or left hypochondrium.

mixed form. The disease is accompanied by all clinical manifestations.

Asymptomatic course. Usually, clinical manifestations are mild, or almost invisible. It occurs mainly in the elderly, during a routine medical examination.

Origin:

Primary. The cause of this form of the disease is usually a violation of the activity of the body as a result of improper diet and lifestyle.

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

Diagnosis of duodenitis

Diagnosis of duodenitis includes the following examination methods:

• Gastroscopy;
• stomach and duodenum;
• Duodenal sanding;
• Biochemical and pH study of gastric juice;
• Fecal analysis (coprogram).

How to treat duodenitis? Treatment of duodenitis depends on the cause and clinical picture of the disease.

Treatment of duodenitis includes the following key points of therapy:

1. Drug therapy
1.1. Antibacterial therapy;
1.2. Removal of helminthiases and giardiasis;
1.3. Normalization of the pH level in the duodenum and stomach;
1.4. Protection of the intestinal mucosa from hydrochloric acid and pathogenic factors;
1.5. Restoration of the mucous membrane and its walls;
1.6. Removal of symptoms and improvement of the activity of the digestive tract;
1.7. Elimination of intestinal obstruction.
2. Diet;
3. Treatment of concomitant diseases.
4. Surgical intervention (if necessary).

Important! If the patient has signs of a complication of the disease, he is subject to urgent hospitalization.

1. Drug therapy of duodenitis (drugs for duodenitis)

Important! Before using drugs, be sure to consult your doctor!

1.1. Antibacterial therapy

Antibiotics are prescribed by a doctor when a pathogenic bacterium Helicobacter Pylori (Helicobacter pylori) is found in the body.

Antibiotics against Helicobacter pylori: penicillins ("Amoxicillin"), macrolides ("Clarithromycin"), tetracyclines ("").

1.2. Removal of helminthiases and giardiasis

Removal of pathogenic microorganisms such as Giardia or helminths (worms) can be done using the following medicines:

Preparations for Giardia (giardia)- "Metronidazole", "Tinidazole", "Furazolidone", "Chloxin";

Preparations for helminths (worms)- mebendazole ("Vermox"), levamisole ("Decaris"), "Diethylcarbamazine".

1.3. Normalization of the pH level in the duodenum and stomach

Restoring the acid-base balance in the duodenum and stomach is a necessary measure to stop pathological inflammatory processes in the digestive organs. This is due to the fact that one of the reasons for the violation of the integrity of the intestinal mucosa is an increased level of hydrochloric acid in them. Acid levels are usually raised by Helicobacter pylori.

To normalize the acid-base balance, antisecretory drugs are used, after the use of which symptoms such as belching, bloating, heartburn, nausea are also removed, and the development of complications of the disease is minimized.

Antisecretory drugs:

Antacids: Almagel, Maalox, Keal, Phosphalugel. This group of drugs neutralizes the increased acidity of gastric juice, thereby preventing its detrimental effect on weakened intestinal walls.

Proton pump and M-cholinergic receptor blockers: Omez, Nexium, Rabelok, Gastrocepin, Pirencepin. These groups of drugs block the proton pump, and also help to reduce the level of production and concentration of hydrochloric acid in the digestive organs.

1.4. Protection of the intestinal mucosa from hydrochloric acid and pathogenic factors

Protection of the mucous membrane of the duodenum is a necessary measure to prevent the development of complications of duodenitis, as well as to accelerate the recovery of this organ. Gastroprotectors are used to protect the mucosa.

Enveloping the intestinal mucosa preparations:"De-nol", "Sukralfat". This group of drugs creates a protective film on the mucosa that protects the organ from infection and increased acidity of gastric juice.

Synthetic analogues of prostaglandin E1: Misoprostol, Cytotec. This group of drugs helps to increase the production of mucus by the digestive organs, which forms the mucous membrane, and also protects it from infection and hyperacidity. In addition, they contribute to the normalization of the body's acid-base (pH) balance.

1.5. Restoration of the mucous membrane and its walls

Drugs that accelerate the recovery of the duodenal mucosa: "Biogastron", "Ventroxol", "Kaved-S".

Drugs that contribute to the restoration of damaged walls of the duodenum 12: "Entrostil".

1.6. Removal of symptoms and improvement of the activity of the digestive tract

Antispasmodics. They are used to relieve pain and spasms of the digestive organs - "Drotaverin", "No-shpa";

Prokinetics. Contribute to the improvement of the activity of the digestive tract - "Itoprid", "", "".

Probiotics. They are used in combination with antibacterial drugs, aimed at preserving the beneficial microflora in the intestines, which is necessary for the normal functioning of the digestive organs - Linex, Bifiform.

Sedatives. They are prescribed for disorders of the nervous system - Valerian, Tenoten.

1.7. Elimination of intestinal obstruction

With duodenitis against the background of duodenal obstruction, treatment is aimed at eliminating obstruction of the duodenum. To do this, probing the intestine with its washing with warm mineral water is periodically prescribed.

At the same time, drugs that bind bile ("Cholestyramine"), antiseptics ("Intestopan", "Enterosediv") and prokinetics "Motilium", "Cerukal" are prescribed.

With duodenitis, the patient is prescribed a diet, usually (according to Pevzner), which excludes the use of foods that irritate the gastric mucosa and duodenum. After the exacerbation of duodenitis subsides, the patient is transferred to or, and in case of reduced tolerance to dairy products, diet No. 4, after which they are transferred to 4B. During the period of remission, you can apply diet number 15.

What can you eat with duodenitis? Nutrition for duodenitis includes: gentle soups from cereals, preferably with the addition of milk or cream, liquid cereals, finely chopped low-fat meats and fish (chicken, turkey), low-fat dairy products (cottage cheese, sour cream, kefir, yogurt, milk, creamy oil), eggs (soft-boiled), white bread, boiled vegetables, compote, jelly, fruit juices rich in tea (especially based on medicinal herbs).

Food is best eaten warm. Cooking method - steam or boil. The number of meals - 5, in small portions.

What can not be eaten with a stomach ulcer? Alcoholic and low alcohol drinks, caffeinated drinks, strong tea, spicy (mustard, pepper), salty, fatty and fried foods, smoked meats, sausages, canned food, raw vegetables and fruits (legumes, cabbage, onions, tomatoes, radish, citrus fruits) , condiments, ketchups, mayonnaise, sauces, ice cream, sweets. Be sure to quit smoking.

3. Treatment of concomitant diseases.

Inflammatory disease of the duodenum duodenitis often develops against the background of other diseases of the digestive system - gastritis, colitis, peptic ulcers and others, therefore, their treatment is a mandatory point of therapy.

4. Surgical intervention (operation) for duodenitis

Surgical treatment of duodenitis is indicated only in some cases, for example:

• Drug treatment did not lead to the necessary results;
• A pathology of the structure of the duodenum was found;
• There were complications of duodenitis: perforation of the walls, bleeding

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

St. John's wort. Pour 2 tbsp. tablespoons of dry chopped grass perforated with 250 ml of water, put it in a water bath, for 30 minutes. Then leave it, let it cool, strain and take 1/3 cup of the product 30 minutes before meals, 3 times a day.

Nettle and oats. Add 200 g of unpeeled oats to the pan and fill it with 1 liter of water, put on a slow fire and cook until a slimy decoction forms. Next, the broth is cooled and filtered. At this time, pour a glass of leaves with 3 cups of boiling water, cover the container for infusion and set aside for 40 minutes, after which the infusion is also filtered. Strained nettle leaves are added to the decoction of oats, and taken 100 ml 3 times a day, before meals. Nettle decoction is drunk as tea during the day.

Plantain. Mix 1 teaspoon with 1 teaspoon of juice. You need to take the remedy with an erosive form of duodenitis, 1 tbsp. spoon 3 times a day, before meals.

- Give up alcoholic beverages, smoking, do not abuse caffeinated drinks;

- Do not leave the disease of the gastrointestinal tract to chance;

- Try not to take medications without a doctor's prescription, because. many of them not only irritate the mucous membrane of the digestive organs, but also suppress the protective functions of the immune system;

- To prevent relapses, try to spend your holidays in thematic sanatoriums and resorts;

Duodenitis- inflammation of the mucous membrane of the duodenum (duodenum). The disease is manifested by acute or pulling pains in the upper abdomen, nausea, vomiting, upset stool.

Duodenitis is the most common disease of the duodenum, with 5-10% of the population experiencing symptoms at least once in their lives. It equally affects representatives of different age groups. In men, it is diagnosed 2 times more often due to addiction to alcohol and an unhealthy lifestyle.

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

Acute duodenitis develops rapidly on the background of poisoning or ingestion of spicy food. It causes superficial inflammation of the mucous membrane, the appearance of ulcers and erosions, rarely phlegmon (cavities filled with pus). The disease is manifested by acute pain and indigestion. With proper treatment and diet, acute duodenitis resolves in a few days. With repeated inflammation, the risk of developing chronic duodenitis is 90%.

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

Anatomy of the duodenum

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

The main pancreatic duct and the common bile duct open into the lumen of the duodenum. In the place of their exit, a large duodenal papilla (vater papilla) is formed. It is a cone-shaped formation equipped with a sphincter. With its help, the flow of bile and pancreatic secretions into the intestine is dosed. There is a small papilla at the outlet of the accessory pancreatic duct.

Functions

• Neutralization of gastric juice. In the duodenum, food slurry mixed with acidic gastric juice acquires an alkaline reaction. Such contents do not irritate the intestinal mucosa.
• Regulation of the production of digestive enzymes, bile, pancreatic juice. The duodenum "analyzes" the composition of food and gives the appropriate command to the digestive glands.
• Feedback from the stomach. The duodenum provides reflex opening and closing of the pylorus of the stomach and the flow of food into the small intestine

Shape and location. The duodenum is located at the level of the 12th thoracic - 3rd lumbar vertebra. The duodenum is partially covered by the peritoneum, and part of it is located behind the peritoneal space. In shape, it resembles a loop or a horseshoe; it can have a vertical or horizontal arrangement.

Parts

• The upper part - the ampulla or bulb is a continuation of the pylorus and, unlike the other parts, has a longitudinal folding.
• Descending part
• horizontal part
• ascending part

The last three sections have transverse folding and differ only in the direction of the bend. Reducing, they contribute to the promotion of food masses in the jejunum. Inflammation can occur along the entire length of the duodenum or in a separate section of it (usually in the upper part).

blood supply The duodenum is provided by 4 pancreaticoduodenal arteries and veins of the same name. The intestine also has its own lymphatic vessels and 15-25 lymph nodes.

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

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

The Brunner glands are located in the submucosal layer, which secrete a thick mucous secretion that neutralizes the aggressive effects of gastric juice and protects the duodenal mucosa. Causes of inflammation of the duodenum

Causes of acute duodenitis

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


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


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

Causes of chronic duodenitis

1. Bowel dysfunction
   • chronic constipation
   • poor peristalsis
   • adhesive processes
   • disruption of innervation
   These pathologies lead to a slowdown in contractions - a deterioration in peristalsis of the duodenum. Stagnation of the contents causes stretching and atrophy of its walls, and also has a bad effect on the condition of the mucosa.
2. Chronic diseases of the stomach. Chronic gastritis with high acidity causes hydrochloric acid to gradually damage the intestinal cells, leading to thinning of the mucosa.


3. Chronic diseases of the pancreas, liver, gallbladder lead to disruption of the entry of enzymes into the duodenum. As a result, the stability of the intestines is disturbed and its protective properties are reduced.

Disposing factors

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

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

Symptoms of duodenitis

Symptoms of duodenitis depend on the cause of the development of the disease and concomitant pathologies of the digestive system. The disease is often "disguised" as a stomach ulcer, gastritis, hepatic (biliary) colic, which makes it difficult to make a diagnosis.

Symptoms of duodenitis

1. Pain in the epigastric region. The pain is aggravated by palpation (palpation) of the abdominal wall.
   • At chronic duodenitis the pain is constant, dull in nature, which is associated with inflammation and swelling of the duodenal wall. The pain intensifies 1-2 hours after eating and on an empty stomach.
   • If duodenitis is associated with violation of the patency of the duodenum, then the pain appears when the intestines are full and is paroxysmal in nature: acute arching or twisting.
   • Local inflammation in the region of Vater's papilla disrupts the outflow of bile from the gallbladder, which is accompanied by symptoms of "renal colic". There is acute pain in the right or left hypochondrium, girdle pain.
   • ulcerative duodenitis, caused by the bacteria Helicobacter pylori. Severe pain appears on an empty stomach or at night.
   • If duodenitis is caused gastritis with high acidity, then the pain occurs after eating after 10-20 minutes. It is associated with the entry into the intestine of a portion of food mixed with acidic gastric juice.
2. General weakness and fatigue are signs of intoxication of the body caused by inflammation products. In acute duodenitis, an increase in body temperature up to 38 degrees is possible.
3. Indigestion. Violation of the synthesis of digestive enzymes leads to fermentation of food in the intestine and its decay. This is accompanied by:
   • loss of appetite
   • nausea
   • rumbling in the stomach
   • increased gas formation
   • diarrhea
4. Bitter eructation, vomiting with an admixture of bile associated with duodenal congestion. Its contents do not pass into the intestines, but are thrown into the stomach - duodenogastric reflux.
5. Jaundice of the skin and sclera with duodenitis due to stagnation of bile and an increase in the level of bilirubin in the blood. This occurs with inflammation of the Vater papilla and narrowing of the bile duct. Bile does not go into the intestines, but overflows the gallbladder and enters the bloodstream.
6. Disorders of the nervous system. Prolonged duodenitis causes atrophy of the mucous membrane and glands that produce digestive enzymes. This negatively affects the absorption of food. The body is deficient in nutrients. To improve digestion, blood flow to the stomach and intestines increases, while the brain and lower limbs are “robbed”. Dumping syndrome develops, the symptoms of which appear after eating:
   • fullness in the stomach
   • feeling of heat in the upper body
   • dizziness, weakness, drowsiness
   • trembling in the hands, ringing in the ears.
   • hormonal deficiency develops, which negatively affects the work of the autonomic nervous system.
   In older people, asymptomatic duodenitis is possible. In this case, the disease is diagnosed by chance during the passage of gastroduodenoscopy.

Diagnosis of duodenitis

Signs of duodenitis:

• areas of narrowing of the duodenum - indicating a tumor, the formation of adhesions, developmental anomalies
• extended areas - the consequences of mucosal atrophy, dysmotility, blockage of the underlying sections of the intestine, a decrease in the tone of the intestinal wall in violation of innervation
• "niche" in the wall of the duodenum may be a sign of erosion, ulcers, diverticulum
• accumulation of gas - a sign of mechanical obstruction of the intestine
• with edema, immobility and inflammation, folding can be smoothed out
• transfer of food mass from the duodenum into the stomach

Radiography is better tolerated by patients, it is available and painless. However, an x-ray is not able to detect changes in the mucous membrane, but only indicates gross violations in the functioning of the organ.

Laboratory studies for duodenitis:

• in the blood test, anemia and an increase in ESR are detected;
• in the analysis of feces - occult blood with bleeding erosions and ulcers.

Treatment of duodenitis

Treatment of duodenitis includes several areas:

• elimination of acute inflammation
• preventing the transition of the disease to the chronic stage
• restoration of the functions of the duodenum 12
• normalization of digestion

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

Indications for hospitalization for duodenitis:

• exacerbation of duodenitis
• suspected small bowel tumor
• severe general condition of the patient, advanced cases of the disease
• inflammation of the serous cover of the duodenum 12 (periduodenitis) and nearby organs
• the presence or threat of bleeding (erosive or ulcerative form of duodenitis)

Treatment of duodenitis with medicines

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

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

Nutrition for duodenitis

Proper nutrition plays a key role in the treatment of duodenitis. In acute inflammation or exacerbation of chronic duodenitis, the first 3-5 days, you must adhere to a strict diet 1a. Its basis is mucous decoctions from cereals (rice, oatmeal), pureed soups, liquid milk porridges (semolina, from buckwheat flour) and baby food. Chicken or lean fish (perch) in the form of mashed potatoes or steam soufflé is allowed once a day. Fractional nutrition: 6 times a day, in small portions.

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

General recommendations

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

Prohibited for duodenitis products that stimulate gastric secretion and food containing coarse vegetable fibers.

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

Consequences of duodenitis

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


• Peptic ulcer of the duodenum. A deep defect is formed on the wall of the duodenum - an ulcer. Its appearance is associated with the action of hydrochloric acid and pepsin on a weakened mucous membrane. It is manifested by pain in the upper half of the abdomen against the background of long breaks between meals, with the use of alcohol and physical exertion. Digestion is also disturbed: bloating, alternating diarrhea and constipation.


• Maldigestion/Malabsorption Syndrome- impaired absorption of nutrients through the intestinal mucosa due to enzyme deficiency. The development of a complex of symptoms is associated with a violation of the glands of the digestive tract. This condition in the early stages is manifested by diarrhea. In the future, exhaustion appears, changes in the composition of the blood - anemia, immunodeficiency - a decrease in the body's resistance to infections. In children, there is a noticeable lag in physical development.


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

Duodenitis is a fairly common disease, but it is well treatable. If symptoms appear, consult a doctor and strictly follow his instructions! Do not self-medicate to prevent the transition of the disease to the chronic stage.