Chronic duodenitis: causes, symptoms and treatment in adults, diet. Duodenitis - what it is, causes, types, symptoms in adults, treatment and diet for duodenitis Where is duodenitis located

The inflammatory process of the mucous membrane of the duodenum leads to the development chronic disease- duodenitis. Treatment of duodenitis folk remedies often helps eliminate the disease.

Not a single digestive process is complete without the participation of the duodenum, which is anatomically a vessel or cavity with a channel for draining digestive juices and enzymes. This organ serves to digest food absorbed by microvilli, then process and distribute nutrients throughout the body.

In addition, the duodenum produces up to 30 hormones necessary to maintain normal several important systems: endocrine, cardiovascular, digestive and nervous.

Infection by viruses and bacteria leads to the development of inflammation in the duodenum, decreased functionality, atrophic changes in the walls of the cavity, and the appearance of erosive areas. As the inflammatory process develops, it begins to extend beyond the walls, affecting the muscular layer and the entire intestine as a whole.

Reasons for the development of duodenitis

The main causes of duodenitis are directly related to diet. These include eating on the go, eating dry food, in large portions or irregularly with long periods of time between meals. Often duodenitis develops as a result of eating processed foods, fast food, canned food, coffee, salty, fried and spicy foods in large quantities.

Provoking factors may be:

• constant malnutrition;
• alcohol and smoking;
• eating hot food, carbonated drinks, spicy dishes.

These are the reasons for the development of initial duodenitis with an acute course.

If measures are not taken to revise diet and lifestyle in general, the disease becomes secondary and chronic.

Symptoms of duodenitis

The disease manifests itself in different ways. The main symptom in the development of acute inflammatory process in the large intestine - sharp pain in the stomach area, attacks of nausea and vomiting. When the disease becomes chronic, the pain becomes dull, pressing in the pit of the stomach, bursting in the upper abdomen, usually together with heartburn, vomiting after eating.

Abdominal bloating and rumbling, bitter belching and constipation are observed. With inflammation of the upper intestines, the symptoms are similar to an ulcer, when the stomach begins to hurt about 0.5 hours after eating.

If pain occurs 2 hours after eating, then an intestinal ulcer can be suspected.

If your stomach hurts on an empty stomach or at night, weakness, headache, irritability and lack of appetite are observed, this indicates the development of a local form of duodenitis.

For chronic duodenitis:

• pain in the right hypochondrium;
• the skin turns yellow due to a violation of the outflow of bile;
• there are hunger pains in the epigastric part of the stomach;
• signs of dyspepsia and intestinal disorders appear;
• Digestion is disrupted.

Symptoms and treatment for the development of inflammation in the duodenum are very similar to ulcers, gastritis, cholecystitis or pancreatitis. This often leads to difficulties in making a definitive diagnosis. A whole series of diagnostic procedures: X-ray of the stomach, endoscopy of the esophagus and duodenum, duodenal intubation, examination of intestinal and stomach secretions if infection with Helicobacter pylori is suspected.

The disease is more common in men, and not many people rush to see a doctor when they experience stomach pain. However, most patients are interested in how to treat duodenitis folk ways. This is quite possible, but it is necessary to follow a diet, adjust the diet, chew food thoroughly, and eat small portions up to 5 times a day.

Treatment with folk remedies

Treatment of duodenitis is carried out with medicinal herbs, sold in pharmacies in the form of tea bags in a wide range. Before you start taking it, you first need to consult a doctor and undergo an examination.

The following herbs are used:

• eucalyptus - suitable for eliminating existing symptoms, stimulating digestion, eliminating stomach pain;
• cardamom (seeds) - to calm the nerves and stomach;
• chamomile flowers - to relieve stomach upsets and improve blood circulation;
• ground cinnamon - to eliminate stomach pain and increase appetite;
• fennel (seeds) - to reduce pain and nausea;
• ginger root - to relax the intestines;
• kava-kava root - to improve mood, relieve stomach pain;
• lemon balm - for the treatment of duodenitis;
• sage (leaves and flowers) - for pain relief, relaxing effect;
• valerian root - to improve digestion;
• licorice root - to increase appetite;
• yarrow - to improve digestion, stimulate the production of gastric juice.

Folk recipes

In the chronic stage of duodenitis, treatment with folk remedies can be carried out with the following formulations:

• infuse fennel fruits and centaury (50 g each), take 1 tbsp. portions up to 4 times a day;
• infuse peppermint (40 g), eyebright herb (20 g) and drink 1/3 tbsp. 3-4 times a day before meals;
• Brew a collection of sage, peppermint, lavender flowers (15 g each) with boiling water, leave and drink in portions before meals;
• infuse peppermint (15 g), chamomile flowers (50 g), fennel fruits (10 g), valerian root (10 g), drink 1 tbsp. for 1 dose, if colic and heaviness in the stomach appear;
• infuse peppermint (20 g), chamomile flowers (30 g), buckthorn (30 g), anise (10 g), take 1 tbsp.;
• Infuse vodka for 7 days in a dark place with juniper (10 g), chamomile and peppermint (25 g each), take 1/2 tbsp. 2 times during the day and at night.

Doctors advise constantly drinking tea from the above herbs at home to eliminate the unpleasant symptoms of chronic duodenitis, but together with a diet and an established diet. The treatment is long-term.

You need to drink herbal teas daily for at least 2 months.

As a result, it is possible to achieve healing of ulcers and erosion, reduce the inflammatory process in the gastric mucosa, reduce the influence of irritating factors on the duodenum, and relieve symptoms of inflammation in the epigastric region of the stomach.

To relieve inflammation, eliminate unpleasant symptoms along with diet healing effect give the following fees:

• Grind licorice, buckthorn root, marshmallow root, shepherd's purse, chamomile, lavender, lemon balm flowers, cinquefoil erecta (10 g each), pour boiling water (1 tbsp.), leave. Then strain and drink 3-4 times a day in portions.
• Prepare cinquefoil tea (1 tablespoon of dry raw material, brew 0.5 liters of boiling water), infuse and drink before meals 3-4 times a day.
• Sea buckthorn oil should be taken for a healing effect. Pour sea buckthorn sunflower oil, leave in a dark place in a sealed container for 7 days. Next, strain, squeeze out the resulting cake, rub through a sieve. Take the resulting pulp on an empty stomach, 2 tbsp. before every meal.
• Brew plantain (dry leaves) with boiling water (0.5 l), leave for 30 minutes, strain and drink 0.5 tbsp. before meals 6-7 times a day.
• To relieve inflammation and improve the activity of the duodenum, pour oatmeal cold water, insist on taking it in the form of liquid porridge for breakfast.
• Grind the aloe, squeeze out the juice, mix with a decoction of oatmeal, take 0.5 cups in the form of jelly 3-4 times a day (first dose in the morning on an empty stomach).
  You can prepare aloe with May honey using natural grape wine. Squeeze the juice out of the aloe, add liquid honey heated to 60 °C, mix, leave for up to 7 days in a cool place, shaking occasionally, then strain. Take the course for 3 months.
• Propolis tincture. Pour alcohol (100 g) into propolis (150 g), leave for 10 days in the dark, shaking occasionally, take 15-20 drops of propolis with added milk 3 times a day. Instead of propolis, you can use flax seeds.
• Pour boiling water (0.5 l) over calamus root, tansy, valerian root, leave for 2 hours, take 0.5 cup 3-4 times a day.
  Any finished product can be stored in the refrigerator for several days.
• You can cure duodenitis by taking it on an empty stomach. sea ​​buckthorn oil 1 tbsp each 2 times a day and for 2 weeks. Next, you need to take a break for 2 weeks and repeat the course of treatment.

Proper nutrition

With duodenitis, the symptoms can be completely different, and only a doctor can establish the correct diagnosis based on the examination and prescribe a full complex treatment and develop a diet. The energy value of the menu must be at least 3000 kcal per day. It is important that the diet is balanced, with complete refusal from eating spicy, sour, fried, smoked foods, alcohol and limiting salt (no more than 2 tsp per day). You need to drink at least 1.5 liters of water per day.

Food should be cooked exclusively by steaming.

To alleviate the condition, eliminate pain in the stomach and other symptoms of inflammation, the diet should be varied. It is recommended to eat dried bread, savory buns, dry biscuits or cookies with the exclusion of fresh yeast products, pancakes, pies, and baked goods from the diet.

To give strength, you can cook any porridge from semolina, rice, buckwheat, rolled oats in water. Make casseroles and puddings from cereals, excluding legumes and pasta from the diet.

With duodenitis, it is required to enter the body sufficient quantity protein, so you definitely need to eat soft-boiled eggs, cook omelettes, scrambled eggs. Lean varieties of meat, chicken, veal, rabbit, and turkey are recommended to be boiled and taken pureed.

Boiled or pureed beets, potatoes, carrots, cabbage, broccoli, and boiled zucchini are useful. Marinated and salty foods, chocolate, nuts, kvass, coffee, sour juices, alcohol and beer should be excluded from the diet.

Gradually the diet can be expanded.

The main rule is to prevent exacerbations and minimize any irritation of the gastric mucosa by products.

Inflamed intestines require restoration, so treatment is long-term and the diet must be followed constantly. You should not overeat, eat 2 hours before bedtime, you need to monitor your well-being, steam food, limit salt intake to 8 g per day, and drink more liquids.

Thanks to diet and constant intake of herbal teas, noticeable relief should occur within a couple of weeks.

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

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

Duodenitis: what kind of disease is it?

Gastric duodenitis - what 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 digestive tract, for example, 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 the bacterium Helicobacter Pylori (Helicobacter pylori), improper location of the organ and disruption of the intestinal production of hormones. 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 certain medications.

Acute duodenitis: what is it?

The acute form of duodenitis appears suddenly. Often precisely after a violation of the diet. Characteristic symptoms is painful sensation in the upper abdomen, nausea, turning into vomiting. Accompanies these signs general weakness, temperature increase.

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.

With proper therapy and diet, it is possible to 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 characterized by a variety of clinical symptoms, which makes it difficult to make a correct diagnosis. Often confused with other organ diseases 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.

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

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 significantly swell and thicken. In addition to organic changes, the functionality of the organ is disrupted, 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. In advanced stages, stomach and intestinal pain may intensify 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

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

Hyperplastic

Manifested by excessive tissue growth.

Patients with chronic duodenitis should be under dispensary observation; anti-relapse treatment is indicated for them.

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

Complications

If you do not seek medical help in a timely manner or do not follow a diet for chronic duodenitis, serious complications can occur. 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.

Diagnostics is based on instrumental research methods:

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

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 in adults 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 chronic duodenitis in most cases occurs in a hospital. To the 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.

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

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,
• low-fat varieties 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, as cold can aggravate the spasm and motor disorders(clinically, the patient will experience renewed or increased 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 in the menu boiled lean meat without skin and veins: chicken breast, veal. You can cook steamed cutlets from lean fish(trout, pollock, pike perch) without bones and skin, and lean meat, passed through a meat grinder.

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.

With strict adherence to the 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!

1. 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 soothe 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 3 large spoons 3 times a day. This remedy is especially effective for erosive duodenitis.
3. 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.
4. For the treatment of the erosive form of the disease, it is recommended to use next recipe: a teaspoon of flax seeds is poured into a glass of boiling water and left for about 15 minutes. Accept healing composition recommended for empty stomach an hour before breakfast. Treatment with flax lasts about a month.
5. 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.

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

Classification

According to the generally accepted classification, duodenitis occurs:

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

Etiology of duodenitis

Alcohol abuse quite often leads to duodenitis.

Most common reasons acute duodenitis are:

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

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

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

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

Pathogenesis

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

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

Symptoms of inflammation of the duodenum

Acute duodenitis is characterized by patient complaints of:

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

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

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

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

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

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

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

Diagnosis of duodenitis

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

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

Duodenitis: treatment

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

The main point in the treatment of duodenitis is diet.

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

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

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

Duodenitis is inflammation of the mucous layer of the 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 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: 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:

1. 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.
2. 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.
3. 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:

1. 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 hydrochloric acid, which reduces the protective properties of the duodenum epithelium.
2. Foodborne toxic infections caused by the bacterium Helicobacter pylori (which causes ulcers), staphylococci, enterococci, clostridia, as well as giardiasis, helminthiasis. 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.
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 causing inflammation 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 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 of the small intestine enter the duodenum, causing reflux duodenitis.
5. Alcohol consumption.
6. Ingestion chemical substances(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

Reasons leading to the appearance of chronic duodenitis:

1. 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 of the intestine.
2. Chronic gastritis with high acidity causes acid damage to the intestinal epithelium with gradual development its atrophy. Gastritis-duodenitis is formed.
3. 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.
4. Regular violation of diet and nutrition.
5. Food allergies.
6. Prolonged stress.
7. Taking a lot of medications.
8. 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:
  • in the 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.
• A slight increase in body temperature is possible (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). It manifests itself as dizziness, drowsiness, a feeling of fullness in the stomach, heat in the upper body.

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

Diagnostics

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

1. The presence of characteristic complaints described above.
2. Inspection. When palpating (feeling) the abdomen, pain is noted in the projection of the duodenum.
3. 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 the patient has consumed a contrast agent (barium sulfate). With such a study, it is possible to identify gross disturbances in the structure and functioning of the organ; 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.

1. 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), subsequently their activity 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) 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 eating

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 meats and fish (duck, pork, carp, mackerel);
• ice cream;
• carbonated drinks;
• alcohol.

1. 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.”
2. Food should be warm, but not hot or cold.
3. A gentle preparation method is preferable to avoid irritation of the duodenum mucosa. These are soups, porridges, steam dishes.
4. 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.

Suitable for this purpose medicinal plants: 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 a 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.
		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.
		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	Contains pancreatic enzymes, helps better digestion food	Pancreatin Creon 10000	After every meal.
Antispasmodics	Remove spasms, relieve pain	No-shpa (drotaverine) Platifillin 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 mucous membrane of the duodenum, 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, sedatives are used. 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.