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

The inflammatory process of the duodenal mucosa leads to the development of a chronic disease - duodenitis. Treatment of duodenitis with folk remedies often helps to eliminate the disease.

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

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

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

Reasons for the development of duodenitis

The main causes of duodenitis are directly related to nutrition. These include meals on the go, dry food, large portions, or irregular meals with long intervals between meals. Often duodenitis develops as a result of the use of semi-finished products, fast food, canned food, coffee, salty, fried and spicy foods in large quantities.

Provoking factors can be:

• persistent malnutrition;
• alcohol and smoking;
• intake of 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 nutrition 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 an acute inflammatory process in the colon is acute pain in the stomach, bouts of nausea and vomiting. With the transition of the disease into a chronic form, the pain becomes dull, pressing under the spoon of the stomach, bursting at the top of the abdomen, usually together with heartburn, vomiting after eating.

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

If pain occurs 2 hours after a meal, then a bowel ulcer can be suspected.

If the 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 integuments of the skin turn yellow due to a violation of the outflow of bile;
• there are hungry pains in the epigastric part of the stomach;
• there are signs of dyspepsia, intestinal disorders;
• digestion is disturbed.

Symptoms and treatment for the development of inflammation in the duodenum are very similar to an ulcer, gastritis, cholecystitis or pancreatitis. This often leads to difficulties in making a definitive diagnosis. A number of diagnostic procedures are carried out: x-ray of the stomach, endoscopy of the esophagus and duodenum, duodenal sounding, examination of the secret of the intestine and stomach in case of suspected infection with Helicobacter pylori infection.

The disease is more common in men, and not many people rush to see a doctor when they experience stomach pain. However, most of the patients are interested in how to treat duodenitis with folk methods. This is quite possible, but it is necessary to follow a diet, adjust the diet, chew food thoroughly, eat in 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, 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 disorders in the stomach, improve blood circulation;
• cinnamon, ground - to eliminate pain in the stomach, increase appetite;
• fennel (seeds) - to reduce pain and bouts of nausea;
• ginger root - to relax the intestines;
• kava-kava root - to improve mood, relieve pain in the stomach;
• lemon mint - 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 compositions:

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

Doctors advise at home to eliminate unpleasant symptoms in chronic duodenitis to constantly drink tea from the above herbs, but together with a diet and a well-balanced diet. The treatment is long.

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 effect of irritating factors on the duodenum, relieve symptoms of inflammation in the epigastric region of the stomach.

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

• Licorice, buckthorn root, marshmallow root, shepherd's purse, chamomile, lavender, lemon balm flowers, cinquefoil erect (10 g each), chop, pour boiling water (1 tbsp), insist. Then strain and drink 3-4 times a day in portions.
• Prepare tea from cinquefoil (1 tbsp of dry raw materials, brew 0.5 liters of boiling water), insist and drink before meals 3-4 times a day.
• Sea buckthorn oil should be taken for a healing effect. Pour sea buckthorn with sunflower oil, insist in a dark place in a sealed container for 7 days. Then strain, squeeze the resulting cake, wipe through a sieve. Take the resulting slurry on an empty stomach, 2 tbsp. before every meal.
• Plantain (dry leaves) brew 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 with cold water, insist on taking it in the form of liquid porridge for breakfast.
• Chop the aloe, squeeze out the juice, mix with a decoction of oatmeal, take in the form of jelly 0.5 cups 3-4 times a day (first dose in the morning on an empty stomach).
  You can cook aloe with May honey on grape natural wine. Squeeze juice from aloe, add liquid honey heated to 60 ° C, mix, keep up to 7 days in a cool place, shaking occasionally, then strain. Drink a course for 3 months.
• Propolis tincture. Pour alcohol (100 g) propolis (150 g), insist 10 days in the dark, shaking occasionally, take 15-20 drops of propolis with the addition of milk 3 times a day. Instead of propolis, you can use flax seeds.
• Pour boiling water (0.5 l) calamus root, common tansy, valerian root, leave for 2 hours, take 0.5 cup 3-4 times a day.
  Any ready-made product can be stored in the refrigerator for several days.
• You can cure duodenitis by taking 1 tablespoon of sea buckthorn oil on an empty stomach. 2 times a day and for 2 weeks. Then 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, prescribe a full-fledged complex treatment and develop a diet. The energy value of the menu should be at least 3000 kcal per day. It is important that the diet is balanced, with a complete rejection of spicy, sour, fried, smoked foods, alcohol and salt restriction (no more than 2 tsp per day). You need to drink at least 1.5 liters of water per day.

You need to cook food only for a couple.

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

To give strength, you can cook any cereals from semolina, rice, buckwheat, oatmeal on the water. Make casseroles and puddings from cereals with the exclusion of legumes and pasta from the diet.

With duodenitis, a sufficient amount of protein is required to enter the body, so be sure to eat soft-boiled eggs, cook omelettes, scrambled eggs. Low-fat meats, chicken, veal, rabbit, turkey are recommended to be boiled and taken in pureed form.

Useful boiled or mashed beets, potatoes, carrots, cabbage, broccoli, boiled zucchini. Pickled 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, to minimize any irritation of the products of the gastric mucosa.

The inflamed intestine requires recovery, so the treatment is long, the diet must be followed constantly. Overeating should not be allowed, eat 2 hours before bedtime, you need to monitor your well-being, cook food for a couple, limit salt intake to 8 g per day, and drink more fluids.

Thanks to the diet and the constant intake of herbal teas, noticeable relief should come in a couple of weeks.

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 of the stomach - what is it? 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.

The reasons

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 of duodenitis 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 in adults 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 of duodenitis 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 dietary nutrition, 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.

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 is:

• 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 associated with another pathology of the digestive tract);
• according to the localization of foci - local, diffuse, bulbar, postbulbar;
• according to the level of structural changes - superficial (affects only the surface layer of the mucous membrane), interstitial (the inflammatory process extends to the deeper layers of the intestine) and atrophic (thinning of the mucosa, absence of glands in the affected areas);
• according to the picture of endoscopy - erythematous, erosive, hemorrhagic, atrophic, hypertrophic, nodular;
• special forms of duodenitis - fungal, immunodeficient, tuberculous, with Crohn's disease ...

Etiology of duodenitis

Alcohol abuse often leads to duodenitis.

The most common causes of acute duodenitis are:

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

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

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

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

Pathogenesis

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

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

Symptoms of inflammation of the duodenum

Acute duodenitis is characterized by complaints of patients on:

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

The symptomatology of chronic duodenitis is smoother and varies greatly in different forms of the disease. Usually patients are 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;
• loss of appetite;
• general weakness, irritability, headaches and other so-called general symptoms.

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

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

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

If the disease proceeds 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, the deepest disorders occur not only in the organs of the gastrointestinal tract, but also in many other systems of our body, including the central and autonomic nervous systems.

Diagnosis of duodenitis

Complaints of the patient, anamnesis of the disease and an objective examination will help the doctor to suspect duodenitis. On palpation, varying degrees of pain in the epigastric region will attract attention. To clarify the diagnosis of duodenitis and differentiate it from other pathologies of the gastrointestinal tract, the patient may be prescribed:

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

Duodenitis: treatment

The food of a patient with duodenitis should be mechanically and thermally gentle, and it is recommended to cook it for a couple, by 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 dishes, as well as alcohol, canned food and smoked meats, are completely excluded for 10-12 days.
• Grated food cooked 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 use: yesterday's wheat bread, cereals cooked in water or milk (rice, buckwheat, semolina, hercules), small pasta, cereal puddings or casseroles, lean meats and fish, soft-boiled eggs or in the form of a steam omelette no more than 2 in day, fermented milk products, whole milk, dry biscuit, vegetables (potatoes, beets, broccoli, cauliflower, zucchini, carrots).
• Excluded from the diet: legumes, millet, pearl barley, large pasta, fresh bread, muffins, pancakes, fried or hard-boiled eggs, fatty dairy products, salty or spicy cheeses, overcooked butter, fatty meat and fish, sweets, carbonated and strong drinks .

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

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

Duodenitis is an inflammation of the mucous 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 (palpation) 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, adhesive process, 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.

Food

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 broths (rice, oatmeal), mashed 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 omelette;
• 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, the 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.