Duodenitis

Description:

The duodenitis is one of the most widespread gastroduodenal diseases which meets approximately the same frequency, as well as gastritis. The duodenitis by 2-3,5 times meets at men more often, than at women and mainly at persons of young age. The isolated duodenitis is diagnosed rather seldom. More often it develops in combination with gastritis and is designated as gastroduodenit. This pattern is caused by close anatomo-physiological interrelations of a stomach, first of all antral department, the peloric channel and an initial part of a 12-tiperstny gut.
Widespread introduction in practice of endoscopy allowed to find a duodenitis and at many other diseases of the alimentary system. This fact demonstrates close interrelation of a duodenum with other digestive organs which damage often leads to a secondary duodenitis.
Relevance of a duodenitis is caused not only its prevalence, but also the fact that the disease can precede a peptic ulcer.  Thus, the problem of a duodenitis is first of all a problem of a peptic ulcer with duodenal localization of an ulcer which strikes mainly men of young age.

Duodenitis reasons:

The etiology of a chronic duodenitis generally matches an etiology of chronic gastritis.
The most common cause of development of a duodenitis, as well as gastritis, existence of a helikobakterny infection is. Besides, the duodenitis is caused by Koksaki's enteroviruses, campylobacters, intestinal infections, viruses of hepatitises, also giardiac etiology of a duodenitis is possible.
Important link of an etiopathogenesis of a duodenitis are alimentary and neurogenic factors. Disorder of nervous control of a duodenum as a result of functional or organic changes of TsNS arises along with dysfunction of a stomach and is implemented by a hyperacidity, a hyper tone, and also neurodystrophy of a mucous membrane of a gastroduodenal zone. Among alimentary factors irregular food, the use of rough, spicy, smoked food, spices, alcohol, plentiful meal for the night are important. The damaging action on a mucous membrane of nicotine does not raise doubts.

Pathogeny:

In mechanisms of exogenous (primary) duodenitis the important role belongs to atsidopeptichesky aggression of gastric and pancreatic juice. The mechanism of acid and peptic injury of a mucous membrane of a duodenum is the basic both in case of an inborn hyperacidity of a gastric juice, and at influence of alimentary factors which stimulate kisloto-and a pepsinobrazovaniye in a stomach.
It is promoted motor эвакуаторная by dysfunction which creates a zone of the long and expressed decrease intraduodenal рН. It was revealed that at patients with a chronic duodenitis chyme atsidifikation duration, i.e. time low intraduodenal рН, by 2-5 times exceeds that at healthy people. In the course of further development of a duodenitis the pathogeny of a disease can become complicated. In particular, distribution of an inflammation in the distal direction, as a rule, leads to emergence of a papillitis (an inflammation of a big nipple of a duodenum). The papillitis can significantly complicate a further current and clinical implication of a duodenitis. Breaking outflow of an alkaline secret of a pancreas and bile, the papillitis leads to sharp increase of acid and peptic aggression of the arriving gastric chyme, to strengthening of damage and irritation of a mucous membrane of a duodenum. Extent of atsidopeptichesky injury of a duodenum is influenced considerably by a functional and morphological condition of the most mucous membrane. Progressing degenerative and dystrophic and inflammatory processes considerably reduce resistance of a mucous membrane and increase its sensitivity to the damaging agents. These changes are most expressed at an atrophy of fibers, crypts and brunnerovy glands which cosecrete slime.
Schematically the sequence of pathological changes in a mucous membrane of a duodenum can be presented as follows: 1) damage (mainly atsidopeptichesky) a mucous membrane with emergence of an inflammation; 2) adaptation and compensatory strengthening of regeneration of an epithelium of fibers and a mutsinoobrazovaniye at the expense of hypofunction and a hyperplasia of scyphoid cells and brunnerovy glands;  3) failure or insufficiency of adaptation opportunities of a mucous membrane and beginning of an atrophy of fibers, crypts and brunnerovy glands; 4) the progressing mucosal atrophy reducing it resistance.
Neuroreflex, humoral and hormonal, metabolic and toxic impacts on a mucous membrane and muscle fibers of a duodenum are the endogenous reasons of a duodenitis. In some cases the helminthic invasion (анкилостомидоз, an opisthorchosis) and a lambliasis is the reasons of a chronic duodenitis.

Duodenitis symptoms:

Clinical manifestations of a duodenitis are very various. The clinical picture is closely connected with symptoms of diseases of the next bodies which were the reason of a duodenitis (gastritis, a peptic ulcer of a stomach, pancreatitis, cholecystitis, etc.) or its investigation. This feature of clinical manifestations of a duodenitis confirms the concept about functional unity of these bodies united in gastroduodenogepatopankreatichesky system.
The most typical symptom – yazvennopodobny pain which arises in 1-2 hours after meal has the acute skhvatkoobrazny, sometimes cutting character with localization in a piloroduodenalny zone. Pain significantly decreases or abates completely after meal, especially milk, porridges, boiled meat. The pain syndrome often is followed by heartburn, feeling of nausea, a raspiraniye in an anticardium, a sialosis. At some patients the pain syndrome and the dispepsichesky phenomena are extremely expressed.
Vegetative frustration are observed almost at all patients with a duodenitis at young age. They can be shown by clinic of a dumping syndrome, is more often late when weakness, perspiration, drowsiness, hypotonia and strengthening of a vermicular movement of intestines arise in 2-3 hours after meal. At a long break between meals hypoglycemia symptoms can be observed: weakness, a shiver in a body, sharply increased appetite.
At a chronic duodenitis, especially at its atrophic option, there is a disorder of endocrine function of a duodenum. Disturbance of development of a gastron, secretin, pancreozymin, an enteroglyukagon and other hormones leads to deep disturbances of autoregulyatorny functions of gastroduodenogepatopankreatichesky system. Because the majority of intestinal hormones, in addition to locally effect, makes the general impact on an organism, numerous neurovegetative symptoms and disbolism appear. There is a basis to believe that at a chronic duodenitis there can be a syndrome of duodenal hormonal insufficiency.
At survey of patients with a duodenitis it is possible to note the language which is laid over by a white or white-yellow plaque with prints of teeth on its side surface. At a palpation of a stomach is defined diffuse, but local morbidity in a piloroduodenalny zone is more often.
Very specific symptom – night secretion of a gastric juice and a hyperacidity of a gastric juice on an empty stomach which take place at 60% of patients and cause emergence of pain at night. Even at a hypochlorhydria of a gastric juice at patients the expressed and long decrease intraduodenal рН which indicates atsidopeptichesky injury of a mucous membrane of a duodenum takes place.
At young people  at a duodenitis the excitable type of secretion is defined more often, is more rare asthenic, inert and brake, and only at 15% - normal.
Now several clinical options of a duodenitis are known: gastritopodobny, yazvennopodobny, holetsistopodobny, neurovegetative, mixed and asymptomatic. Most often occur at persons of young age yazvennopodobny option which on clinical symptoms can be identical to a peptic ulcer with localization of an ulcer in a duodenum.
Less often the chronic duodenitis is shown by symptoms of dyskinesia of biliary tract, chronic cholecystitis, a chronic holetsistogepatit or chronic pancreatitis. At these options of a disease of pain can irradiate in the right or left hypochondrium, sometimes accept the cross or surrounding character, the ikterichnost of scleras, easy yellowness of skin is quite often observed. Patients complain of bitterness in a mouth, sometimes a skin itch, the calla, urine darkening note periodically light coloring. In the period of the expressed pains there can be displays of intestinal dyspepsia in the form of a meteorism, diarrhea, temporary intolerance of milk. At survey of patients, in addition to the specified symptoms, define an ochroleucous fur, pain at a palpation of a stomach not only in a piloroduodenalny zone, but also in a vesical point, in the right and left podreberye. At some patients the painful liver edge acting because of a costal arch is palpated.
Thus, the duodenitis is shown by various options of clinical symptoms and courses of a disease.

Treatment of the Duodenitis:

Treatment of patients has to be performed taking into account clinical option of a duodenitis. At primary chronic duodenitis treatment is carried out, as at chronic gastritis with hypersecretion or a peptic ulcer. At treatment of a secondary chronic duodenitis it is necessary to consider first of all a disease which consequence the chronic duodenitis is. The expressed symptoms at a duodenitis are the indication for hospitalization.
To important components of complex therapy clinical nutrition is. During the acute period of a disease of all patient appoint a diet No. 1a which is consistently replaced with a diet No. 1b and No. 1 with an interval of 10 days. At the same time it is important to consider features of dietary food at some forms of a duodenitis. In particular, at patients with a holetsistopodobny duodenitis in the acute period the intolerance of milk, oil while patients with the expressed neurovegetative syndrome not always should appoint so rigid diet is quite often observed. During remission the diet is differentiated, considering clinical features of a disease: at yazvennopodobny option – a diet No. 1, at holetsistopodobny – a diet No. 5, at gastritichesky – a diet No. 2 if at the patient the hypochlorhydria or an anacid state is established.
Appointing medicamentous therapy, consider features of a pathogeny of a disease, functional and morphological changes in gastroduodenal department and clinical symptoms. In particular, treatment of patients with yazvennopodobny option of a duodenitis is usually similar to that at patients with a peptic ulcer of a duodenum. At the same time the crucial role is played by cholinolytics (atropine) which appoint taking into account a rhythm of a pain syndrome, features of gastric secretion and in a combination with antacids. It is possible to use several options of their appointment.
At a hyperoxemia of a gastric juice on an empty stomach and in both phases of secretion 0,1% atropine solution on 1 ml under skin are shown. Antacids: Almagelum on 1 dessertspoon in 1 hour after meal.
At patients with a duodenitis with a high rate of acidity only in a basal phase of gastric secretion atropine is appointed in 15-20 minutes prior to food in a combination with antacids. Antacids after meal are shown only at the remaining pain syndrome.
At a neurotic syndrome, to often accompanying duodenitis at young people, appoint sedatives (tincture or extract of a valerian), tranquilizers and drugs of a belladonna which part phenobarbital and derivatives of barbituric acid are respectively.
The Holetsistopodobny current of a duodenitis demands additional purpose of the cholagogue drugs possessing holeretichesky effects. Are not shown to Holekinetiki in connection with possible strengthening of a pain syndrome in the conditions of a delay of evacuation of the bile caused by hypostasis of a big nipple of a duodenum in the period of a duodenitis aggravation.
In case of the expressed inflammatory and erosive changes of a mucous membrane of a duodenum, especially with involvement in process of a big nipple of a duodenum, with the phenomena of a cholestasia it is possible to appoint antiinflammatory therapy.
Vitamin therapy and physiotherapeutic procedures are carried out the same as at functional gastric disturbances and chronic gastritises.

Prevention:

Prevention of a duodenitis is a prevention of functional frustration which precede them. Secondary prevention of a disease which is intended to prevent a yazvoobrazovaniye in a duodenum, a periduodenitis, diseases of gepatobilliarny system and a pancreas is not less urgent.
The main content of secondary prevention – preventive antirecurrent treatment which is carried out in the course of medical examination. Treatment includes dietary food and medicamentous means which appoint taking into account features of clinical manifestations and the forecast. So, the patient with yazvennopodobny option of a duodenitis of display antiulcerous therapy. At persistent, often reidiviruyushchy therapies of a chronic duodenitis with threat of a yazvoobrazovaniye and other complications preventive treatment has to be year-round with periodic hospitalization in case of typical clinical symptoms of a peptic ulcer.
Medical examination of patients includes their account, periodic medical examination in the fall and in the spring with carrying out out-patient inspection and antirecurrent preventive treatment.