Duodenitis is an inflammation of the mucous membrane of the duodenum. With lesions of the upper parts, the symptoms of the disease resemble stomach ulcers, duodenitis of the lower parts causes symptoms similar to pancreatitis or cholecystitis. The disease is accompanied by general weakness, pain in the stomach, heartburn, belching, nausea, vomiting. Acute inflammation with a sparing diet (sometimes fasting) usually ends after a few days. Repeated diseases turn into a chronic form, complicated by intestinal bleeding, perforation of the intestinal wall, the development of acute pancreatitis.
Duodenitis is an inflammatory disease of the mucous membrane of the duodenal wall (duodenum). There are acute and chronic forms. Acute duodenitis is characterized by pronounced symptoms of inflammation, which completely subside after the therapy and do not leave noticeable structural changes in the mucosa. Chronic duodenitis is a disease with a long recurrent course characterized by the development of foci of inflammation in the mucosa with subsequent pathological restructuring of its structure. It is the most common lesion of the duodenum. 94% of all inflammatory processes in the DPC acquire a chronic course. Chronic duodenitis occurs more than twice as often in men than in women.
Causes of duodenitis
The causes of primary inflammation are considered by specialists in the field of modern gastroenterology to be 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 processes (developed as a result of another pathology).
The causes of secondary duodenitis include infection of the duodenum with Helicobacter Pylori, chronic gastritis of various etiologies, duodenal ulcer, duodenal blood supply disorders, deterioration of trophic, innervation and tissue respiration in the intestinal wall. Pathology can be provoked by chronic diseases of thve intestine and digestive organs: liver, pancreas (colitis, hepatitis and cirrhosis of the liver, acute and chronic pancreatitis of various etiologies, inflammatory diseases of the mesentery, etc.).
The mechanism of development of inflammation of the duodenum is associated with damage to the intestinal mucosa by hyperacid juice coming from the stomach. Increased acidity combined with a decrease in the protective properties of the intestinal wall leads to irritation, and then inflammation of the mucosa. If acute inflammation proceeds without pronounced symptoms, then it develops into a chronic process, acquires a cyclical recurrent course, degenerative and atrophic processes begin in the intestinal wall.
In the case of secondary duodenitis, the main pathogenetic link in the development of the disease is duodenostasis – a consequence of functional digestive disorders, insufficient peristalsis, adhesive processes, compression obstruction of the duodenum. Chronic diseases of the liver, gallbladder and pancreas cause violations of the enzyme balance, which provokes a change in the homeostasis of the internal environment of the intestine, reduces the protective properties of the mucosal epithelium, becomes the basis of chronic inflammation. The lesion of the dudenal papilla, as a rule, is the result of pathological processes in the bile ducts.
Chronic duodenitis is classified according to several signs. By origin, primary and secondary processes are distinguished, by localization of foci of inflammation – bulbar, post-bulbar, local or diffuse variants of pathology. According to the endoscopic picture, erythematous, hemorrhagic, atrophic, erosive, nodular duodenitis are distinguished. According to the degree of structural changes, the superficial, interstitial, and atrophic types of the disease are considered. There are also special forms (specific duodenitis: tuberculosis, Whipple’s disease, immunodeficiency, fungal, intestinal amyloidosis, Crohn’s disease, etc.). The clinical classification includes:
- Chronic acidopeptic bulbitis, usually combined with type B gastritis.
- Chronic duodenitis in combination with enteritis and various enteropathies.
- Duodenitis, as a result of duodenostasis.
- Local process (periarticular diverticulitis, papilla inflammation).
Symptoms of duodenitis
The symptoms differ for different clinical forms of the disease. Acidopeptic duodenitis associated with antral bacterial gastritis often accompanies peptic ulcer of the stomach and duodenum, which causes the presence of an ulcer–like syndrome – pronounced soreness in the epigastrium on an empty stomach, at night or a couple of hours after eating.
Duodenitis combined with enteritis is manifested primarily by intestinal symptoms (digestive disorders, dyspepsia, malabsorption syndrome). Duodenostasis is characterized by a pronounced pain syndrome – paroxysmal, bursting and twisting nature, pain in the epigastric region, or in the right half of the abdomen, a feeling of bloating, rumbling in the stomach, bitter belching, nausea and vomiting with bile.
With a local lesion, the outflow of bile is disrupted, as a result, symptoms of biliary dyskinesia occur. Soreness in the area of the projection of the DPC can radiate to the right or left hypochondrium, acquire a shingling character. It is characterized by the development of signs of jaundice, light yellowness of the skin (a brownish tint is characteristic of cholestatic jaundice) and sclera, lightened up to white (with complete obturation of the biliary tract) stool. Bilirubinemia is in the blood.
A prolonged chronic process is characterized by a violation of the synthesis of secretin, enkephalins and other gastrointerstitial enzymes. This is due to a decrease in the secretory properties of the mucosal epithelium due to its dystrophy. These peptides are extremely important in digestive activity, and their insufficiency leads to profound disorders not only of the digestive tract, but also of other body systems, up to disorders of the autonomic and central nervous system.
There are several clinical forms of the disease. With an ulcer-like form, “nocturnal” and “hungry” pain is noted in the epigastrium or in the area of the projection of the duodenum of a pulling nature without irradiation. It is stopped by eating and taking antacid drugs and gastroprotectors. Heartburn and bitter belching often occur. With a gastritis–like form, pain is noted almost 15-20 minutes after eating, dyspeptic syndrome – nausea, vomiting, belching, rumbling in the stomach, diarrhea, flatulence, lack of appetite.
With cholecyst-like and pancreatic-like forms, the pain is acute, pronounced, located in the right or left hypochondrium, prone to irradiation, proceeds according to the type of biliary colic, there are signs of cholestasis, dyspeptic disorders. In patients with neuro-vegetative form, vegetative asthenoneurotic disorders come to the fore, deping syndrome is a consequence of duodenal hormonal insufficiency. The mixed form combines the signs of different clinical forms of duodenitis. The asymptomatic form is detected with functional diagnostic methods during examination for other pathologies.
Duodenitis can be diagnosed on the basis of an endoscopic picture during gastroscopy. Additional diagnostic methods are
- x-ray of the stomach and duodenum
- gastric juice examination – biochemical and pH determination
- duodenal probing
- blood test
If there is a suspicion of malignancy of the affected areas of the mucosa, a biopsy is examined.
Treatment of duodenitis
Treatment of chronic duodenitis is carried out by a gastroenterologist, varies depending on their clinical form. With acidopeptic chronic duodenitis, treatment implies a complex action in three directions: eradication of helicobacteria; protection of the mucous membrane: reduction of hydrochloric acid secretion (proton pump blockers, H2 blockers, antacids) and gastroprotection (enveloping drugs); restoration of digestion with the help of enzyme preparations.
In duodenitis with enteritis, the treatment of exacerbation is primarily aimed at excluding from the diet foods that are poorly digested (primarily milk, cereals), the use of enzyme preparations to restore intestinal digestive function, normalization of intestinal flora. During periods of remission, a proper balanced diet is indicated. Therapeutic and preventive measures should be carried out taking into account the clinical variant of chronic duodenitis and the nature of concomitant diseases.
With duodenitis against the background of duodenostasis, it is always aimed at eradicating the cause of duodenal obstruction. Functional duodenostasis is treated conservatively – frequent meals in small portions with the exception of products that promote bile secretion, drugs that bind bile, drugs that promote the regulation of intestinal motility. Duodenal probing with WPC flushing is effective.
In cases of persistent obturations as a result of pronounced adhesions, mechanical obstacles, as well as functional obstruction that is not amenable to therapeutic treatment, surgery is indicated. Treatment of duodenal obstruction is always carried out in a hospital setting to prevent possible severe complications.
Prognosis and prevention
The primary prevention of duodenitis is a proper balanced diet, smoking cessation and moderation in alcohol consumption. Timely detection and treatment of gastrointestinal diseases, the use of medicines strictly for their intended purpose. Prevention of relapses consists in regular monitoring and annual outpatient examination, sanatorium treatment. The prognosis with regular monitoring and timely treatment is favorable, with duodenitis caused by duodenostasis, after measures aimed at eliminating stagnation, there is a decrease in inflammatory symptoms and, as a rule, a cure.