Gastroduodenitis is a combined inflammation of the gastric mucosa (more often its pyloric part) and the duodenum, characterized by impaired secretion and motility of the gastrointestinal tract. Disease occurs with both general (weakness, pallor, weight loss) and local manifestations (pain, dyspeptic syndromes). Diagnosis is based on instrumental methods of examination of the mucosa, assessment of the functional state of the stomach and intestines, determination of the degree of infection with helicobacter infection. The treatment of gastroduodenitis is based on diet, a healthy lifestyle, drug therapy with antibacterial, antacid and other drugs.
Meaning
Gastroduodenitis is a disease characterized by inflammatory changes in the mucosa of the initial gastrointestinal tract (stomach, duodenum 12), leading to a disorder of the functions of these organs, and in the absence of rational treatment – to complications in the form of the development of peptic ulcer, etc. Gastroduodenitis occurs in various age groups, but it is most common among children and adolescents. According to research, gastroduodenitis in children in the primary school age group occurs in at least 45%, middle school age – in 73%. The decrease in morbidity among high school students to 65% is associated with the transition of part of chronic gastroduodenitis to peptic ulcer of the stomach and duodenum. There are also differences in the morphological substrate of gastroduodenitis in different age groups: in children and adolescents, gastroduodenitis occurs more often with an increased acid-forming function, while the atrophic process is more characteristic for adults.
Causes of gastroduodenitis
There is still debate whether gastritis and duodenitis are a single, inextricably linked pathological process or separate, independent diseases. In the course of research, the general pathogenetic mechanism of the development of inflammatory changes in the stomach and the initial parts of the small intestine has been clarified. The main factor in the initiation of inflammation is infection with H.pylori (HP), damage by microorganisms to the gastric mucosa and duodenum, followed by disruption of all functions of the upper digestive tract. Nevertheless, the question of the determining role of helicobacter infection remains open – its prevalence among the population reaches 70%, while the incidence of various inflammatory diseases of the stomach and duodenum is much lower. Scientists associate this fact both with the specifics of the structure of the microorganism itself and its varying degree of pathogenicity, and with the innate characteristics of the human body – it is noted that gastroduodenitis has a family predisposition associated with the genetic weakening of the barrier protective mechanisms of the mucosa.
The microorganism Helicobacter pilory has a tropicity to the epithelium of the stomach (i.e. it affects only this organ). Penetrating into the mucosa, bacteria begin to destroy the cells of the gastric glands, which leads to a change in the acidity of gastric juice. The regulation of the interrelated functions of the stomach is disrupted, which is why there is no alkalinization of the acidic gastric contents before its transition to the duodenum 12. Permanent damage to the duodenal mucosa by the acidic contents of the stomach leads to metaplasia (degeneration) of the intestinal epithelium into the gastric epithelium. After that, the duodenal mucosa becomes vulnerable to helicobacter infection, which is why inflammation is activated in this part of the digestive tract.
The duodenum participates in the regulation of the entire digestive tract by producing biologically active substances and intestinal hormones. Against the background of chronic inflammation of the duodenum, the normal production of hydrochloric acid and digestive juices in the stomach and duodenal segment is disrupted, as well as the work of other digestive organs, which leads to chronic inflammation in these parts of the gastrointestinal tract.
Chronic stress, vegetative-vascular dystonia in children and adolescents have a great influence on dysregulation of the digestive system. Violation of vegetative regulation provokes a change in the production of gastric and digestive juices, reduces the protective functions of the mucosa, leads to the persistence of inflammation.
Classification
Taking into account the variety of morphological substrates of the inflammatory process and clinical manifestations, several types of gastroduodenitis are distinguished. According to the etiology, the disease is classified into a primary and secondary process. Primary gastroduodenitis develops under the influence of exogenous factors – improper nutrition, exposure to aggressive chemical and temperature agents on the mucosa, infection with HP. Secondary, or endogenous gastroduodenitis, occurs against the background of disorders of the endocrine, immune and other systems of the body, with diseases of other gastrointestinal organs.
Based on morphological changes in the mucosa, gastroduodenitis is divided into superficial catarrhal, erosive, hyperplastic and atrophic. During the biopsy, different degrees of the inflammatory process (mild, moderate, severe), atrophy and metaplasia of the epithelium are distinguished. According to the brightness of clinical manifestations, there is an exacerbation of gastroduodenitis, complete or incomplete remission. Acute and chronic gastroduodenitis are also differentiated, which differ in the duration of clinical manifestations.
Symptoms of gastroduodenitis
The inflammatory process in the stomach and duodenum usually proceeds with both symptoms of general intoxication and local changes in the mucosa. The general symptoms of gastroduodenitis are weakness, fatigue, asthenization. The skin is pale, there is a decrease in body weight against the background of digestive disorders.
Leading in the gastroduodenitis clinic are pain and dyspeptic syndromes. Pain in the epigastrium is more associated with dyskinesia of the duodenum, which causes duodenoastric reflux with the throwing of intestinal contents into the stomach. The pain is dull, aching, most often occurs a couple of hours after eating. It can radiate into the umbilical region, hypochondria. Pain syndrome in gastroduodenitis is often accompanied by nausea, acid or bitter belching, sometimes vomiting.
Depending on which department the focus of inflammation is localized, various clinical forms of gastroduodenitis are distinguished. The most common ulcer-like variant is usually characterized by inflammation of the duodenal bulb in combination with antral gastritis, stomach ulcers. The clinical picture of this variant of gastroduodenitis is based on ulcerative pains that occur on an empty stomach or before meals, characterized by seasonal exacerbations. A gastritis-like variant develops with atrophy of the mucous membrane of the stomach body, which gradually spreads to the duodenum and small intestine. The basis of clinical manifestations is a violation of the absorption of nutrients and digestion. Cholecystitis-like variant of gastroduodenitis occurs against the background of stagnation in the duodenal segment; it is characterized by constant pain in the epigastric region and the right half of the abdomen, nausea, belching bitterness, bloating and rumbling of the abdomen. With inflammation of the papilla of the duodenum, a pancreatitis-like form of gastroduodenitis develops, in which the outflow of bile and pancreatic juice along the common bile duct is disrupted. It is characterized by the appearance of pain syndrome after eating fatty and spicy foods, jaundice of the skin and mucous membranes.
The clinical picture of gastroduodenitis is characterized by a change of phases of exacerbation and remission. Exacerbations usually occur in the autumn or spring period, provoked by dietary disorders, concomitant diseases. The severity of the disease during exacerbation depends on the severity of the clinical picture, the brightness of endoscopic manifestations. Usually the exacerbation lasts about two months. The symptoms of the disease regress within no more than 10 days, local pain during palpation of the abdomen persists for another three weeks. After the symptoms of gastroduodenitis disappear, remission occurs – incomplete in the absence of symptoms, but the presence of objective signs, moderate inflammatory changes during EGD. Complete remission is characterized by the absence of clinical and endoscopic signs of gastroduodenitis.
Diagnostics
Consultation of a gastroenterologist is mandatory if any inflammatory process in the gastrointestinal tract is suspected. To confirm the diagnosis of gastroduodenitis, a number of additional studies of the function of the stomach and duodenum are required. Esophagogastroduodenoscopy allows you to detect an inflammatory process in the pyloric part of the stomach and the initial part of the duodenum 12. During this study, an endoscopic biopsy is performed – with its help, an inflammatory process, atrophy, hyperplasia or metaplasia of the epithelium is detected. Antroduodenal manometry usually detects a spasm of the duodenum with increased pressure in the intestine.
It is mandatory for gastroduodenitis to conduct gastric and duodenal probing with sampling of the contents, studying the activity of enzymes and biologically active substances in portions of the material. Intragastric pH-metry is performed to determine the acidity of the stomach and duodenum – treatment with increased and decreased acidity will be radically different.
Diagnosis of helicobacter infection is mandatory: determination of helicobacter in the feces by ELISA, PCR diagnostics, determination of antibodies to helicobacter in the blood, a respiratory test. An informative method of diagnosing HP is a morphological examination of biopsies – at the same time, a large number of microorganisms are found in the thickness of the mucosa. For the diagnosis of gastroduodenitis, ultrasound of the abdominal cavity is of less importance – this method is mainly used to identify concomitant pathology.
Treatment for gastroduodenitis
Treatment of severe gastroduodenitis should be carried out in the gastroenterology department. With the development of an acute condition, one course of therapy and adherence to a strict diet is enough for a complete cure. Complaints about repeated episodes of the disease require repeated consultation with a gastroenterologist and full-fledged treatment.
A patient with gastroduodenitis must be prescribed a therapeutic diet. During periods of exacerbation, special rules must be observed: food must be mechanically, chemically and thermally sparing. You can not use spicy, smoked and extractive substances. During the period of remission, a special diet is not required, a healthy, rational diet is enough. To prevent relapses, it is recommended to permanently give up smoking, alcohol, carbonated drinks, strong coffee.
Drug therapy of gastroduodenitis depends on the clinical form of the disease. With increased acidity of the stomach, antacids, proton pump inhibitors are prescribed; with reduced acidity, enzyme preparations and natural gastric juice are prescribed. The detection of a helicobacter infection requires the mandatory appointment of antibacterial drugs, which, in combination with bismuth preparations and proton pump inhibitors, make it possible to achieve almost complete eradication of the pathogen. Also, complex therapy should include antispasmodics, reparative drugs, phytotherapy. In the period of remission, sanatorium treatment and the use of mineral waters are recommended.
The main problem in the management of gastroduodenitis is that many patients are trying to be treated on their own, irrationally using symptomatic means, abandoning the therapy started with the weakening of the symptoms of the disease, without achieving a complete cure. Proper and timely treatment of chronic gastroduodenitis is the best prevention of peptic ulcer disease. Even after achieving stable remission, constant adherence to the principles of rational nutrition and a healthy lifestyle is required to prevent relapses.
Prognosis and prevention
The prognosis for gastroduodenitis is favorable only with regular examination by a gastroenterologist and compliance with his recommendations regarding proper nutrition and lifestyle. In patients who do not adhere to a diet, do not undergo a full course of treatment for exacerbations, chronic gastroduodenitis turns into a stomach ulcer, which threatens to significantly worsen the condition and serious complications.
Prevention of gastroduodenitis largely echoes the basic principles of treatment. To prevent the disease, it is necessary to lead a healthy lifestyle, give up such bad habits as smoking and drinking alcohol, drinking a large amount of strong coffee. It is necessary to eat right – include more fresh vegetables and fruits, cereals, lean meat and fish in the diet. You should give up carbonated drinks, spicy and spicy food, fried dishes. These recommendations are the key to a healthy state and proper functioning of the digestive system.
