Bulbit – a catarrhal or erosive inflammation of bulbarny department of a duodenum. In most cases infection with helikobakteriya acts as an etiologichesky factor of a bulbit. Clinical symptoms of pathology include a pain syndrome of various degree of intensity, a dispepsichesky syndrome, at the heavy course and existence of ulcers bleedings are possible. Diagnostics of a bulbit is based on results of an endoscopic research and a biopsy, rn-metriya, tests for existence of H. pylori, contrast X-ray analysis. Therapy consists in application of antikhelikobakterny antibiotics, medicines for decrease in production of hydrochloric acid and regeneration of a mucous membrane.
Bulbit – an inflammatory disease of a mucous membrane of a duodenum (DPK) with localization of pathological process in its bulbarny department. In a bulb of DPK the general bilious channel, a channel of a pancreas opens. In this department there is a neutralization of sour contents of a stomach, processes of digestion under the influence of pancreatic and hepatic enzymes begin. In gastroenterology the tendency to decrease in frequency of helikobakter-dependent bulbit is noted that it is connected with performing effective eradikatsionny therapy, however the frequency of the idiopathic forms (which are not connected with H. pylori) remains high. At the same time the arising complications can threaten life of the patient and demand surgical intervention.
Reasons of a bulbit
The main reason for development of a bulbit – a helikobakterny infection. Normal the person has a balance between factors of aggression and protection of a gastroduodenal zone. The bicarbonates produced by a pancreas reduce acidity of contents of the stomach getting into a duodenum. At violation of this balance hydrochloric acid, enzymes of a liver and pancreas injure a mucous membrane. The increased acidity creates favorable conditions for settling of helikobakteriya. They are adapted for existence in hostile acidic environment and create around themselves a protective alkaline barrier. Helicobacter pylori causes production of pro-inflammatory substances therefore the mucous membrane is injured. At the same time the erosive form of a disease develops, and in the absence of due treatment ulcers are formed.
Bulbit it can be caused by anatomic prerequisites. Normal the duodenum has no bryzheyka. Sometimes owing to violations of an embryonal development the bryzheyka remains, at the same time gut loops in which the contents with high acidity which are directly getting from a stomach stand can be formed. Such conditions are favorable for existence of microorganisms that at aggressive chemical influence leads to an inflammation and an erozirovaniye of mucous.
The factors reducing protective properties of a mucous membrane of a duodenum contribute to development of a bulbit: immunity violations, serious associated diseases, genetic, psychoemotional and constitutional prerequisites. Bulbit arises at a disease Krone, Zollingera-Ellison's syndrome, a tseliakiya less often. Reception of hard alcoholic beverages, abuse chemically, mechanically irritating food injures mucous, provoking a catarrhal inflammation. Sharp bulbit as the local form of a duodenit, develops at a shigellezny infection (dysentery), viral hepatitis A, salmonellosis.
Symptoms of a bulbit
Symptoms of this pathology depend on a clinical form. The main sign - a pain syndrome which can have different intensity. Catarrhal bulbit it is characterized by insignificant pain in the top part of a stomach. At an erosive bulbit there are sharply expressed pains on an empty stomach and in 10-15 minutes after food. Patients note a loss of appetite, nausea, sometimes there is a vomiting giving relief, an eructation bitter and heartburn.
If during progressing of erosive process ulcers are formed and blood vessels are injured, bleeding with characteristic signs can develop: a pain syndrome of high intensity, vomiting with impurity of the blood expressed by the general weakness; at plentiful blood loss hemorrhagic shock is possible.
Sharp bulbit, arising against the background of a food toksikoinfektion, is followed by temperature increase of a body, the expressed nausea, frequent vomiting, frustration of a chair. The general condition of the patient significantly suffers. Due to insufficient enzymatic processing of food there are digestion violation symptoms. The feeling of discomfort in a stomach, frustration of a chair, symptoms of dysbacteriosis is possible.
Diagnostics of a bulbit
At survey of the patient pallor of integuments is defined (in case of blood loss), at a palpation of the top departments of a stomach there is a morbidity. Language is laid over by a white raid, on it prints of teeth are visible. Clinical and biochemical blood tests reveal changes, nonspecific for a bulbit: decrease in erythrocytes, hemoglobin (at erosive option with bleedings), change of level of hepatic and pancreatic enzymes. At suspicion of bleeding the test a calla on the hidden blood is made.
If bulbit developed against the background of giperatsidny gastritis, the rn-metriya defines increase in acidity of gastric juice, and specific tests reveal helikobakteriya. For the purpose of confirmation of existence of H. pylori the ureazny respiratory test, the immunofermental analysis, PTsR-diagnostics a helikobakter, a research of the bioptat taken at EGDS is carried out.
Obligatory method of diagnostics of a bulbit is the ezofagogastroduodenoskopiya – the endoscopic research allowing to estimate visually a condition of a mucous membrane of a stomach, duodenum and in particular bulbarny department, to reveal erosion, to find out a damage rate and to carry out an endoscopic biopsy for the purpose of histologic assessment of DPK fabrics. Often superficial bulbit is a find and comes to light in the form of diffusion hyperaemia mucous and hypostasis.
Carrying out a survey X-ray analysis of an abdominal cavity at a bulbita gives the chance to reveal violations of topographical relationship of a stomach and a duodenum that happens at preservation of an embryonic bryzheyka and formation of loops. After contrasting in a picture ulcer defects are visible. The barium passage X-ray analysis on a small intestine allows to estimate motility of DPK. For this purpose also the antroduodenalny manometriya is carried out.
In the diagnostic program at a bulbita ultrasonography of abdominal organs can be applied. This method does not allow to define directly a condition of a duodenum, however gives the chance to investigate a liver and a pancreas.
Treatment of a bulbit
Complex treatment of a bulbit is carried out by the gastroenterologist, in case of complications – the surgeon. The diet is surely appointed. The sharp period assumes full refusal from mechanically, thermally and chemically rough food. Liquid and pyurirovanny dishes are recommended. Food has to be fractional – at least 6 times a day. Out of the period of an aggravation of a bulbit the diet gradually extends. However the patient has to adhere to the general recommendations constantly. It is necessary to exclude products with preservatives and chemical additives which irritate mucous and provoke an aggravation.
Basis of medicamentous therapy is the activator eradikation. Antikhelikobakterny antibiotics, inhibitors of a proton pomp, bismuth medicines are for this purpose appointed. Antatsida, M-holinolitiki, H2-gistaminoblokatory are applied to decrease in acidity of gastric juice. For healing of erosive defects of a mucous membrane use the medicines accelerating processes of a reparation (oil of a dogrose, a sea-buckthorn, ), and the means increasing formation of slime (a glycyrrhiza root, ).
The physical therapy of a bulbit includes purpose of magnetotherapy, an electrophoresis with analgetics and spazmolitika (novocaine, a papaverine). Out of the aggravation period patients have to undergo twice a year sanatorium treatment with application of mineral waters. Phytotherapy at a bulbita includes use of collecting which part is chistotet, a camomile, a yarrow, a St. John's Wort, fennel, a linden. In house conditions application of mineral waters Yessentuki No. 17 and No. 4, Borjomi is recommended.
Surgical treatment of the bulbit which is followed by formation of ulcers consists in carrying out a vagotomiya – surgery which purpose is the parasympathetic denervation of a gastroduodenal zone and reduction of production of hydrochloric acid. The stem vagotomiya (at the same time all stomach denervirutsya) or a selective proximal vagotomiya can be applied (the acid-forming zone denervirutsya). The emergency surgical intervention consists in a stop of gastroduodenal bleeding by clipping or an alloying of the bleeding vessels at a gastroduodenoskopiya. If at endoscopy the source of bleeding is not found, the duodenotomiya and ushivany ulcers of a 12-perstny gut is carried out.
Forecast and prevention of a bulbit
At the timely request for the specialized help, purpose of adequate therapy of a bulbit and eradikation helikobaktery forecast favorable. Patients have to observe recommendations about a dietotherapy, if necessary correct a way of life. It is necessary to stop smoking and alcohol intake.
Prevention of a bulbit means timely treatment of gastritis with obligatory carrying out after therapy of the tests confirming an activator eradikation. Even out of aggravations it is necessary to visit professional surveys regularly. Many medicines are aggressive in relation to a mucous membrane of a stomach, a duodenum therefore at a bulbita all medicines have to be used only after consultation with the doctor. For the purpose of prevention of infection with helikobakteriya it is necessary to observe hygiene of food, to carefully wash hands before food.