Chronic duodenit – the persistiruyushchy polietiologichesky dystrophic defeat of an epithelium of a duodenum which is characterized by an inflammation, transformation, a metaplaziya and an atrophy of intestinal glands. Symptoms of a disease are not specific: pain in the top half of a stomach, the dispepsichesky phenomena, vegetative symptoms (weakness, trembling of fingers, perspiration, sudden heartbeat, etc.). The diagnosis is established on the basis of a radiological research of a stomach and DPK, EGDS, duodenal sounding, an antroduodenalny manometriya. Treatment includes etiotropny therapy, observance of a diet and day regimen; according to indications – operation (at impassability of DPK).
Chronic duodenit – the proceeding disease which patomorfologichesky basis are inflammatory, degenerate and dystrophic and recovery processes in an epithelium of a mucous membrane of a duodenum is long; become their result polymorphic on prevalence and expressiveness of reorganization of an epithelium and DPK glands. It is the most widespread pathology of a duodenum though in the isolated look meets seldom. In most cases the persistiruyushchy inflammation in DPK is combined with pathology of a stomach and intestines (YaBZh, chronic gastritis or enteritis), other internals. At men this pathology develops three times more often than at women. Relevance of studying of this disease is in what chronic duodenit most often is the predjyazvenny state which is formed at men of young age. With this pathology therapists, gastroenterologists are engaged in patients.
Classification of a chronic duodenit
All chronic gastroduodenita are divided on several signs: etiology, localization, clinical option, morphological picture and phase of a disease. On an etiology chronic duodenit happens primary or secondary (developing against the background of other pathology of a digestive tract).
Pathology is divided by prevalence on total (all duodenum is surprised) and limited (an inflammation of a nipple, initial or final departments of a gut) types. Defeat of a proximal part of DPK usually meets at stomach ulcer of 12 items of a gut, disteel part and duodenal nipple – at pathology of a liver, ZhVP and .
Depending on prevalence of these or those symptoms, allocate the following clinical options of a chronic duodenit: gastrito-and yazvennopodobny, holetsistopodobny, pankreatopodobny, mixed, hidden. During the endoscopic research the following types of morphological changes in a mucous membrane can be revealed: superficial, diffusion, erosive, atrophic. During a disease allocate phases of an aggravation and remission.
Reasons of a chronic duodenit
The reasons of formation of pathology at its primary or secondary genesis various. Primary process develops against the background of violations of food, abuse of spicy and spicy food, smoked products and fried, strong tea, coffee, alcohol; at surplus of lipids and carbohydrates in a diet; at constant smoking. The listed factors lead to strengthening of gastric secretion, oppression of production of bicarbonates in and to delay of physical activity of a stomach and duodenum. Development of a chronic inflammation as independent disease is possible, is more rare – after the postponed earlier sharp duodenit. Also heredity influence is not excluded.
Many researchers in the field of gastroenterology consider the listed above reasons not belonging to an etiology of a duodenit, and contributing to its development. These experts point to the general pathogenesis of formation of a chronic duodenit and gastritis: violation of balance of factors of aggression (H. pylori, the increased release of pepsin and hydrochloric acid, a travmatization of a mucous membrane) and protection (sufficient blood supply and a reparation of a wall of DPK).
Secondary chronic duodenit is diagnosed much more often and develops as a result of other diseases of a gastrointestinal tract (a helikobakterny invasion, chronic gastritis, hepatitis, pancreatitis, cholecystitis, a holangit, enteritis and colitis, an allergopatologiya, infection with parasites, etc.), respiratory and cardiovascular system (start an intestines hypoxia), kidneys (uraemia leads to injury of a mucous membrane).
The mechanism of formation of the given disease at stomach ulcer of a stomach is connected with regeneration of an intestinal epithelium in gastric, damage of metaplazirovanny sites by hydrochloric acid and formation of erosion, gradual spread of stomach ulcer and on a duodenum. At chronic pancreatitis and hepatitis the increased absorption of enzymes on a mucous membrane is observed; oppression of secretion of bicarbonates; decrease in resistance of mucous DPK to the damaging factors. At an inflammation of biliary tract the flora, alien for these departments of a GIT, leading to destruction of its epithelium, especially at the reduced acidity of gastric juice gets into a duodenum.
Symptoms of a chronic duodenit
This disease is expressed by a number of signs: pain in an epigastriya, dyspepsia, vegetative dysfunction. At a bulbita and a yazvennopodobny form of a chronic duodenit the pain, as a rule, aching, moderated is more rare strong and skhvatkoobrazny. Painful feelings usually decrease or vanish after food, reception of antatsid. Holetsistitopodobny chronic duodenit is expressed by the morbidity in the right podreberye irradiating in the right half of a back, a shovel. Emergence of pain is provoked by reception of greasy and fried food. At pankreatopodobny option the pain surrounding is displaced in the left half of a stomach, also irradiates in a back. Most often develops at an inflammation of a big duodenal nipple. Gastritopodobny chronic duodenit is characterized by the pressing pain in a stomach and feeling of overflow in it.
The following dispepsichesky manifestations are inherent in a chronic duodenit: nausea, feeling of weight and a raspiraniye in a stomach, bitter taste in a mouth, an eructation. Less often vomiting and heartburn meet.
The dysfunction of the autonomic nervous system which is shown the weakness increased by perspiration, feeling of heartbeat, trembling of fingers of hands, tenezma with diarrhea attacks is characteristic of a chronic duodenit. There are these phenomena usually in a couple of hours after meal, mainly at young patients. In a phase of an aggravation of a chronic duodenit at survey the doctor can reveal a language oblozhennost a white raid, insignificant morbidity and insignificant tension of muscles of a stomach in pilorichesky area.
Diagnostics of a chronic duodenit
The radiological picture at this pathology is described as "the angry DPK": a chaotic hyperactive vermicular movement, periodic spasms of a gut with episodes of a retrograde vermicular movement, acceleration of a passage of contrast substance on a small intestine, reduction or increase in caliber of folds of a gut (a thickening at the expressed inflammation, thinning at an atrophy). Because of increase in a tone of DPK emergence in it of stagnation, a duodeno-gastralny reflux is possible. Also for assessment of motility of initial departments of a gut carry out an antroduodenalny manometriya.
EGDS does not allow to estimate fully the DPK motor function, however gives the chance to visualize morphological changes of an epithelium (an inflammation, erosion, ulcerations, an atrophy etc.). During a gastroduodenoskopiya the endoscopic biopsy of a mucous membrane, a fence of contents of a stomach and with a research objective of secretion of digestive juice is made. For identification accompanying pancreatitis, hepatitis or cholecystitis duodenal sounding, ultrasonography of abdominal organs is made.
In diagnostics of a chronic duodenit detection of a helikobakterny infection (IFA, PTsR, the respiratory test, a morphological research of a mucous membrane) is of great importance. To differentiate chronic duodenit follows with stomach ulcer of a stomach and duodenum, a spasm of a sphincter of Oddi, cholecystitis, pancreatitis, cancer of a duodenal nipple, hernia of an esophageal opening of a diaphragm.
Treatment of a chronic duodenit
The prevailing direction of treatment of a secondary chronic duodenit is therapy of the main disease. At detection of a helikobakterny or parasitic infection etiotropny treatment is appointed.
Therapy of a chronic duodenit in the period of an aggravation is made in office of gastroenterology. Medical hunger with gradual transition to a table No. 1 is appointed. Symptomatic and pathogenetic treatment includes use of spazmolitik, antatsid, astringents; completion of deficiency of vitamins and protein. At the long course of this pathology with a heavy dispepsichesky syndrome prescription of antidepressants can be required.
Surgical treatment of a chronic duodenit is required at identification of its flegmonozny option; a bystry iskhudaniye in combination with the expressed pain and dyspepsia; detection of duodenal impassability.
Forecast and prevention of a chronic duodenit
The forecast at a chronic duodenit favorable, excepting the expressed atrophic and displastichesky processes. Approximately at 10% of patients the disease is complicated by bleedings, cases of transformation of process in cancer of a duodenal nipple are known. Patients with a chronic duodenit demand long medical examination, regular antirecurrent treatment, at identification of an atrophy and a dysplasia of an epithelium – planned biopsies during EGDS. Prevention of a chronic duodenit consists in observance of a healthy lifestyle and food, timely identification and treatment of associated diseases of a GIT, infectious and parasitic pathology.