Chronic duodenitis - Persistent polietiologic dystrophic defeat duodenal epithelium, characterized by inflammation, transformation, metaplasia, and atrophy of the intestinal glands. The symptoms are non-specific: pain in the upper abdomen, dyspeptic symptoms, autonomic symptoms (weakness, trembling fingers, sweating, sudden palpitations, etc.). Diagnosis is based on radiological examination of the stomach and duodenum, endoscopy, duodenal intubation, antroduodenalnoy manometry. Treatment includes causal treatment, diet and mode of the day; on the testimony - operation (with obstruction KDP).
duodenitis - long flowing disease pathological basis of which are inflammatory, degenerative-dystrophic and regenerative processes in the epithelium of the mucous membrane of the duodenum; they are the result of polymorphic on the prevalence and severity of epithelial restructuring and KDP glands. This is the most common pathology of the duodenum, although in isolated form is rare. In most cases, persistent inflammation in the PDK is combined with the pathology of the stomach and intestines (gastric ulcer, chronic gastritis or enteritis) and other internal organs. In men, this pathology develops three times more often than women. The relevance of the study of this disease lies in the fact that chronic duodenitis is often a predyazvennym state emerging in young men. Patients with this disorder are engaged therapists, gastroenterologists.
gastroduodenitis divided on several grounds: etiology, localization, clinical variant, the morphological pattern and the phase of the disease. According to the etiology of chronic duodenitis it is primary or secondary (developing against the background of other diseases of the digestive tract).
As the prevalence of pathology is divided into a total (affecting all of the duodenum) and limited (inflammation of the papilla, primary or final intestine) types. The defeat of the proximal part of the duodenum is usually found at a peptic ulcer 12P. colon and the distal part of duodenal papilla - the pathology of the liver, pancreas and GVP.
Depending on the predominance of certain symptoms distinguish the following clinical variants of chronic duodenitis: gastrito- and yazvennopodobny, holetsistopodobny, pankreatopodobny mixed hidden. During endoscopy following types of morphological changes in the mucosa can be identified: surface, diffuse, erosive, atrophic. In the course of the disease is isolated phase of exacerbation and remission.
smoking. These factors lead to increased gastric secretion, inhibition of production of bicarbonate in the pancreas and slow motor activity of the stomach and duodenum. Perhaps the development of chronic inflammation as an independent disease, at least - after suffering a previous acute duodenitis. Also not ruled out the influence of heredity.
Many researchers in the field of gastroenterology consider the reasons listed above are not related to the etiology of duodenitis, and predisposing to its development. These experts point to the formation of a common pathogenesis of chronic duodenitis and gastritis: an imbalance of aggression factors (H. pylori, increased release of pepsin and hydrochloric acid, trauma of the mucous membrane) and protection (adequate blood supply and repair of duodenal wall).
Secondary chronic duodenitis is diagnosed more often develops as a consequence of other diseases of the digestive system (H. pylori infestation, chronic gastritis, hepatitis, pancreatitis, cholecystitis, cholangitis, enteritis and colitis of allergy, infection with parasites, etc), The respiratory and cardiovascular system (launch bowel hypoxia), kidneys (uremia lead to mucosal damage).
The mechanism of this disease stomach ulcers associated with degeneration of the intestinal epithelium in the stomach, damage metaplazirovannyh areas hydrochloric acid and the formation of erosions, the gradual spread of peptic ulcer and duodenum. In chronic pancreatitis and hepatitis, there is increased absorption of enzymes to the mucous membrane; inhibition of secretion of bicarbonate; reduced resistance of the mucous DPK to damaging factors. When inflammation of the bile ducts into the duodenum falls for alien flora of the gastrointestinal tract, leading to the destruction of its epithelium, especially with reduced gastric acidity.
indigestion, autonomic dysfunction. When Bulba and yazvennopodobnom form of chronic duodenitis pain is usually aching, moderate, severe and less cramping. Soreness usually diminish or disappear after meals, antacids. Holetsistitopodobny chronic duodenitis expressed tenderness in the right upper quadrant radiating to the right half of the back, shoulder blade. The emergence of pain is provoked by the reception of oily and fried food. When pankreatopodobnom embodiment girdle pain, shifted to the left side of the abdomen, and may radiate to the back. Most often, inflammation develops in the major duodenal papilla. Gastritopodobny chronic duodenitis is characterized by oppressive pain in the stomach area and the overflow sense in it.
Chronic duodenitis have the following dyspeptic symptoms: nausea, feeling of heaviness and fullness in the stomach, bitter taste in the mouth, belching. Less common are vomiting and heartburn.
For chronic duodenitis is characterized by dysfunction of the autonomic nervous system, which is manifested by weakness, increased sweating, palpitations, trembling fingers, tenesmus with bouts of diarrhea. There are these phenomena are usually a couple of hours after a meal, especially in young patients. In the acute phase of a chronic duodenitis with the examination, the doctor can detect a touch of white coated tongue, little pain and a slight tension of the abdominal muscles in the pyloric region.
duodeno-gastric reflux. Also for the initial evaluation of motility intestine spend antroduodenalnuyu manometry.
Endoscopy does not allow to fully assess the motor function of the KDP, but makes it possible to visualize the morphological changes in the epithelium (inflammation, erosion, ulceration, atrophy, and so on. D.). During gastroduodenoscopy performed endoscopic mucosal biopsy, sampling the contents of the stomach and duodenum in order to study the secretion of digestive juices. To identify related pancreatitis, hepatitis or cholecystitis performed duodenal intubation, ultrasound of the abdomen.
The diagnosis of chronic duodenitis great importance is the identification of H. pylori infection (ELISA, PCR, breath test, morphological study of the mucous membrane). Differentiate chronic duodenitis should be a stomach ulcer and duodenal ulcer, spasm of the sphincter of Oddi, cholecystitis, pancreatitis, duodenal papilla cancer, hiatal hernia.
bleeding, there are cases of the transformation process in the duodenal papilla cancer. Patients with chronic duodenitis require prolonged clinical examination, regular anti-treatment, the detection of atrophy and epithelial dysplasia - routine biopsies during endoscopy. Prevention of chronic duodenitis is in compliance with a healthy lifestyle and nutrition, early detection and treatment related gastrointestinal diseases, infectious and parasitic diseases.