Gastritis of the duodenum: how to identify and how to treat it

What is gastritis

The constant increase in diseases of the digestive system is a consequence of the development of civilization, associated with the ability to produce food in large quantities.
The abundance of fast food establishments, temptingly shiny displays of prepared foods in supermarkets, eliminating the need to spend time preparing food at home - all this, if left uncontrolled, can quickly turn into serious health problems. Therefore, the word gastritis is familiar to almost every resident of a modern city. This is a collective diagnosis denoting an inflammatory process in the gastric mucosa, which leads to its degenerative changes. The causes of inflammation can be different.

Inflammation of the gastric mucosa, for example due to poor nutrition, is considered primary gastritis. Secondary gastritis develops against the background of general intoxication of the body or infectious diseases.

The consequence of a long-term pathological process on the gastric mucosa is a violation of its basic functions:

• secretory - inflammation disrupts the mechanism of gastric juice production, its enzymes not only break down food, but also protect the mucous membrane from physical and chemical damage;
• motor - the work of smooth muscles, which ensures the movement of digested food from the stomach into the duodenum, is hampered;
• endocrine - the process of producing hormones that regulate the functioning of the digestive system is disrupted.

Gastritis affects more than half of the world's population. In Russia alone, over the five-year period from 2013 to 2021, the incidence increased by 7% - from 3.8 to 4.1 million people or 20,806 cases per 100 thousand population.

It has now been clinically proven that in most cases the cause of gastritis is Helicobacter pylori infection. This bacterium colonizes the gastric mucosa. More than 50% of the world's population is infected with H.pylory, but the majority of those infected have no symptoms of the bacteria. However, in some people the bacterium provokes the development of atrophic gastritis, stomach and duodenal cancer.

The risk of gastritis increases with age: most patients are people over 60 years of age. Also at risk are people with high or low stomach acidity, which leads to:

• love of spicy and fatty foods;
• a large amount of citrus fruits in the diet;
• alcohol abuse, cocaine addiction.

At risk are also people with weakened immune systems due to previous infectious diseases and those with various systemic pathologies of internal organs.

Inflammation of the gastric mucosa can be a consequence of taking certain antibiotics, nonsteroidal anti-inflammatory drugs, glucocorticoids, and certain heart medications.

What is characteristic of exacerbation of duodenitis

With gastritis of the duodenum, inflammation develops in it, which causes stagnation of food masses passed here from the stomach due to insufficient production of the substances necessary for this. This, in turn, leads to inflammation in nearby organs: the small and large intestines, the gallbladder, and the pancreas.

Very often, duodenitis is diagnosed against the background of other diagnoses related to the gastrointestinal tract: pancreatitis, cholecystitis, gastritis. The location of the duodenum makes it more vulnerable to infection. It can be carried out either ascending from the small or large intestine, or descending, when the disease is provoked by gastric contents entering here.

Types of gastritis

Classifications of gastritis have been developed by scientists from different countries. In clinical practice, Russian medical institutions use the Houston classification, developed on the basis of clinical and morphological criteria. In it, gastritis differs according to several characteristics:

• The nature of the course of the disease. The main types of gastritis are acute and chronic. There are also special types of pathology - allergic gastritis, granulomatous, hypertrophic and some others.
• Area of ​​inflammation. The pathological process may affect the mucous membrane of one of the sections of the stomach. When the mucous membrane of the entire stomach becomes inflamed, a diagnosis of pangastritis is made.
• Causes of inflammation. According to this criterion, 3 types of gastritis are distinguished: autoimmune (A), caused by the bacterium H.pylory (B), and inflammation due to chemical toxic effects (C). Gastritis can also be caused by a combination of several reasons.
• Features of the process and the nature of changes in the mucosa. Gastritis can manifest itself as erosions on the mucous membrane, diffuse purulent lesions, and areas of tissue atrophy.
• Concentration of hydrochloric acid in gastric juice. Stomach acidity during gastritis can remain normal, increase or decrease.

According to other common classifications, gastritis is divided by the degree and activity of inflammation, by phases - exacerbation and remission, by subsequent complications, etc.

Figure 1. H.pylory in the stomach with gastritis. Source: verywellhealth.com

Gastritis (inflammation of the stomach lining)

Gastritis is limited only to the mucous membrane of this important organ of the digestive system. To understand the characteristics of this type of pathology, you need to understand the structure of the stomach and its epithelium.

The stomach is a hollow muscular organ, the inner layer of which protects the muscle wall from the aggressive effects of hydrochloric acid produced during digestion. In normal condition, the mucous membrane retains its integrity and ability to rapidly regenerate cells, due to which it absorbs water well.

The cells of a healthy gastric mucosa are renewed very quickly - within 4-5 days. With prolonged exposure to negative factors, epithelial cells lose their protective function, and pathological changes begin in the mucosa. As a result of this process, gastritis develops.

Depending on the duration of the influence of negative factors and the intensity of the impact, two forms of gastritis are distinguished:

• Acute - occurs suddenly due to a severe allergic reaction, overeating, large amounts of alcohol consumed and other reasons. It manifests itself as severe pain after eating, heartburn, and nausea. With timely and correct treatment, the manifestations of acute gastritis disappear within a week.
• Chronic - occurs in the absence of treatment for acute gastritis or as an independent pathology. Symptoms of inflammation are not as pronounced as in the acute form, or are completely absent. Unlike acute gastritis, a chronic disease is characterized by more extensive damage to the gastric mucosa.

Gastritis goes through several stages in its development:

• redness and swelling of the gastric mucosa as a response to factors that provoke inflammation;
• thickening and chronic inflammation of the mucous membrane and changes in the epithelium of the stomach;
• thinning and atrophy of the mucosa with replacement of epithelial cells with scar tissue;
• the appearance of erosions and ulcers on the mucous membrane.

Important! A timely visit to a gastroenterologist at the first symptoms of gastritis will help determine the cause of inflammation and prevent further development of the pathological process.

Duodenitis (inflammation of the duodenal mucosa)

The inflammatory process can develop in other parts of the digestive system. Duodenitis is a lesion of the mucous membrane of the duodenum, the organ immediately following the stomach.

The function of the duodenum is to “process” food that enters it from the stomach with enzymes that are part of the pancreatic juice and prepare the bolus of food for absorption in the intestine.

The inflammatory process leads to dysfunction of this organ and the development of serious pathologies.

The cause of inflammation is the same as with gastric gastritis, in 90% of cases it is Helicobacter pylori. Chronic gastritis and other systemic pathologies can lead to the development of the disease. Among them: pancreatitis, cholecystitis, malignant neoplasms of the digestive system and others. In the vast majority of cases, duodenitis is a secondary disease; it occurs in acute or chronic form.

Duodenitis often develops in children, since their endocrine system has not yet fully formed. In adults, the risk group includes people suffering from food allergies, alcohol abusers, workers in hazardous industries, as well as people who have an unbalanced diet.

Probable causes of the disease

The cause of primary duodenitis is mainly an improper diet and addiction to food that is harmful to the gastrointestinal tract: irregular meals, addiction to “strict” diets for weight loss, abuse of salty, fried, smoked foods, and meat with a high fat content. Frequent smoking and drinking alcohol, as well as a love of coffee and constant stress, can also provoke the onset of the disease.

Secondary duodenitis occurs as a concomitant disease with gastritis or stomach ulcers, enterocolitis, cholecystitis, pancreatitis, hepatitis (as a result of insufficient production of enzymes), Crohn's disease, Whipple's syndrome, pancreatic cancer, intestinal ischemia, abdominal trauma, frequent diarrhea and dyspeptic symptoms in postoperative period. The causative agents of the disease are helminths, Giardia, and the bacterium Helicobacter pylori.

Causes

Source: graphicube/Depositphotos
Despite the fact that gastritis is the most common disease of the digestive system, the true causes of its occurrence were established relatively recently.

A revolution in gastroenterology occurred in 2005, when Australian scientists received the Nobel Prize for the discovery of Helicobacter pylori and the development of fundamentally new approaches to the diagnosis and treatment of gastritis.

Most pathogenic bacteria die in the stomach under the influence of hydrochloric acid, but Helicobacter pylori secrete urease, a special enzyme that neutralizes the effect of acid. The bacterium enters the body through household contact and through contaminated water and food. Having reached the stomach through the digestive tract, it begins to actively multiply on the mucous membrane. Colonies of harmful microorganisms destroy the epithelium, causing inflammation.

Although bacterial damage to the mucous membrane of the stomach or duodenum is the main cause of the occurrence and development of gastritis, it is not the only one. Other factors include:

• Reflux. In some diseases of the digestive system, the contents of the intestines are thrown into the stomach. At the same time, bile irritates its mucous membrane. The combination of these negative aspects causes inflammation of the mucous membrane and its subsequent destruction.
• Chemical and radiation exposure. Inflammation of the mucous membrane can be triggered by the ingestion of heavy metal salts, salts, alkalis and other aggressive substances into the stomach. Damage to the mucosa can occur with radiation injury within 15 Gy.
• Poor nutrition. Dietary habits also significantly affect the acidity of the stomach. Inflammation of the gastric mucosa can be triggered by excessively hot or cold food, excessively hot seasonings, poorly chewed, hard foods, and abuse of sweet carbonated drinks.
• Alcohol abuse and smoking. Ethyl alcohol is a strong irritant to the gastric mucosa. Systematic consumption of alcoholic beverages is one of the main risk factors for the development of acute and chronic gastritis. Nicotine also causes inflammation, as it has a pronounced vasoconstrictor effect. Impaired blood supply to the mucous membrane leads to the occurrence of foci of inflammation.
• Altered reactivity due to antibody formation. Autoimmune gastritis often occurs against the background of certain diseases, for example, insulin-dependent diabetes mellitus.

In older people, gastritis often occurs with various chronic diseases: pathologies of the cardiovascular and nervous systems, malignant tumors, sepsis. Inflammation can also be a consequence of age-related fibrofatty changes in the gastric mucosa.

Drug therapy for duodenitis

For gastritis of the duodenum, complex therapy is prescribed, which includes:

• antispasmodics (Papaverine, No-shpa, etc.);
• drugs that improve motility of the lower gastrointestinal tract (Maalox, Domperidone);
• antacids that reduce the acidity of gastric secretions (Omeprazole, Almagel);
• anthelmintic drugs (in the presence of parasites);
• antibiotics (if the bacterium Helicobacter pylori is detected) – Flemoxin solutab and others;
• enveloping drugs that protect the mucous membrane of the 12th intestine (De-Nol, Vis-Nol and others).

For the chronic type of the disease, long-term use of the following medications is required:

• anti-inflammatory drugs that promote the regeneration of mucous membranes (aloe extract, B vitamins, Methyluracil, Duogastron);
• anticholinergic drugs such as Gastrocepin, Atropine, Peritol, which eliminate pain;
• dopamine blockers, effective for duodenal motility disorders, which are accompanied by nausea and vomiting (the most popular are Cerucal, Reglan);
• sedatives that eliminate the symptoms of neurasthenia, which often accompanies duodenitis (motherwort, valerian);
• enterosorbents that create a protective cover on the mucous membranes (Smecta, Phosphalugel, Enterosgel).

Symptoms

Symptoms of gastritis are varied, their severity depends on the form and nature of the disease. The chronic course is characterized by periodic stomach pain and heartburn. The period of exacerbation is replaced by long-term and short-term remission, when a person is not bothered by stomach discomfort and is in no hurry to see a doctor.

The first signs of gastritis

Often, the first signs of inflammation of the gastric mucosa do not cause any particular concern in a person, and he can attribute them to poor quality food or general fatigue.

Important! Taking painkillers during attacks of gastritis will only improve the condition for a short time. Long-term use of analgesics will lead to increased inflammation and rapid spread of the pathological process.

What symptoms should you pay attention to first:

• A feeling of heaviness in the upper abdomen 20-30 minutes after any meal.
• Heartburn is a burning sensation under the breastbone that rises to the throat. Heartburn is characteristic of gastritis with increased stomach acidity.
• Nausea immediately after eating or with a long break between meals. The condition may be accompanied by bouts of vomiting with leftover food.
• Metallic taste in the mouth, belching with an unpleasant odor.
• White coating on the tongue.
• Decreased appetite.
• Drawing pain in the navel area, radiating to the back. This may be a signal of problems with the pancreas.

During periods of exacerbation, the temperature may rise to subfebrile levels (37.2 - 37.5), general weakness, chills, dizziness.

Symptoms can manifest themselves complexly or individually, but each of them is a reason to consult a gastroenterologist.

Important! Widely known remedies for heartburn and stomach pain can cause irreparable harm to health and give the opposite result.

There are also nonspecific signs of gastritis, which also require careful attention. These symptoms include: cracks in the corners of the lips, increased sweating, brittle nails, split ends, and excessive dry skin.

Later symptoms

If you ignore the first symptoms of the disease and do not treat it at the initial stage, gastritis develops into more severe forms. Significant damage to the gastric mucosa is accompanied by symptoms requiring emergency medical care:

• constant acute pain in the stomach, burning in the upper abdomen, radiating to other organs;
• vomiting mixed with pus or blood is a sign of excessive acid secretion and severe ulceration of the mucous membrane;
• black stool due to gastrointestinal bleeding;
• vomit, similar in color to coffee grounds, is a sign of destruction of the mucous membrane and bleeding.

Losing time when seeking emergency help can lead to serious complications, including death.

Figure 2. Memo - what to look for and suspect gastritis. Source: macrovector/Depositphotos

Diet as a means of treating duodenitis

In case of acute inflammation, completely exclude canned foods, bakery yeast products, smoked foods, pickles, sour, fried and overly spicy foods. It is also better to forget about alcohol and tobacco. This diet should be followed during the acute stage for at least 10–14 days. Meals are organized as follows:

1. Eat often (up to five to six times a day), but in small portions.
2. Steam or boil foods;
3. All dishes must have a mushy, liquid or semi-liquid consistency and be warm: hot and cold food is strictly prohibited for this diagnosis.

If duodenitis has become chronic, it is recommended to adhere to the diet for life. Depending on concomitant diseases, choose the following diet:

• No. 5 for diseases of the liver, gall bladder and biliary tract;
• No. 5p for diagnosed pancreatitis;
• No. 2 for gastritis with low acidity;
• No. 1 or 16 for ulcerative complications.

Traditionally, they include the following dishes and products:

1. Meat and fish of low fat content in the form of steamed cutlets, meatballs, chopped schnitzels;
2. White crackers.
3. Puree and creamy soups made with vegetable and low-fat meat broths, as well as milk.
4. Cottage cheese, sour cream, steam omelettes, butter and vegetable oils in not very large quantities.
5. Vegetables (potatoes, cauliflower, zucchini, carrots, broccoli) and non-acidic fruits, preferably boiled or baked.
6. Kissel, unsweetened tea, compote made from dried fruits and fruits with a high sugar content.
7. Porridges, puddings, savory desserts and casseroles made from rice, buckwheat and semolina, and oatmeal.

To avoid relapses, it is advisable to avoid eating sweets, soda, soft bread and pastries, spices, pancakes and pancakes, cheese, milk, meat and fish with a high fat content, eggs in any form (except omelet), pearl barley and millet, and legumes. , tea and coffee of increased strength.

Diagnosis of the disease

A doctor can identify the disease by a number of characteristic symptoms. To find out the causes of the pathology, a comprehensive laboratory and instrumental examination is necessary; the nature and composition of further treatment depends on this.

Main types of studies for gastritis:

• Esophagogastroduodenoscopy is a study of the condition of the inner wall of the stomach using a device with a probe equipped with a video camera. The analysis helps to identify areas of affected epithelium and the presence of ulcers and erosions on the mucosa.
• X-ray with contrast to identify nodes and erosions.
• Intragastric pH-metry - determination of stomach acidity to prescribe specific treatment.
• The Helicobacter breath test is a modern and highly informative method for determining the presence of Helicobacter pylori in the body by analyzing the carbon concentration in exhaled air.
• Study of gastric juice to assess the secretory function of the stomach.

Mandatory laboratory tests - general and biochemical blood tests, stool analysis.

Treatment of gastritis

Therapy should be carried out systematically, taking into account the characteristics and nature of the disease, the causes of inflammation, the presence of concomitant pathologies and data from a comprehensive examination.

The treatment regimen is prescribed only by a gastroenterologist; any self-medication is strictly excluded.

Diet for gastritis

Strict adherence to the diet prescribed by your doctor is an important component of effective treatment of gastritis. The diet is prescribed depending on the acidity of the stomach.

If you have low acidity, your doctor will help you develop an individual nutritional style. Products included in the diet should moderately stimulate the secretory function of the stomach. Main components of the diet:

• soups with low-fat meat or fish broth;
• porridge with water;
• dishes of boiled and stewed vegetables, fresh vegetables and fruits;
• dairy products.

If you have low acidity, it is not recommended to eat pickles, sauerkraut, or pickled foods. White bread and pastries, canned food, smoked meats, dishes made from any legumes, and garlic should be excluded from the diet.

Spicy foods and seasonings do not cause gastritis, but they irritate the gastric mucosa, increasing inflammation.

With high acidity, the diet provides for frequent split meals. Avoid spicy pickled foods, fatty meats and other foods that irritate the mucous membranes. In any case, a nutritionist or gastroenterologist will help you create a diet.

Only boiling and stewing of dishes is allowed; fried foods are strictly prohibited.

Folk remedies

Alternative medicine can only be used as a component of complex therapy and taken after consultation with the attending physician. Traditional medicine recipes can alleviate the general condition and reduce the severity of symptoms, but they are not able to eliminate the cause of the pathology.

Phytotherapy

Medicinal herbs can also be used in the treatment of gastritis only as an adjunct and after mandatory approval by the attending physician.

In folk medicine, decoctions and infusions of wormwood, plantain, oregano, licorice root and other medicinal plants are used to relieve symptoms of gastritis.

It is better to purchase ready-made medicinal herbal mixtures in pharmacies after consultation with your doctor.

Drug treatment

The choice of medications is determined by the type of gastritis and the cause of its occurrence. The main components of complex drug therapy:

• Antibacterial drugs depending on the causative agent of inflammation. In the presence of Helicobacter pylori, macrolides, tetracyclines and other groups of antibiotics are prescribed in combination with bismuth preparations. The choice of drugs when other pathogens are detected depends on their resistance to antibacterial agents.
• To normalize secretory function, proton pump inhibitors are used to reduce the production of hydrochloric acid or drugs with peptin to enhance it.
• Gastroprotectors are prescribed to protect the gastric mucosa from negative factors and preserve the integrity of the epithelium.

To alleviate the patient’s condition, sorbents are prescribed; according to indications, hormonal drugs, sedatives, antispasmodics, and others.

Gastritis in children

During the period of exacerbation, children are prescribed bed rest with abstinence from any food for at least half a day. Frequent drinking in small portions, gastric lavage or enema are indicated.

Any manifestation of gastritis in children requires immediate consultation with a pediatrician and strict adherence to his recommendations.

Antibiotics, absorbents and antireflux drugs are prescribed after identifying the causes of inflammation, taking into account the general condition of the child and the individual characteristics of his body.

Physiotherapy treatment

All patients with chronic inflammation of the duodenum are recommended to undergo sanatorium treatment at least once a year, which reduces the incidence of relapses. Physiotherapeutic procedures that have an analgesic and anti-inflammatory effect, activate blood circulation and improve lymph flow in the abdominal organs, and stimulate the secretory function of the gastrointestinal tract also have a good effect. These include:

• electrophoresis;
• ultrasound;
• magnetic therapy;
• ozokerite therapy;
• paraffin compresses;
• balneotherapy;
• warming up the epigastric area;
• diadynamic therapy;
• electrosleep.

Complications of gastritis

Source: lacheev/Depositphotos
Neglect of medical recommendations and lack of timely treatment can lead to serious complications, including:

• the occurrence of stomach and duodenal ulcers;
• thinning of the gastric mucosa and its atrophy;
• internal bleeding and anemia;
• malignant formations in the organs of the digestive system.

Gastritis significantly reduces the quality of life, so timely diagnosis and proper treatment should be a priority at the first signs of the disease.

Lifestyle with gastritis

Recommendations for lifestyle correction are given by the attending physician, but following general simple rules will significantly improve the condition and avoid exacerbations:

• It is important to limit your alcohol consumption, it is better to quit smoking. A glass of wine with dinner, of course, will not lead to gastritis, but any alcohol in excess is a direct path to illness.
• Choose simple, minimally processed foods. Processed meat products, such as sausages and sausages, are best avoided completely.
• Drink more plain clean water. This will help normalize stomach acidity between meals.
• Develop healthy eating habits; while eating, it is better to chat with friends and family, rather than watching TV or scrolling through the news.
• The last meal should be at least 4 hours before bedtime.

And one more important recommendation: you should not endure pain! At the first attacks of exacerbation, consult a doctor.

Alternative medicine for the treatment of duodenitis

You can try to cope with acute manifestations of inflammation of the duodenum at home. For this use:

1. Potato broth. It is taken when the first signs of duodenitis occur, warm, half a glass three times - four times a day.
2. Vegetable juices. The juice is squeezed out of potatoes by taking unpeeled potatoes, preferably of a bluish tint. Take it half a glass after any snack. A mixture of cabbage and celery juices (in a ratio of 4:1), which is drunk on a full stomach up to 5 times a day, also gives a good result.
3. Aloe mixture. The juice is squeezed out of 0.5 kg of washed leaves and mixed with half a kilogram of honey and half a liter of red semi-dry or dry wine. The mixture is infused for ten days, then the infusion is separated from the raw materials and during the 1st, 4th and subsequent weeks, consume 1 teaspoon after breakfast, lunch and dinner, and during the 2nd and 3rd weeks - 1 tablespoon in the same dosage. The duration of such treatment is up to three months.
4. Honey drink. A couple of tablespoons of honey are dissolved in half a glass of cooled, freshly boiled water and consumed three times a day until the condition improves.
5. Sea buckthorn oil, 1 teaspoon of which is recommended to be added to each breakfast. It perfectly eliminates inflammation and ensures mucosal regeneration.
6. Chamomile or dandelion tea (from plant flowers), which is drunk warm throughout the day.
7. Herbal collection: 50 g each of nettle and coltsfoot leaves, goose cinquefoil, yarrow, shepherd's purse, dandelion roots, lemon balm, marshmallow, wheatgrass and valerian are mixed, 2 tablespoons of raw materials are taken, which should be boiled in 2 glasses of water, cooled , filter and drink half a glass half an hour before meals.

Duodenitis is a rather unpleasant disease, but modern medicine knows many effective ways to completely cure or at least partially alleviate its symptoms.