Catarrhal duodenitis: what it is, symptoms of the disease, diagnosis and treatment methods

DUODENITIS

(
duodenitis
; lat. duodenum duodenum + -itis) is an inflammatory-dystrophic process that involves all layers of the wall of the duodenum or is limited to its mucous membrane. There are also bulbitis (bulbitis) - inflammation of the duodenal bulb and odditis (odditis) - inflammation of the sphincter of the common bile duct (Oddi) - a ring-shaped muscle covering the common bile duct before it exits into the cavity of the duodenum.

D. was first described by F. B. Rousset in 1824. The introduction to the wedge, the practice of duodenoscopy (see) and targeted biopsy significantly expanded the diagnostic capabilities in relation to this disease. According to a number of researchers (A.V. Efremov, K.D. Eristavi, 1969), chronicle. D. meets at least hron, gastritis and makes up 22-30% in relation to all go.-kish. diseases. Sick Ch. arr. middle-aged men.

Catarrhal duodenitis: what is it?

It is difficult to determine from the name of the disease which part of the gastrointestinal tract it affects. In fact, in medicine this is the name for inflammatory damage to the duodenum, which is in an acute form. We need this organ to digest food. When it gets there, it is processed by juices coming from the pancreas. Also, the duodenum is responsible for the production of hormones, so its inflammation greatly affects the patient’s well-being. And although the catarrhal form is considered acute, with timely treatment it is easy to cure. In this case, only the upper layer of the mucous membrane becomes inflamed. Sometimes this disease is also called superficial duodenitis.

The bacterium Helicobacter pylori is the most common cause of the development of this pathology. It can develop at any age and is often found even in young children.

Pathological anatomy

Rice.
1. Microslides of the mucous membrane of the duodenum: a - normal - for comparison (1 - brush border; 2 - goblet enterocytes; 3 - duodenal glands); b - with moderately severe duodenitis (1 - pronounced infiltration of the own layer of the mucous membrane by lymphoid cells; 2 - dilated duodenal glands); hematoxylineosin staining; x 150. Fig. 2. Microscopic specimen of the mucous membrane of the duodenum with pronounced duodenitis: significant thickening of the folds of the mucous membrane; sharp infiltration of the stroma of the mucous membrane, spreading to the deep layer; hematoxylin-eosin staining; X 150. Fig. 3. Microslide of the duodenal mucosa in chronic atrophic duodenitis: 1 - shortened and enlarged intestinal villi; 2 — sclerotic stroma of the mucous membrane; 3 - cystically dilated duodenal glands; hematoxylin-eosin staining; x 135. Morphologically, D. is distinguished between moderately expressed, pronounced and D. with atrophy of the mucous membrane. With moderately severe D., the mucous membrane of the duodenum is hyperemic, swollen, and in places covered with mucus. There is a slight expansion of the zone of tall cells with a narrow cytoplasm and a nucleus shifted to the center, a certain increase in goblet enterocytes; pronounced infiltration of the own layer of the mucous membrane with lymphoid and plasma cells; spherical expansion of the duodenal (Brunner's) glands and filling them with mucus (Fig. 1). With pronounced D., the mucous membrane of the duodenum is swollen, its folds are thickened, arranged randomly, the stroma of the mucous membrane is densely infiltrated with lymphoid cells (Fig. 2). Dystrophic changes in the intestinal epithelium are revealed: the cytoplasm of the cells of the mucous membrane is vacuolated (see Vacuolization), the number of goblet enterocytes is significantly increased (see Goblet cells). Increased infiltration extends to deeper layers. Duodenal glands with enlarged lumens merge with each other, forming large cysts. D. with atrophy of the mucous membrane is characterized by smoothing of the relief of the mucous membrane due to the shortening and expansion of intestinal villi, compaction of the intestinal epithelium with a sharp decrease in the number of goblet enterocytes, and an increase in deep crypts (Fig. 3). It has been established that the mucous membrane of the bulb is much more often and to a greater extent subject to patol changes (proximal D.) than the distal parts of the duodenum (distal D.).

Types of disease

Catarrhal duodenitis affects only the superficial layer of the duodenal mucosa. But it is also conventionally divided into several types. A pathology that occurs without significant deterioration in the patient’s condition is called asymptomatic. As a rule, the patient is unaware of its presence and it can only be diagnosed during an examination by a doctor. This type is especially common in young children, who may suffer from duodenitis for several years and not know it.

Catarrhal duodenitis can develop into chronic duodenitis only in the absence of timely treatment. Therefore, at the first symptoms of the disease, you should seek help from a doctor.

Depending on the symptoms, duodenitis is usually divided into the following types:

Nervous-vegetative. The patient suffers not only from the typical symptoms of the disease, but also from headaches, dizziness, severe weakness and anxiety.
Gastro-like.
Cholecystithopodonous.
Ulcer-like.
Mixed. During an exacerbation, many different symptoms appear that are uncharacteristic of duodenitis. This complicates the diagnosis of the disease.

There is another classification. The type of disease in this case depends on the degree of inflammation. Focal catarrhal duodenitis is diagnosed if inflammation affects individual areas and not the entire mucosa. If there are erosions on it, then it is called erosive. Flagmetous duodenitis is diagnosed if there is pus on the mucous membrane.

Treatment

In the case of catarrhal and erosive-ulcerative acute duodenitis, self-healing is possible after a few days, however, in some cases the disease can become chronic. Superficial duodenitis requires hospital stay and fasting for 1–2 days. From the third day there is a transition to dietary nutrition. In case of dehydration, plenty of fluids are prescribed; in case of vomiting, saline solutions are prescribed. Antibiotics and surgical treatment may be indicated. With a disease such as duodenitis, symptoms and treatment are closely related, since the former determine the course of therapy.

For a form such as chronic duodenitis, treatment is developed depending on its stage and the clinical course of the disease, as well as the presence of other gastrointestinal diseases. Drug treatment of duodenitis includes antacids, antisecretory drugs, as well as prokinetics in case of disorders of duodenal patency.

With the atrophic process in the intestine and the extinction of its secretory function, replacement therapy and herbal medicine are used. In the case of neurovegetative disorders, tranquilizers and sedatives are used; if there is anxiety-depressive syndrome, then antidepressants may be indicated. In case of chronic duodenal obstruction, surgical treatment of duodenitis is necessary. Correction of the patient’s lifestyle and nutrition plays a role. The diet for duodenitis is prescribed depending on the characteristics of the disease.

In complex therapy of chronic duodenitis, physiotherapeutic treatment is used, which has an analgesic and anti-inflammatory effect and helps to normalize the motor-evacuation function of the gastrointestinal tract. The most effective are complexes that include a combination of hardware methods of physiotherapy, balneotherapy and treatment with mineral waters. Electrosleep techniques are useful for neurasthenic syndrome. For patients who are prone to exacerbations, treatment with mud, paraffin and ozokerite applications is indicated.

Causes of the disease

This is a fairly common pathology that is diagnosed in both adults and children. There are many causes of catarrhal duodenitis, but often its appearance is provoked by the bacterium Helicobacter pylori. It accumulates on the walls of the mucous membrane and irritates it, causing inflammation. In addition, because of it, the patient usually suffers not only from duodenitis, but also from other concomitant diseases: gastritis, cholecystitis, reflux esophagitis and others.

Typically, these bacteria enter the body due to poor hygiene. The following reasons increase the risk of developing duodenitis:

Poor nutrition. Constant consumption of fatty, spicy and fried foods increases the risk of developing inflammation. Fasting and overeating are also harmful. Excessive consumption of strong tea or coffee on an empty stomach can also provoke duodenitis.
Constant stress and nervous breakdowns, as well as lack of sleep and overwork.
Long-term use of certain medications, including painkillers and anti-inflammatory drugs.
Poor environmental conditions or working in unfavorable places can contribute to a decrease in immunity, which will lead to the active proliferation of bacteria and the development of inflammation.
Abuse of alcoholic beverages and cigarettes.
Not fully cured or advanced gastritis.

Recovery period

In general, the prognosis, provided that the diagnosis is made in a timely manner and a rehabilitation course is carried out, is usually favorable, and the likelihood of developing certain complications is minimal. Only self-treatment along with the use of folk remedies can lead to complications. As for the rehabilitation period, as practice shows, patients, provided proper treatment, manage to recover within three months.

We looked at what it is - proximal duodenitis.

Main symptoms of duodenitis

The disease does not have specific symptoms, so it is easy to confuse it with other gastrointestinal pathologies. Only a doctor can diagnose its presence, and he must also prescribe treatment. Symptoms of catarrhal duodenitis can also have varying degrees of severity. Some patients do not notice a significant deterioration in their health. Others, on the contrary, need urgent treatment.

Duodenitis can be recognized by the following signs:

Severe pain in the epigastric region. It may get worse about 2 hours after eating fatty, fried or spicy foods.
Nausea and increased salivation, which can develop into vomiting. After it, the patient usually feels better.
Heartburn and an unpleasant bitter taste in the mouth, which appears 2-3 hours after eating.
Constant bloating and bowel movements. As a rule, a patient with advanced duodenitis suffers from alternating constipation and diarrhea.
Lack of appetite, which leads to weight loss if left untreated.
General deterioration in health. Due to inflammation of the mucous membrane, food cannot be absorbed properly. Therefore, patients also suffer from headaches and general weakness. They become irritable and get tired quickly.

Symptoms

If the patient has been diagnosed with duodenitis, then the existing symptoms will strongly resemble the manifestation of gastritis. The main signs of this disease in the proximal region are divided into several groups:

The development of an ulcer-like pain syndrome in the intestines and stomach, which occurs some time after eating food.
Dyspeptic symptoms, that is, digestive dysfunctions, which are characterized by excessive gas formation, a tendency to constipation and nausea. In this case, frequent vomiting is also possible.
Symptoms of intoxication and inflammation can manifest as general weakness, and at the same time dizziness, fever, loss of appetite and, very often, sudden weight loss.

How to diagnose duodenitis?

If his health worsens, the patient should consult a therapist. It will help accurately diagnose the disease and prescribe treatment. As a rule, the symptoms of duodenitis can be easily confused with other gastrointestinal pathologies. Therefore, self-medication is not recommended.

Diagnosis of catarrhal duodenitis begins with a general examination and medical history. The doctor is interested in the location and severity of the pain and asks how long such symptoms have been observed. If duodenitis is suspected, he may prescribe the following studies:

Blood analysis. The patient takes it to find out whether there is an inflammatory process in his body.
FGDS. This is the most effective way to diagnose the disease. Using an endoscope, the doctor can quickly assess the condition of the stomach and duodenum and determine if their mucous membranes are inflamed.
Ultrasound of the abdominal cavity.
In some cases, an additional test is prescribed to help determine the presence of the Helicobacter pylori bacterium.
Fecal analysis.
To assess the motor function of the duodenum, fluoroscopy is sometimes additionally prescribed.

Diagnostics

The clinical picture of duodenitis is diverse and nonspecific; in addition, isolated duodenitis is very rare; as a rule, it is combined with other diseases (chronic gastritis, peptic ulcer, enteritis, pancreatitis, diseases of the biliary tract). Therefore, reliable diagnosis of chronic duodenitis is possible only with the help of instrumental research methods, such as:

fibrogastroduodenoscopy with biopsy;
duodenoscopy;
pH-metry;
floor manometry;
impedancemetry.

In parallel with the diagnosis of duodenitis, it is necessary to conduct a study of the digestive organs associated with the duodenum.

How to treat the disease?

Inflammatory lesions of the duodenum always require timely treatment. Only a doctor can prescribe it after conducting appropriate diagnostics. What needs to be done to treat duodenitis?

First of all, the doctor prescribes a number of medications to the patient that will help relieve inflammation and relieve unpleasant symptoms. It is imperative to follow a diet, otherwise treatment may be ineffective. To speed up the healing process, you can also use traditional medicine, but only after consulting a doctor.

Etiology and pathogenesis of duodenitis

The duodenum is located immediately after the stomach.
This section of the gastrointestinal tract is extremely important for the digestive process. Acute duodenitis develops under the influence of strong irritants:

food infections;
too spicy food in large quantities, often supplemented with alcohol;
poisoning with substances with irritating effects;
entry of foreign objects into the duodenum.

Chronic duodenitis occurs under the influence of the following provoking factors:

irregular meals;
excessively hot or spicy food;
excessive alcohol consumption,
smoking,
diseases of neighboring organs (chronic gastritis, gastric ulcer, pancreatitis, etc.);
repeated acute duodenitis;
Helicobacter infection.

Chronic inflammation persists when the mucous membrane cannot neutralize the constant impact of aggressive environmental factors: excess hydrochloric acid and enzymes coming from the stomach, disruption of the normal balance of intestinal microflora, the influence of pathogenic bacteria.

Drug therapy

Drugs are the most effective way to treat duodenitis. If the disease is caused by Helicobacter pylori, then the patient must take a course of antibiotics. Otherwise, after some time, the symptoms of the disease may return.

To relieve pain and discomfort in the epigastrium, the patient is prescribed antispasmodic drugs. Medicines that reduce the acidity of the gastric enzyme will help cure inflammation. It irritates the inflamed duodenal mucosa, causing severe pain. To protect it, coating medications can also be used. They form a film that covers the mucous membrane. These medications should be taken before meals.

The duration of the course of drug therapy will depend on the severity of the disease. As a rule, it is enough to take the prescribed medications for 2-3 weeks to recover from duodenitis, if it is not advanced.

Diet

What is catarrhal duodenitis? Many patients ask this question, fearing that they will have to treat this disease for a long time. But in fact, drug therapy in combination with diet helps to quickly alleviate the patient’s condition.

As a rule, duodenitis is caused by poor nutrition. Therefore, to recover, the patient must first change his diet. If the duodenum is affected, you should only eat soft foods at room temperature. Any spicy, fatty or fried foods should be excluded from the menu. The patient should not eat fast food, processed foods, or drink alcohol. It is also advisable to give up cigarettes. Meals should be fractional, so you need to eat often, but in small portions. It is recommended to eat at least 5 times a day. For duodenitis, it is useful to eat porridge, pureed fresh vegetables and fruits, and jelly. All dishes are best cooked in a steam or water bath.

Folk remedies

What is catarrhal duodenitis? Can it be cured using traditional medicine? Many people ask these questions. Non-traditional remedies can indeed speed up recovery, but they can only be used as an auxiliary therapy. Various decoctions that have an anti-inflammatory effect are often prescribed. So, for duodenitis, you can take infusions of chamomile or nettle. Decoctions of mint or centaury have an analgesic and calming effect. You can buy them at the pharmacy. In summer, you can collect and dry the plants yourself.

Laboratory and instrumental studies

The following laboratory and instrumental studies are carried out:

The condition of the blood is examined. To do this, biochemical and general tests are performed to detect a decrease in hemoglobin and red blood cells.
A stool test shows the presence of blood in it.
A pH study determines an increase in acidity, which allows the specialist to assume that duodenitis was caused by gastritis.
The presence of Helicobacter pylori infection is detected using specific tests.
Endoscopic examinations allow visual assessment of the condition of the mucosa. Thanks to such techniques, it is possible to determine the extent of intestinal damage, and in addition, take a biopsy for histology.

Medical specialists also perform a survey X-ray of the abdominal cavity. In the presence of proximal duodenitis, it can be used to identify a topographic disturbance in the relationship between the intestines and the stomach. X-rays using a contrast agent make it possible to evaluate intestinal motility.

Forecast

Many patients, having heard the diagnosis, wonder why catarrhal duodenitis is dangerous. Since this disease affects only the superficial part of the mucosa, it is easily treatable. As a rule, relief of the patient's condition occurs immediately after the start of therapy. You can be completely cured within 3-4 weeks of taking medications. The exact recovery time will depend on the severity of duodenitis. Changing the patient's lifestyle and diet has a great influence on improving well-being.

In the absence of timely treatment, the catarrhal form can develop into a chronic form. In the future, complications may develop, including ulcerative lesions.

Main forms of the disease: erosive, catarrhal and moderate

Proximal duodenitis, like any other inflammation that develops in the digestive organs, can occur in acute or chronic form. This disease can be localized in a specific area. Particularly important is the division of this pathology into morphological forms. Thanks to this classification, it is possible to develop the correct treatment tactics.

What is it - superficial proximal duodenitis?

Experts identify the following forms of this disease:

The initial stage, or in other words, follicular duodenitis of the proximal region, is characterized by the presence of a significantly increased number of lymphoid follicles on the walls of the bulb.
At the stage of moderate duodenitis, endoscopic examination reveals slight damage and deformation of the upper layer of the epithelium on the intestinal walls.
The severe form is erosive proximal duodenitis. It is characterized by the presence of abundant lymphoplasmacytic infiltrates and multiple erosions on the surface of the mucosa.
Proximal catarrhal duodenitis, which is caused by Helicobacter. A characteristic clinical manifestation of this variety is a rich brightness of the intestinal mucosa along with increased blood filling of the capillaries and swelling of the folds.

Now let's move on to consider the symptoms of this disease and find out how it manifests itself.

Prevention of duodenitis

To prevent the recurrence of the disease, it is enough to follow simple preventive rules. First, you need to carefully monitor your diet. Limit your consumption of fatty, spicy and fried foods. Try to drink less alcoholic drinks, as well as tea, soda or strong coffee. Secondly, practice basic hygiene to prevent harmful bacteria from entering your body. Always wash your hands with soap and water before eating and thoroughly clean vegetables and fruits before eating.

It is also useful to strengthen your immunity. Walk outdoors more often and don’t forget to exercise. Stop taking anti-inflammatory drugs or at least try not to take them on an empty stomach.

Doctors' advice

Doctors say that proximal duodenitis, like any other pathology, must be subject to appropriate preventive measures. Experts consider it mandatory not so much to treat with medications or other special means, but to maintain general health along with timely treatment of diseases of the stomach and the entire digestive system as a whole.

Doctors advise patients not only to eat a balanced diet, but to completely give up bad habits, namely nicotine and alcohol. In addition, experts insist that patients engage in moderate physical activity and lead a healthy lifestyle. It is very important to take daily walks along with physical exercises and other activities that improve the metabolic process and other physiological activities.

In particular, doctors advise annual endoscopic examination to assess the condition of the inner surface of the esophagus, stomach and intestines. In addition, according to experts, a mandatory step in the treatment of this disease is taking a biopsy.