How to diagnose a duodenal ulcer. Duodenal ulcer. Causes, symptoms, modern diagnostics and effective treatment. Treatment of duodenal ulcers with antibiotics

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Inflammation of the duodenum is a disease that affects the initial part of the intestine and is called. It definitely needs to be treated: block inflammatory processes and restore damaged mucous membranes. Otherwise, the human digestive system will not be able to function normally, the patient will suffer from unpleasant symptoms, and the quality of his life will significantly decrease. This is a common disease, but most often duodenitis occurs in the male population, but can also be diagnosed in women and children.

Causes

Inflammation of the duodenum can be primary or secondary. If this is primary duodenitis, it develops due to the fact that the patient did not eat properly for a long time: he ate a lot of salty foods, loved everything fried and fatty, preferred sour and spicy foods, which irritated the digestive organs. The reason may also be a person’s diet on dry food. This disease can also occur in drinkers and heavy smokers.

There are other factors that contribute to the appearance of inflammation in patients:

• constant stress;
• the person works too much;
• he doesn’t get enough sleep or rest;
• if the patient took certain medications for a long time and in large quantities.

In addition to primary duodenitis, there is also secondary duodenitis, which develops against the background of other diseases:

1. Gastritis that was caused by bacteria.
2. Stomach ulcer with high acidity.
3. , due to which duodenostasis develops over time, which leads to a deterioration in the blood supply to the intestinal wall.
4. Liver diseases (hepatitis, cirrhosis), due to which the synthesis of bile acids changes in patients.
5. If chemicals have entered the digestive tract and caused a burn to the patient’s mucosa. Or the patient had food poisoning or toxic infection.
6. There is a foreign body in the patient's intestines.

There are other reasons that cause inflammation of the duodenum in patients, for example, Crohn's disease or the appearance of neoplasms in the gastrointestinal tract.

Signs of the disease

Symptoms of inflammation of the duodenum in patients can be different, sometimes they are completely absent. Duodenitis is characterized by these symptoms:

• The main symptom of the disease is pain in the epigastric region or near the navel. In the acute form of the disease, the pain is severe and sharp. It appears in the patient a few hours after eating or at night;
• a patient with duodenitis has poor appetite;
• after eating he experiences abdominal discomfort and a feeling of heaviness;
• the patient suffers from belching, flatulence, diarrhea, constipation;
  the patient experiences nausea and vomiting;
• weakness makes itself felt, dizziness, the patient may become irritable;
• If the bile and pancreatic ducts are damaged during duodenitis, the patient may experience girdle pain, bile in the vomit, and the patient’s skin and sclera will become yellow.

Duodenitis can be acute, when all the symptoms are particularly pronounced, and chronic. The disease becomes chronic if acute duodenitis appears in the patient again, or if this disease could not be cured in time.

With a chronic inflammatory disease, the pain becomes constant, but it is not severe, but rather aching or “sucking.” The patient also experiences severe heartburn, nausea, and sometimes vomiting.

Why is inflammation of the duodenum dangerous?

If the patient does not want to treat duodenitis, the inflammation lasts long enough, this can lead to atrophy, which cannot but affect the patient’s digestion: the breakdown of food, the production of enzymes, and the absorption of substances will worsen. Because of this, over time, the patient may develop anemia, a lack of vitamins or microelements, which will affect their well-being.

And that is not all. Some patients may experience the following complications of duodenitis:

1. Intestinal bleeding.
2. An ulcer in which both the duodenum and the patient’s stomach suffer.
3. Stenosis of the pylorus of the stomach. With this pathology, the passage between the patient's duodenum and the stomach is greatly narrowed, which can even cause intestinal obstruction.
4. Malignant tumor of the patient's intestine.
5. Purulent inflammation of the tissues that surround the duodenum (phlegmonosis) of the patient.

Therefore, when the first unpleasant symptoms appear, it is advisable for patients to immediately consult a doctor, undergo examination and begin treatment while duodenitis proceeds without complications.

Diagnostics

If you have duodenitis, you should consult a gastroenterologist. He will definitely ask you questions, find out what exactly is bothering you, and also palpate your abdomen. If pain appears in the epigastric zone, this may indicate duodenitis.

An accurate diagnosis will be made by the attending physician after the examination. The most informative of them is esophagogastroduodenoscopy or endoscopy. A probe is inserted into the patient's mouth and a camera is attached to it. Thanks to this device, a physician can examine the entire gastrointestinal tract and determine what kind of disease the patient has, examine the intestinal mucosa and diagnose duodenitis.

The patient may be prescribed other examinations:

1. X-ray.
2. Determination of acidity level.
3. A test that shows the presence of Helicobacter pylori bacteria.
4. Blood and stool tests.

Treatment

If the examination confirms that the patient has inflammation of the duodenum, the symptoms and treatment will be the same as for most gastrointestinal diseases. If this is an acute form of the disease, then doctors wash the intestines and remove any remaining food from it. Then medications are prescribed. At first, it is better for the patient to refrain from eating, then he needs to adhere to a special diet. During exacerbations of the chronic form of duodenitis, the patient is prescribed a gentle regime and a treatment table.

Diet

A diet for inflammation is mandatory; proper, gentle nutrition as much as possible will help quickly restore the patient’s gastrointestinal tract. The patient should eat at least 5-6 times a day, in small portions. It is advisable to either boil or steam all dishes for duodenitis; liquid or semi-liquid food is useful. The patient can only eat warm foods.

For patients with duodenitis, it is better to give up alcohol, as well as everything fried, sour, salty, spicy and smoked; canned food is not allowed.

If this is an acute form of the disease, a diet is necessary, but not for long, on average 10-12 days. The attending doctor must decide exactly how long to go on a diet for acute duodenitis, and he also selects the most suitable diet for the patient. If duodenitis has become chronic, then you will have to stick to the diet for the rest of your life. For exacerbations of duodenitis, especially if it is an ulcerative version of the disease, table No. 1a and 1b, then No. 1 are recommended. If duodenitis occurs against the background of gastritis with low acidity, then diet No. 2. Sometimes patients simultaneously have pathologies of the gallbladder or liver, or pancreatitis. Then he is prescribed diet No. 5.

What can you eat if you have inflammation of the duodenum?

Despite the fact that only a doctor can choose the right diet, and it depends on the state of the gastrointestinal tract, there are lists of products recommended for inflammation of the duodenum.

You can eat:

1. Soups, especially pureed soup, in which all the ingredients are pureed. For duodenitis, you can prepare milk soups, vegetable broths, or low-fat meat broth.
2. The bread is white and dried, you can buy crackers.
3. Meat - in the form of chopped dishes, minced meat. Meatballs and steam cutlets are prepared from it.
4. Porridge is also useful. For duodenitis, it is better to choose the following cereals: oatmeal, semolina, rice, buckwheat. Add a little oil to the porridge.
5. The patient is allowed small pasta, as well as casseroles, puddings, and omelettes (steamed).
6. Patients can eat some vegetables, but in case of intestinal inflammation they are served only boiled, in the form of puree. These are potatoes, carrots, cauliflower and zucchini, broccoli.
7. It is also better to boil or bake fruits, for example, to prepare compotes from them. But the patient can eat sweet berries or fruits if they are soft.
8. The patient is allowed to eat fresh cottage cheese and sour cream, mild cheeses.
9. If you have duodenitis, you can drink milk and fermented milk drinks, compotes, jelly, and rosehip drink. Vegetable juices are also allowed, but they are diluted with water. You can also have tea, but only weak.

What not to eat with duodenitis

If a patient has inflammation of the duodenum, many foods are contraindicated for him. This list may expand or, conversely, contract, depending on the patient’s well-being.

You can't eat:

• For duodenitis, fatty meat or fish, anything fried or smoked is prohibited;
• you will have to forget about canned food, marinades, pickles, hot seasonings and sauces;
• for intestinal inflammation, porridges made from coarse cereals, such as millet or pearl barley, and all legumes, are harmful;
• with duodenitis, you should not eat hard-boiled eggs or fried eggs, fatty or spicy cheeses;
• pasta, if large, is also not recommended;
• For patients, many sweets and ice cream are prohibited;
• Do not drink full-fat milk, coffee, strong tea, carbonated drinks and alcohol.

Medications

Diet is very important for the treatment of duodenitis, but you cannot do without medications. The doctor decides which tablets to prescribe for the patient in each specific case. The patient may take the following medications:

1. Pain medications, that is, antispasmodic drugs (No-shpa, Papaverine).
2. Antacids that help neutralize hydrochloric acid, protect the mucous membrane (Almagel, Gastal, Phosphalugel, Maalox), contribute to the rapid restoration of the walls of the duodenum.
3. Proton pump inhibitors and H2 blockers (ranitidine, omeprazole), which reduce the production of hydrochloric acid.
4. Enveloping drugs (De-Nol).
5. If Helicobacter Pylori is detected, antibiotics are prescribed.
6. To cope with duodenostasis and stimulate intestinal motility, special drugs (Domperidone) are prescribed.
7. If this is a chronic disease, then anti-inflammatory drugs are prescribed that promote healing of the intestinal mucosa (Methyluracil, aloe extract).
8. Medicines that help cope with nausea and vomiting (Reglan, Cerucal).
9. Sedatives that help calm people under severe stress (Valerian, Motherwort).

Inflammation of the initial part of the intestine or duodenitis often occurs due to poor nutrition, but can also develop against the background of other diseases. If you start treatment immediately, you can completely get rid of duodenitis, the chronic form is more difficult to cure, then periods of remission will be replaced by periods of exacerbation. But even in this case, it is important to undergo a course of treatment, even if the pain and other symptoms are not very disturbing, since due to under-treated duodenitis, the digestive process may be disrupted and complications may arise.

According to its purpose, it performs many functions. It is the initial section of the small intestine, but is anatomically connected to the stomach, liver and pancreas through the ducts of Oddi entering the sphincter. Therefore, diseases of the duodenum have their “roots” in disruption of the functioning of different parts of the digestive tract.

What reasons necessitate the identification of duodenal pathology?

Statistics indicate a “younger” appearance of patients with diseases of the duodenal zone and an increase in prevalence among schoolchildren. The relevance of studying the structure and pathophysiology of the organ is associated with the need to determine the method of damage to the intestine and select methods of optimal treatment.

Favorable results of therapy at the level of the duodenum make it possible to prevent dysfunction and problems of the organs involved. There is no separate classification of the pathology of this particular intestine. In the ICD, diseases of the duodenum are included in the same class as diseases of the esophagus and stomach.

Clinicians divide them according to etiological principles:

• for dyskinesia (functional disorders);
• inflammation (duodenitis);
• peptic ulcer;
• malignant tumors;
• structural anomalies.

Developmental anomalies include: congenital stenosis, diverticulum (protrusion) of the wall. They occur rarely and accompany other defects of the digestive system.

Brief Anatomy and Function

The history of medicine tells that the name of the duodenum comes from its length, equal to the width of 12 fingers. Let us immediately note that the fingers must have been very thick, since it is 30 cm long. It is delimited from the stomach by the pyloric sphincter. According to their location, taking into account the bends, 4 sections are distinguished.

The sphincter of Oddi forms the internal papilla in the descending zone. The ducts of the gallbladder and pancreas come together here. The inner mucous membrane is covered with villi; between the epithelial cells there are goblet cells that produce mucus. The muscle layer provides motor skills and tone.

The main tasks of the body:

• neutralization of gastric juice by the incoming contents of the pancreas and chemical treatment of the food bolus;
• further crushing of food particles, creating conditions for more complete access of intestinal bacteria in the underlying sections of the intestine;
• regulation, through feedback from brain centers, of the amount of required production and supply of pancreatic enzymes;
• coordination with the stomach of the “order” for juice synthesis.

Violation of these functions leads to the manifestation of clinical symptoms in diseases of the duodenum.

Helicobacter is able to pass into the intestine from the pyloric part of the stomach with antral gastritis, peptic ulcer

Causes of defeat

The causes of diseases of the duodenum are practically no different from the general damaging factors of the digestive organs:

A person who has 2 or more causes is highly likely to be affected by damage to the duodenum. We will look at the main signs of pathology using examples of individual diseases.

Major diseases

Dyskinesia

Disruptions in nervous activity and stress overload lead to the disease. Damage to the innervation is possible during gastric surgery. Another name is “duodenostasis”.

The essence of the violations: the contents are retained in the intestine and do not reach other parts. The patient develops: dull arching pain in the epigastrium, in the hypochondrium on the right, nausea and loss of appetite, prolonged constipation.

Duodenitis

Inflammation of the duodenum (duodenitis) occurs in acute or chronic form. Acute - occurs within three days if a person takes some strong medications, herbal tinctures, accompanies infectious gastroenteritis. Chronic - practically never isolated. Accompanies stomach diseases, cholecystitis, pancreatitis.

Manifests: abdominal pain without precise localization, aching in nature, without irradiation. Patients feel worse on an empty stomach, early in the morning. After eating, improvement occurs 40 minutes later. Constipation is typical. The long process is accompanied by blockage and spasm of the sphincter of Oddi, cramping pain, and vomiting. With duodenitis, pain in the epigastrium and around the navel is possible.

Bulbit

The disease is a type of duodenitis. The inflammation is localized in the uppermost part of the duodenum - the bulb, so it often “continues” gastritis. According to the form they are distinguished: catarrhal and erosive, according to the course - acute and chronic. With the catarrhal variant, the pain is aching in nature, rarely cramping. Appear on an empty stomach or at night. Accompanied by heartburn, sour belching, bad breath, a feeling of bitterness, and nausea.

Erosive - characterized by prolonged, debilitating dull pain in the epigastrium that appears several hours after eating. There is vomiting with bile, belching with bitterness.

Patients complain of general weakness, insomnia, drooling, and headaches.

Morphological studies show the presence of cracks and macerations against the background of hyperemic, inflamed mucosa. It is important that they are only in the superficial layer and do not penetrate the muscle wall. For a chronic course, periods of exacerbations in spring and autumn are typical, the rest of the time there is a lull (remission).

Ulcer

Duodenal ulcer is observed as a complication and the next stage of duodenitis, erosive bulbitis. The prevalence is higher among women than men.

In a morphological study, it differs from erosion by deeper penetration, damage to the muscle layer, blood vessels

In severe cases, it can cause bleeding, perforation of the wall (perforation), and penetration into a neighboring organ. It is most often localized in the bulb. It is possible to form two ulcers lying on opposite walls (“kissing” in the terminology of radiologists).

• by itching of the skin, the appearance of acne;
• constipation or diarrhea;
• dryness and pigmentation of the skin;
• bloating and rumbling stomach;
• pain in joints and muscles;
• tendency to allergic reactions;
• weight loss;
• restless sleep with frequent awakenings;
• increased frequency of colds due to decreased immunity.

Helminths feed on the contents of the intestines, some penetrate through the wall into the blood

Neoplasms

Malignant and benign neoplasms in the duodenum are a rare find. Of the benign ones, the growth of adenomas, fibroadenomas, papillomas, lipomas, hemangiomas, and neurofibromas is important. Tumors of the duodenal papilla occur. In appearance they may resemble pedunculated polyps. Identifies single or multiple.

They are asymptomatic and discovered by chance. If they reach large sizes, they cause symptoms of mechanical intestinal obstruction and obstructive jaundice (compression of the bile ducts).

Duodenal cancer accounts for only 0.25-0.3% of all localizations of malignant tumors of the digestive system. Most cases occur in the descending area above and around the duodenal papilla, least of all in the bulb.

Older men are more likely to get sick. The possibility of transformation from an ulcer and a benign tumor has been proven. The cancerous tumor is a late metastasizing type. The nearest lymph nodes, pancreas, and liver grow. Other metastases are rare.

Clinical signs:

• excruciating pain;
• loss of appetite and exhaustion;
• signs of mechanical obstruction (severe vomiting, dehydration);
• decay causes severe bleeding;
• yellowness of the skin and sclera.

Intestinal obstruction

Symptoms of duodenal diseases can manifest as obstruction in this area of ​​the small intestine. She is called:

• congenital developmental anomalies;
• atypical turn;
• inverted shape;
• increased mobility;
• blockage by a tumor of the duodenum or compression by a neoplasm of the pancreas;
• stone migration.

Hernia

A hernia is a characteristic protrusion of the intestinal wall. It is more often found in people over 50 years of age who lead a sedentary lifestyle. Formed as a result of loss of muscle tone. The disease can be suspected if the patient has gastroesophageal reflux. Patients complain of heartburn, especially at night, belching, and flatulence.

Main types of diagnostics

In the diagnosis of diseases of the duodenum, the following are used: a blood test - allows one to judge the intensity of inflammation, identify anemia, the reaction of feces to occult blood, examination of feces for worm eggs, methods for detecting Helicobacter.

If there is yellowness of the skin, be sure to examine the blood for viral hepatitis, liver tests, and enzymes. Fibrogastroduodenoscopy is also necessary - the main method of visual examination of the mucous membrane, identifying forms of inflammation, erosions, ulcers, and tumors.

A morphological examination of a piece of tissue taken during a biopsy is carried out, which helps to distinguish the growth of a malignant and benign neoplasm, as well as an ultrasound examination.

The X-ray method continues to be used in the clinic. An examination with a series of images is carried out after the patient ingests barium salt. On the recommendation of specialists, relaxation duodenography with a probe is used for an improved overview of the upper intestines.

Directions for treating diseases of the duodenum

Diseases of the upper small intestine must be treated in combination with other digestive organs. Strict adherence to the patient's diet is considered mandatory.

In the acute phase of bulbitis and ulcers, fasting is prescribed for 1–2 days. Maximum sparing of the organ is ensured in the future by excluding fried, salty, smoked, spicy and fatty foods from the diet; alcohol and carbonated drinks; strong coffee and tea.

The daily diet must include: boiled meat and fish, soups without spices, liquid porridges, low-fat cottage cheese, jelly. It is necessary to eat 6 times a day, in small portions. After 2 weeks, the diet is gradually expanded, but general restrictions for chronic diseases apply for the rest of your life.

In case of exacerbation, pureed dishes, well crushed, are recommended for several days.

Bed rest is necessary for patients with duodenitis, peptic ulcers, and tumors. If the patient’s condition is satisfactory, then you just need to get rid of physical activity and learn to cope with stressful situations.

Some diseases of the duodenum do not require treatment. These include: hernia, diverticula, structural anomalies, benign formations in the absence of clinical manifestations. Doctors perform annual fibrogastroduodenoscopy to monitor the dynamics of the pathology.

Treatment with medications

Medicines are prescribed on an etiological basis, taking into account the identified functional disorders. Infection with worms will require a course of therapy with anthelmintic drugs with control stool tests. Dyskinesia is treated with a regimen, diet, sedatives, and physiotherapy.

Confirmation of the presence of Helicobacter is an indication for a course of eradication with Amoxicycline, De-nol, Sumamed. For pain relief, the administration of antispasmodics is indicated. To protect the intestines, drugs should be prescribed by injection. For high acidity, antacids are prescribed: Maalox, Almagel, Gastal.

To restore the tone of the pyloric sphincter and motility, and relieve nausea, Omeprazole, Ranitidine, and Metoclopramide are used. Symptomatic medications (vitamins, choleretic drugs) will be needed for patients with a long-term chronic course of the disease.

Methyluracil has an anti-inflammatory effect, promotes the healing of erosions and ulcers

Chemotherapy for malignant neoplasms is carried out with cytostatic drugs that stop the reproduction and growth of cancer cells. Combination with radiation therapy helps delay tumor development.

Application of surgical methods

Surgical methods of treatment are certainly used for diseases such as tumors, hernias, cicatricial stenoses, changes in the structure of the duodenum, obstruction, long-term non-healing ulcers, and acute bleeding. Ineffective conservative therapy requires consultation with a surgeon.

Benign neoplasms and hernial protrusions are operated on only if they grow to a significant size and interfere with the passage of food. The most common types of operations are:

• vagotomy - excision of the adductor branch of the vagus nerve, often performed laparoscopically;
• removal of part of the stomach along with the duodenum (resection) and formation of a gastroenteroanastomosis with the jejunum;
• removal of the hernial sac and suturing of the wall.

When choosing a method, surgeons are guided by: the state of organ damage (erosions, deep bleeding ulcers), the age and concomitant diseases of the patient, and the prognostic risk of postoperative complications.

Resection of the stomach and affected duodenum practically cures up to 80% of patients

In cases of ulcer breakthrough or acute bleeding, surgery is performed according to emergency indications in order to save the patient’s life. Interventions are not equivalent in results. After vagotomy, relapses of the disease occur in 1/3 of patients.

In case of malignant neoplasm of the duodenum, surgical tactics are selected depending on the location of the tumor. In addition to bowel resection, removal of the pancreatic head and duct may be necessary.

Folk remedies

Herbal medicine for diseases of the stomach and duodenum should support the directions of basic drug treatment. Healers recommend:

• decoction of oats, flaxseed;
• Drink warm chamomile tea daily;
• infuse a collection of marshmallow and licorice roots;
• alcohol or water tincture of propolis;
• oak bark decoction.

Sanatorium-resort treatment consolidates the results of therapy and restores the functions of the duodenum. The health resorts of Essentuki and Kislovodsk are suitable for this purpose. Natural mineral water and mud in the form of applications contain a natural complex of healing substances.

Diseases of the upper intestine rarely occur in isolation and are more often accompanied by other lesions of the digestive organs. Timely detection allows you to prevent serious consequences.

, which occurs as a result of the action of acid on the mucous membrane. Unlike a superficial mucosal defect (erosion), an ulcer heals with the formation of a scar.

Causes

Duodenal ulcers most often occur due to infection with Helicobacter Pylori. An ulcer can develop due to increased acidity in the duodenum. In addition, ulcerative processes can develop with regular use of non-steroidal anti-inflammatory drugs (diclofenac sodium, aspirin, ibuprofen and others).

The development of ulcers is promoted by smoking, frequent alcohol consumption, and poor diet.

It has been proven that when working night shifts, the risk of developing ulcers increases by 50%.

Symptoms of duodenal ulcer

Flatulence.

Nausea.

Bloating.

Belching of sour contents.

Treatment of duodenal ulcers

In the past, surgical treatment was one of the most common treatments for duodenal ulcers.

Since the discovery of Helicobacter Pylori, modern therapies have been developed to cure this disease without surgery. Currently, surgical treatment is indicated only in the presence of complications (bleeding, penetration, perforation of the ulcer, formation of pyloric stenosis).

The goal of drug therapy is to destroy (eradicate) the Helicobacter Pylori bacterium, prevent the development of complications, and restore the duodenal mucosa.

For peptic ulcers associated with Helicobacter Pylori infection, the main treatment strategy is “triple” anti-Helicobacter pylori therapy for 7-10 days. First-line therapy includes a proton pump inhibitor, clarithromycin, amoxicillin, or metronidazole. The most effective second line of therapy is quadruple therapy with the addition of bismuth subcitrate.

Complications

Bleeding;

Perforation (perforation) of the ulcer;

Pyloric stenosis.

Prevention of duodenal ulcers

Prevention of duodenal ulcers involves regular, healthy lifestyle and proper nutrition. It is advisable to avoid drinking alcohol and quit smoking.

To prevent exacerbations, you should stick to a diet, avoid stress, and give up bad habits. Night shift work is not recommended.

Duodenal ulcer (DU) is a lesion of the mucous membrane due to the harmful effects of acidic contents and pepsin. The disease occurs in the form of exacerbations and remissions. The main symptom is the presence of an ulcerative defect in the wall.

Along with the duodenum, the stomach is often affected. Combinations of gastric and duodenal ulcers or gastric and esophageal ulcers should be called combined diseases.

To understand the reason for the development of this disease, why gastric and duodenal ulcers appear more often than ulcers in other locations, it is necessary to become familiar with the anatomy of the intestine.

To better understand treatment methods, it is necessary to understand what substances are released into the lumen; consider the action and functions of the intestine.

Anatomical structure and topographic location of the duodenum

The duodenum is the initial section of the intestine. Located in front of the small intestine. The duodenum begins from the stomach, in the area of ​​the pylorus, and ends with the transition to the jejunum. The length of the duodenum is 30 cm. The diameter is approximately 5 cm.

Located below the epigastrium, covering the pancreas. The intestine is divided into several sections along its length. The ampullary part, the site of the ulcer, begins in the pyloric region, then bends, passing into the descending part at the level of the third lumbar vertebra, where it bends again and forms the next part - the horizontal one. The described part of the intestine crosses the abdominal aorta and, bending, returns to the II lumbar vertebra - called the ascending part of the intestine.

Structure of the duodenal wall

The intestinal wall consists of 3 membranes. The outer one is the serous, which continues from the stomach. The middle layer is muscular and consists of an outer layer and an inner layer of muscle fibers. The inner shell is mucous. The shell is a collection of folds and villi, in the depths of which there are special glands responsible for the production of duodenal juice. A number of hormones are produced in the duodenal mucosa. The effect of hormones is visible when there is sufficient secretion of gastric contents.

DPC function:

1. Normalization of Ph levels for further processing of contents in the intestines.
2. Participates in the regulation of the amount of pancreatic enzymes and gastric juice.
3. Participates in the processes of opening/closing the pyloric part of the stomach.
4. Secretes hormones involved in digestion.

Etiology and pathogenesis of the disease

The causes of duodenal ulcers are multifaceted. The origin of the disease consists of factors that, coming together, attack the mucous membrane. One of several factors is an imbalance of protective and aggressive factors of the intestinal environment. For example: hydrochloric acid of the stomach with increased acidity of gastric juice. This happens due to the insufficiently efficient functioning of the pyloric part, causing damage to the mucosa in the area of ​​​​contact of the contents of the stomach and duodenum.

The bacterium Helicobacter pylori (HP) is capable of secreting substances that increase the acidic environment. By multiplying and developing in the duodenum and stomach, it releases substances that have a destructive effect on the intestinal wall. In case of a lack of “protective factors”: sufficient blood supply, an intact bicarbonate barrier, a sufficient number of T- and B-lymphocytes, a shift occurs in favor of aggressive factors, leading to the formation of an ulcer. The disease has not been fully studied, and the etiological factors of its occurrence have not been elucidated.

Risk factors

Duodenal ulcer occurs due to unfavorable environmental factors. Risk factors include activities and diseases that favor an increase in acidity. These include: smoking, abuse of strong drinks: alcohol, coffee. An important role is played by a history of gastritis, which is a pre-ulcerative condition, and gross dietary violations (fast food, fasting, poor nutrition). Eating spicy, smoked, and salty foods leads to a decrease in Ph, increasing acidity. Such a violation of the diet leads to disorders of the gastrointestinal tract in other localizations.

When consuming significant quantities of non-steroidal anti-inflammatory drugs or glucocorticosteroids, acidity increases significantly. A genetic factor cannot be ruled out: a predisposition to high stomach acidity.

Clinical picture of the disease

Duodenal ulcers appear during periods of exacerbation, which occur in the spring and autumn. The patient's first complaints are pain resembling cutting pain localized in the epigastric region. Often the pain is acute, radiating to the right hypochondrium or back. Soreness is often associated with food intake, eating disorders and occurs within 2 hours from the moment of eating. The duodenum and stomach produce hydrochloric acid at night, pain may occur at night.

Flatulence, bloating, nausea, vomiting, occasional heartburn. Abnormal stool in the form of constipation. Appetite is absent or significantly reduced.

Diagnosis of duodenal ulcer

Diagnosis is based on criteria. They include the collection of complaints, examination of the patient and a full examination according to the list: blood tests, X-ray and other research methods specific to the disease.

The procedure for prescribing methods is determined by the doctor. Based on the clinical picture, the doctor decides which study needs to be carried out immediately and which is not indicated in a particular situation.

Collection of data for the presence of gastrointestinal pathology

To begin with, at an appointment with a doctor, a thorough collection of complaints is made, because the disease manifests itself with a corresponding clinical picture (pain in the epigastric region, cutting in nature, associated with food intake and dietary errors, sometimes unmotivated weight loss). Collection of anamnestic data (when these complaints first appeared, whether the person was examined before, what medications he took to relieve pain, dosage of medications, etc.).

Unreasonable use of non-steroidal anti-inflammatory drugs in large doses provokes the formation of stomach and duodenal ulcers. The diet is clarified: what types of food and drinks are more likely to be consumed, and whether the patient eats spicy foods. The symptoms of duodenal ulcer in women and men are identical.

The family history is ascertained (whether similar diseases were recorded in relatives of the 1st line of kinship, malignant formations of the gastrointestinal tract). Symptoms of peptic ulcer disease are found out from the patient’s relatives; the disease is definitely infectious. The doctor draws the patient’s attention to the time of year when symptoms appear or intensify.

You should pay attention to the signs of a duodenal ulcer: early pain in the epigastric region. They appear half an hour to an hour after eating and are seasonal. When the stomach and intestines are affected by the disease, the symptoms remain similar, but pain appears early after eating and later. Stomach ulcers are characterized by late pain that occurs one and a half or 2 hours after eating. Characteristic pain occurs during long breaks in food - fasting. A diet that includes periods of fasting, for example, in case of obesity, is prohibited.

Considering that gastric and duodenal ulcers often occur in one patient, it is necessary to carefully collect anamnesis and complaints regarding the pathology of the stomach, not just the intestines.

Objective research

Inspection of covers. The skin is of normal color and moisture, clean. Palpation examination reveals tension in the anterior abdominal wall, pain in the upper abdomen (in the area where the stomach and duodenal ulcers are located), to the right of the umbilical region, at a point at the level of the 12th rib from the back along the paravertebral line. When you tap the area under the xiphoid process of the sternum with your fingers, soreness and muscle tension are determined.

Laboratory examination methods

There will be no changes in a detailed blood test for uncomplicated disease. If the ulcer “opens” and bleeds into the intestinal lumen, erythrocytosis and a decrease in hemoglobin in a complete blood count may occur. The stool is examined for occult blood - if the course is uncomplicated, no blood is found.

Instrumental examination methods

Diagnosis of the disease is structured and includes measurements:

Treatment

If the above complaints occur, you should consult a doctor. Treatment involves:

1. Diet.
2. Antibiotic therapy according to recommendations. Three or four component circuits. New generation schemes.
3. Surgical treatment according to indications.
4. Prevention of complications (bleeding, perforation of ulcers).

Considering the versatility of treatment, we will consider the points in order.

Diet

Consists of limiting a certain amount of foods that affect the acidity of gastric juice. Unlimited food: fermented milk products (cottage cheese, milk), low-fat fish products, chicken, crackers, vegetables, fruits, vegetable oil. The following should be excluded from the diet: alcohol, salty, spicy, citrus fruits, fatty meats, canned food.

Drugs for treatment

Surgery

Acceptable only in cases of complications: bleeding from an ulcer, degeneration into a malignant one, perforation.

A serious complication is duodenal stenosis. With frequent relapses, a complication forms - a scarring ulcer. On the one hand, such a process means the closure of the ulcerative defect and the absence of the danger of perforation of the ulcer or bleeding. But the scar is a dense connective tissue that tightens the intestinal walls. Intestinal patency is disrupted and a cicatricial blockage appears, which is an indication for surgical treatment. A complication manifests itself in the form of profuse vomiting, which occurs due to the appearance of a scar: gastric contents cannot penetrate further into the intestines and stagnate.

Surgical treatment involves resection of the affected area of ​​the intestinal tube, intersection of the branches of the n.vagus. Thanks to the measures taken, the secretion of hydrochloric acid and gastric juice is reduced.

Physiotherapeutic treatment

1. Thermal procedure using heating pads and compresses with a warming effect. The effect is achieved by reducing spasm of the myocytes of the duodenal wall, relieved by heat. Treatment has contraindications: complicated course of the disease, suspicion of cancer.
2. Electrophoresis. Medicines that relieve antispasmodic pain (drotaverine, papaverine) are used. When taking the solution orally, galvanic currents are supplied.
3. Magnetotherapy.
4. Hydrotherapy.
5. Oxygen therapy.
6. Hyperbaric oxygenation.

Prevention of the disease

It is necessary to prevent the entry of Helicobacter pylori. Need to:

1. Use only a clean plate, spoon, and mug.
2. Do not use dishes that have been previously used by someone else and have not been washed. Peptic ulcer is an infectious disease. Transmitted through saliva. For this reason, you cannot taste food, drink from a mug, or use a family member’s cup. In cafeterias with friends you cannot try each other's food.
3. Erosive and ulcerative lesions of the duodenal mucosa were detected and treated in a timely manner.

It will be necessary to prevent a significant increase in the level of hydrochloric acid in gastric juice. The solution involves strict adherence to dietary recommendations - exclusion from food of fried, spicy foods, spices, overly salty products, canned food, and winter preparations. Patients with gastric and duodenal ulcers often neglect the diet that is the basis of treatment.

Interesting data have been obtained regarding the beneficial effects of sleep on digestion. Doctors came to the conclusion that after lunch the person needed a short nap. It is believed that during rest, more blood flows to the brain and heart. It has been proven that during sleep, these organs work in an “energy-saving” mode; most of the blood, compared to waking hours, enters the stomach and intestines, leading to a sufficient supply of nutrients, rapid regeneration of the mucous membrane of the duodenum, and a therapeutic effect.

Ulcer disease is considered not only as an independent disease. Often pathology is the cause of untreated erosions. Erosion – changes in the mucous membrane on the inner layer. With proper treatment, erosive and ulcerative lesions disappear without a trace; in advanced cases they turn into ulcers.

Oncological alertness

Many doctors and scientists believe that duodenal ulcer can develop into intestinal cancer. The following conditions must be present: a genetic predisposition to cancer, a family history of oncology, frequent recurrent exacerbations of duodenal ulcer. Has the ulcer been fully treated? When was the last treatment completed? It is necessary to study a history of erosive and ulcerative lesions that develop into an ulcer.

Symptoms of cancer are sometimes nonspecific; it is necessary to obtain a certain alertness from the patient regarding possible malignancy of the ulcer, to motivate the patient to adhere to the diet, diet, and medications. Even a scarring version of a duodenal ulcer is at high risk of malignancy: an ulcer that has not completely closed can again be complicated by bleeding. By following the doctor's instructions, the purity of relapses and the risk of malignancy of the ulcer will be reduced. Only a doctor should treat a duodenal ulcer. With incorrectly prescribed treatment or self-medication, there is a high risk of frequent relapses of the disease. This will lead to severe complications of peptic ulcer disease. After treatment of a duodenal ulcer, the patient remains under dispensary observation by a therapist at his place of residence.

Answers to patient questions

1. Which doctor should treat peptic ulcers? Answer: therapist or gastroenterologist.
2. Will it be possible to cure stomach and duodenal ulcers? Answer: yes, quite.
3. Is the disease inherited? Answer: no, the disease is not transmitted, only a predisposition to the disease.
4. Can a peptic ulcer of the stomach and duodenum be detected in one patient? Answer: this happens.
5. Will you be able to independently identify stomach and intestinal diseases? The answer is positive if symptoms are identified: pain in the upper abdomen, acute cutting pain. They appear in spring - autumn and are associated with food intake. They are considered the first signs of an ulcer.
6. Is it possible to play sports if a stomach ulcer is diagnosed? Answer: exclusively for compensation. An untreated ulcer can open at any time and bleeding will occur.
7. Is bleeding from stomach and duodenal ulcers treated? Answer: hemostatic drugs and surgical suturing of the wound.
8. What to do if the patient discovers an ulcer in old age? Answer: be sure to consult a therapist at the first symptoms. Treatment does not depend on the person's age. There are known contraindications only for surgical treatment.
9. Will an ulcer harm the baby during pregnancy? Answer: during pregnancy, most drugs cannot be prescribed; if complaints arise, you need to undergo an FGS; an ulcer is dangerous due to complications. The manifestation of the disease in pregnant women will be similar to other groups of the population.
10. Is it true that complications of peptic ulcer disease can occur when flying? Answer: partly yes, complications can arise at any time with an untreated form of the disease.
11. What are the symptoms and treatment of the disease? Answer: described in the article above. Methods include: diet, antibiotic therapy, surgical treatment of complications.
12. The manifestation of which diseases is similar to a duodenal ulcer? Answer: peptic ulcer of other localizations, gastritis, enteritis.
13. How long does it take for an ulcer to heal? Answer: several years. With adequate treatment with antibiotics – several months. For surgical treatment – ​​several months.
14. Can diseases of the stomach and intestines turn into cancer? Answer: malignancy of an ulcer is possible, and polyps also become malignant.
15. What localizations of the ulcer are possible? Answer: duodenum, stomach, esophagus. The first of those described, the causes of which are indicated above, is more common than esophageal ulcers.

The human intestine begins with the duodenum– it is located immediately behind the stomach and is relatively small in size compared to other parts of this organ (see photo above). Also called DPC for short.

Why was she called that: Medieval scientists - anatomists did not have modern means of measurement, and they, having measured the length of this organ with their fingers, received an indicator of 12 fingers in diameter - 25 - 30 cm.

Functions of the duodenum

The duodenum plays an important role in the entire digestive process. Since it is the initial link of the intestine, the processes of absorption of nutrients from incoming food and liquid actively occur here. It brings the acid-base indicator of food to a level that will be optimal for subsequent stages of digestion in the intestines. It is in this organ that the stage of intestinal digestion begins.

Another integral phase of the work of this part of the intestine is the regulation of pancreatic enzymes secreted by the pancreas, as well as bile, depending on the acidity of the food bolus and its chemical composition.

The duodenum affects the proper functioning of the secretory function of the stomach, since the opposite interaction occurs. It involves the opening and closing of the pylorus of the stomach and humoral secretion.

Evacuation and motor functions.

The 12 duodenum carries the function of further promoting food gruel, treated with enzymes, into the next section of the small intestine. This occurs due to the massive muscle layer of the duodenal wall.

Features of the structure of the organ (shape, location, fastening)

The shape of most people is varied, and even in one person, both the shape and the location of the duodenum can change over the course of a person’s life. It can be V-shaped, and resemble a horseshoe, loop and other shapes. In old age, or after weight loss, it is lowered compared to where the duodenum is located in young and middle-aged people and overweight people. But most often it originates at the level of the seventh thoracic or first lumbar vertebra, located from left to right. Then there is a bend with a descent to the third lumbar vertebra, another bend with an ascent parallel to the upper part and the intestine ends in the area of ​​​​the second lumbar vertebra.

It is attached to the abdominal organs by connective fibers located on the walls. The upper part of the duodenum has the fewest such attachments, so it is mobile - it can move from side to side.

The structure of the wall of the duodenum:

• The serous outer layer performs mechanical protective functions.
• The muscle layer is responsible for the peristalsis of the organ during the digestion of food.
• The submucosal layer contains nerve and vascular nodes.
• the inner layer is the mucous membrane, strewn with a large number of villi, folds and depressions.

Organs adjacent to the duodenum

This section of the intestine is in contact with other abdominal organs on all sides:

• and the main duct;
• right kidney and ureter;
• ascending colon.

This anatomical location of the organ has a huge impact on the characteristics and course of diseases that arise in it.

The most common diseases of the duodenum.

• - the most common ailment of the duodenum of acute or chronic type, manifested in the form of inflammation of the mucous membrane.
• Ulcer– develops as a result of chronic duodenitis. Chronic damage to the duodenum, in which ulcers form in the mucous layer.
• Cancer tumor– a malignant neoplasm localized in different layers of the duodenal wall.

Duodenitis

More than 90% of patients develop chronic duodenitis. It can develop due to many factors, including:

• consumption of low-quality products;
• alcohol abuse;
• smoking;
• ingress of foreign bodies and toxic substances;
• other chronic intestinal diseases.

This disease manifests itself in the form of pain in the epigastrium of moderate intensity, weakness, belching, heartburn, nausea, turning into vomiting. Symptoms are often accompanied by fever.

A variation of this inflammatory phenomenon is in which the pathological process occurs only in the duodenal bulb. This form of duodenitis does not occur just like that - it is a consequence of other pathologies of the intestines or stomach. The cause of bulbitis can be:

• or DPK.

If the disease is at an acute stage, the person feels pain and nausea and suffers from repeated vomiting. Acute bulbitis develops against the background of long-term use of a large group of drugs, or poisoning. In the chronic form, there is also an aching pain syndrome, sometimes it can be accompanied by nausea.

Patients also experience chronic duodenal obstruction, which occurs against the background of tumor processes, developmental anomalies and other disorders in the duodenum. It is expressed in a violation of motor and evacuation functions in this part of the intestine and is characterized by the following symptoms:

• decreased appetite;
• feeling of heaviness and discomfort in the epigastric region;
• constipation;
• gurgling and bubbling.

The manifestation of this disease is influenced by the causes that caused duodenal obstruction, the stage of progression and how long ago the disease arose.

Peptic ulcer

The main cause of this dangerous disease is the reflux of acid from the gastric contents and its destructive effect on the mucous membrane of this part of the intestine. But this pathological process develops only when the surface layers of the intestine fail to cope with their protective functions. The ulcer is localized in the initial part of the duodenum and in the bulb, that is, in that zone of the intestine that is located at a minimum distance from the stomach.

Many gastroenterologists unanimously speak about the negative impact of frequent use of anti-inflammatory drugs, which lower the protective barrier of the mucous layer of the duodenum. These drugs are aspirin and dosage forms based on it, ibuprofen, diclofenac, etc.. Therefore, if possible, you should limit your intake of medications from this group as much as possible.

Poorly treated or neglected duodenitis, abuse of alcoholic beverages and consumption of foods harmful to the body can also cause the duodenum.

It also tends to affect not only the stomach, but also the mucous membrane of the duodenum. It is a fairly common cause of ulcerative pathology, opening the way for acid into the mucous layers of the intestine. In 19 out of 20 cases of the development of ulcers of this organ, it is the Helicobacter bacterium that is to blame.

Symptoms:

Since this disease is very common in gastroenterological practice, you should know what kind of symptomatic picture it manifests. This is a paroxysmal pain syndrome in the upper abdomen slightly below the sternum. during a feeling of hunger or, conversely, immediately after eating. After eating, symptoms worsen such as:

• nausea;
• urge to go to the toilet.

The main dangerous complications of this disease of the duodenum are bleeding or perforation, which require emergency surgical assistance. Bleeding is fraught with dangerous loss of blood and filling of the abdominal cavity with it. Perforation is when food with all the enzymes and acids enters the abdominal cavity through an ulcerative hole formed in the intestine.

If medical assistance is not provided on time, such complications can lead to the death of the patient. There are cases in medical practice when a peptic ulcer turns into a cancerous state.

An ulcer, like other lesions of the duodenum, is diagnosed by an endoscopy procedure. Using this procedure, a gastroenterologist can visually assess the condition of all organs of the digestive system. A blood test may also be necessary, especially if we are talking about duodenal ulcer caused by the Helicobacter bacterium. Complex diagnostics may also include a biopsy of the affected area of ​​the intestine - this is carried out directly during an endoscopic examination (a procedure for taking a small volume of affected tissue for laboratory examination).

Duodenal cancer

, bladder;

eating large amounts of animal food.

According to scientists, components of coffee in combination with nicotine can also affect the development of duodenal cancer. Therefore, doctors do not recommend getting carried away with coffee: you should limit yourself to 2–3 cups per day as a maximum. Constant ingestion of carcinogens and chemicals that have a detrimental effect on the entire gastrointestinal tract can also cause duodenal cancer. The unfavorable environmental conditions of the region of residence undoubtedly influence the development of many groups of diseases, including cancer. Both men and women over 50 years of age are at risk.

This disease is considered insidious because it is difficult to diagnose in the initial stages of development. The first signs of the disease can be easily confused with ordinary gastrointestinal disorders. Later, pain is added to these sensations during the development of oncology, especially when a person feels a feeling of hunger and heaviness. The patient feels weak, loses his appetite and experiences depression. These symptoms are associated with the process of intoxication.

A person with duodenal cancer has a much greater chance of a normal outcome if the tumor is detected in the primary stages of development. To make an accurate diagnosis, an endoscopy and a biopsy of the affected area of ​​the intestine are performed, and a complex of laboratory tests (CBC, etc.) is also connected to them. After this, an urgent operation must be performed to remove the tumor and the lymph nodes closest to it.

From all of the above, a simple and logical conclusion can be drawn. The duodenum is, like all organs, a very important part of our body. It performs complex and important functions in the digestive system, so every person should be attentive to their food preferences - if possible, exclude unhealthy foods from their diet and give up bad habits. After all, it is much easier to prevent diseases than to then go to the doctors and stay in the hospital in the hope of overcoming them.

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