Duodenitis, Bulbit

Inflammatory diseases of the duodenum. They occur frequently, mainly in men. Duodenitis is distinguished between acute and chronic, widespread and limited (mainly by the duodenal bulb - bulbitis).

Acute duodenitis usually occurs in combination with acute inflammation of the stomach and intestines as acute gastroenteritis, gastroenterocolitis; It can be catarrhal, erosive-ulcerative and phlegmonous. Etiology, pathogenesis. Foodborne illnesses, poisoning with toxic substances that have an irritating effect on the mucous membrane of the digestive tract, excessive intake of very spicy foods, usually in combination with large amounts of strong alcoholic drinks, and damage to the mucous membrane of the duodenum by foreign bodies play a role.

Symptoms, course. Characterized by pain in the epigastric region, nausea, vomiting, general weakness, pain on palpation in the epigastric region.

The diagnosis (if necessary) is confirmed by duodenofibroscopy, which detects inflammatory changes in the mucous membrane of the duodenum.

In very rare phlegmonous duodenitis, the patient’s general condition sharply worsens, tension of the abdominal wall muscles in the epigastric region, a positive Shchetkin-Blumberg sign, fever, neutrophilic leukocytosis, and increased ESR are detected. Duodenal intubation and duodenofibroscopy are contraindicated.

Acute catarrhal and erosive-ulcerative duodenitis usually ends in self-healing after a few days; with repeated duodenitis, a transition to a chronic form is possible.

With phlegmonous duodenitis, the prognosis is serious. Possible complications: intestinal bleeding, perforation of the intestinal wall, development of acute pancreatitis.

Treatment. In case of acute catarrhal and erosive-ulcerative duodenitis, 1-2 days - fasting, bed rest, gastric lavage with a weak solution of potassium permanganate, followed by the introduction of 25-30 g of magnesium sulfate in a glass of water (to cleanse the intestines). In the following days - diet No. 1a-1, astringents and enveloping agents inside, for pain - antispasmodic and anticholinergic drugs. For phlegmonous duodenitis, treatment is surgical in combination with antibiotic therapy.

Chronic duodenitis can be superficial, atrophic, interstitial (without gland atrophy) or erosive-ulcerative. Irregular diet with frequent consumption of spicy, irritating, too hot food, and alcoholism are important. Bulbit is usually associated with gastritis, peptic ulcer of the stomach and duodenum.

Distal duodenitis often accompanies diseases of the pancreas (chronic pancreatitis), liver (biliary tract, intestines. Chronic duodenitis is also observed with giardiasis and helminth infections. In addition to the direct effect of the irritating agent on the duodenal mucosa, proteolytic is important in the pathogenesis of chronic duodenitis the effect of active gastric juice on it (with trophic disorders, dyskinesias).

In the development of chronic duodenitis in recent years, great importance has been attached to Helicobacter pylori infections. Antral Helicobacter gastritis promotes the discharge of acidic gastric contents into the duodenum, metaplasia of the gastric epithelium in it. The introduction of Helicobacter pylori into metaplastic cells reduces the resistance of the duodenal mucosa to the effects of the acid-peptic factor, and erosive damage to the duodenal bulb develops.

Characteristic pain in the epigastric region is constant, dull or ulcer-like, a feeling of fullness or fullness in the upper abdomen after eating, decreased appetite, nausea, and sometimes vomiting. Palpation reveals pain deep in the epigastric region.

The diagnosis is confirmed by duodenofibroscopy. If necessary, conduct bi