Duodenitis: causes, symptoms and treatment. Distal duodenitis symptoms and treatment Chronic d duodenitis what

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In today's article, we will consider with you such as - duodenitis, as well as its symptoms, causes, types, diagnosis, treatment, folk remedies, as well as the prevention of duodenitis. So…

What is duodenitis?

Duodenitis- an inflammatory disease of the duodenum, mainly its mucous membrane.

The danger of duodenitis is that the duodenum (Latin duodenum) is one of the most important organs in the digestive system, which immediately follows the stomach, and is the initial section of the small intestine. Food in the duodenum is processed by pancreatic juice and prepared for absorption. In addition, the duodenum is involved in the production of hormones that regulate the normal functioning of the digestive system and metabolism. Duodenal disease leads to a number of disorders of the entire digestive system, including deadly diseases, for example -.

Some doctors refer "duodenitis" to a group of diseases united by the name - "".

The main symptoms of duodenitis are - pain in the right side of the abdomen, grumbling in the abdomen, lack of appetite.

The main causes of duodenitis in most cases are the bacterium Helicobacter Pylori (Helicobacter pylori), improper location of the organ and a violation of the production of hormones by the intestine.

According to the form, acute and chronic duodenitis are distinguished, which in turn are also divided into various types of the disease. But the most dangerous thing is precisely chronic duodenitis, because over time, if the necessary measures are not taken to treat this disease, it contributes to destructive changes in the structure, and, accordingly, the functionality of the duodenum.

Development of duodenitis

The development of inflammatory processes is due to two factors: the first is pathology in the intestine or its weakening due to various pathological processes (alcohol, unhealthy foods, stress, etc.), the second is the effect of an irritating or infectious factor on the weakened place of the intestine (gastric juice, bacteria, etc.).

Thus, when the duodenum is weakened, it is more susceptible to the negative effects of acidic gastric juice, bacteria, and other factors that, in the normal state of this organ, cannot harm it. The integrity of the mucosa is broken, the same gastric juice, which by its very nature of digesting food has high acidity, begins to “corrode” the mucous layer of the intestine. Toxins produced by the bacterium Helicobacter pylori can also increase the amount of acid in the intestine.

The combination of these processes, if they are not stopped at this stage, contribute to complications of duodenitis, which can be expressed in dystrophic changes in the structure of the walls of this organ, and then, perforation of the intestinal walls, internal bleeding, etc.

Statistics

According to statistics, it is noted that most often, inflammatory disease of the duodenum duodenitis is observed in men, and it develops in many cases in childhood. In addition, as practice shows, acute inflammatory processes of the duodenum in 94% of cases become chronic.

Duodenitis - ICD

ICD-10: K29.8
ICD-9: 535.6

Symptoms of duodenitis

The main symptoms of duodenitis are:

dull constant or in the right hypochondrium, which increases at night, with an empty stomach or palpation;
lack of appetite;
feeling of fullness in the abdomen, especially after eating;
bitter eructation;
, sometimes with ;
, general malaise;
dyspepsia.

Important! In the elderly, duodenitis often occurs in a secretive form, i.e. asymptomatic, so it causes all the same harm to human health.

Complications of duodenitis

Complications of duodenitis may be accompanied by the following symptoms:

perforation of the wall of the duodenum 12;
intestinal bleeding;
acute pancreatitis;
yellowing of the skin;
dystrophy of the duodenum;
disorders in the autonomic and central nervous systems.

Causes of duodenitis can be:

Improper location of the duodenum in the body;
Weakness of the hormonal apparatus of the duodenum;
Violation of the motor function of the duodenum (duodenostasis);
Infection of the organ with the bacterium Helicobacter Pylori;
Violation of the diet;
The use of spicy, sour, fried, fatty and smoked foods;
Abuse of alcoholic and caffeinated drinks, smoking;
Uncontrolled intake of certain medications, such as non-steroidal anti-inflammatory drugs (NSAIDs - "Aspirin", ""), antibiotics;
Violations in the functionality of the intestine: violations of its blood supply, trophism, tissue respiration;
Others - the liver (,), pancreas (), intestines (), gallbladder, mesentery.

Types of duodenitis

Duodenitis is classified as follows ...

By shape

Acute duodenitis. It usually proceeds in an acute form, with acute attacks of pain, especially with a long period of time between meals, as well as with the use of spicy, sour, fried, smoked. Often accompanied by inflammatory processes in the stomach and intestines. It often ends in self-healing, but with repeated attacks it usually becomes chronic.

Chronic duodenitis. A very diverse form of the disease, both in etiology and in symptoms. The main symptom is dull and dull pain, pursuing the patient throughout the entire period of inflammatory processes, sometimes intensifying. All the types of duodenitis listed below will more accurately characterize the chronic form of this disease.

According to the endoscopic picture:

Atrophic duodenitis. It is characterized by the suppression of activity, incl. motility of the duodenum 12, the mucous membrane of which becomes thinner in this form of the disease.

Hemorrhagic duodenitis. It is characterized by the appearance of bleeding in the intestine, which later can leave the body along with feces or vomit. The main causes of the development of the disease are considered to be the use of substances that strongly irritate the intestinal mucosa - drugs, alcohol, acids.

Interstitial duodenitis. It is characterized by the absence of processes of atrophy of the glandular part of the intestine.

Catarrhal duodenitis. It is characterized by severe acute pain in the abdomen, nausea and vomiting, general weakness and. The main reason is damage to the intestinal mucosa with coarse or irritating food - alcohol, spicy, salty, fried, sour, smoking. Treatment usually comes down to a sparing diet.

Superficial duodenitis. Inflammatory processes develop mainly on the surface layers of the mucous membrane of the duodenum 12.

Phlegmonous duodenitis. It is characterized by an acute purulent lesion of the lower part of the duodenum, in the region of the Vater (large) papilla, against the background of a weakened organism.

Erythematous duodenitis. It is characterized by general weakness, paroxysmal pain in the abdomen, sometimes the work of the respiratory and cardiovascular systems is inhibited. It usually develops against the background of a long course of inflammation of the intestinal mucosa and other organs of the gastrointestinal tract.

Erosive and ulcerative duodenitis. It is characterized by the appearance of ulcerative and erosive formations on the mucosa of the organ.

According to clinical manifestations:

Chronic bulbar duodenitis with acidopeptic genesis. It is characterized by damage to the mucous membrane of the duodenal bulb. It is often accompanied by peptic ulcers of the stomach and duodenum. Pain is usually paroxysmal, worse on an empty stomach or after eating junk food (spicy, smoked, etc.), at night, and also during palpation of the epigastric region of the abdomen.

Chronic duodenitis, which develops against the background of a violation of intestinal obstruction (duodenostasis). It is characterized by severe twisting paroxysmal pains, belching, flatulence, grumbling in the abdomen, nausea and in some cases, vomiting with bile;

Chronic duodenitis, accompanied by an atrophic form of gastritis and enteritis. It is characterized mainly by disorders of the digestive system - dyspepsia, pain after taking spicy or smoked food, nausea, heartburn.

Neuro-vegetative duodenitis. It is characterized with a predominance of symptoms, mainly disorders of the nervous system.

Local duodenitis (diffuse), accompanied by the development of peripapillary diverticulitis and / or papillitis. This form of the disease is usually accompanied by a violation of the outflow of bile, which is expressed by yellowing of the skin and whites of the eyes (). The stool is clarified, in severe cases almost white. There are also pains in the epigastric region, with a return to the right or left hypochondrium.

mixed form. The disease is accompanied by all clinical manifestations.

Asymptomatic course. Usually, clinical manifestations are mild, or almost invisible. It occurs mainly in the elderly, during a routine medical examination.

Origin:

Primary. The cause of this form of the disease is usually a violation of the body's activity as a result of improper diet and lifestyle.

Secondary. The development of the disease occurs against the background of other diseases of the gastrointestinal tract - gastric and duodenal ulcers, gastritis, hepatitis, infection with the bacterium Helicobacter pylori and others.

Diagnosis of duodenitis

Diagnosis of duodenitis includes the following examination methods:

Gastroscopy;
stomach and duodenum;
Duodenal sanding;
Biochemical and pH study of gastric juice;
Fecal analysis (coprogram).

How to treat duodenitis? Treatment of duodenitis depends on the cause and clinical picture of the disease.

Treatment of duodenitis includes the following key points of therapy:

1. Drug therapy
1.1. Antibacterial therapy;
1.2. Removal of helminthiases and giardiasis;
1.3. Normalization of the pH level in the duodenum and stomach;
1.4. Protection of the intestinal mucosa from hydrochloric acid and pathogenic factors;
1.5. Restoration of the mucous membrane and its walls;
1.6. Removal of symptoms and improvement of the activity of the digestive tract;
1.7. Elimination of intestinal obstruction.
2. Diet;
3. Treatment of concomitant diseases.
4. Surgical intervention (if necessary).

Important! If the patient has signs of a complication of the disease, he is subject to urgent hospitalization.

1. Drug therapy of duodenitis (drugs for duodenitis)

Important! Before using drugs, be sure to consult your doctor!

1.1. Antibacterial therapy

Antibiotics are prescribed by a doctor when a pathogenic bacterium Helicobacter Pylori (Helicobacter pylori) is found in the body.

Antibiotics against Helicobacter pylori: penicillins ("Amoxicillin"), macrolides ("Clarithromycin"), tetracyclines ("").

1.2. Removal of helminthiases and giardiasis

The removal of pathogenic microorganisms such as Giardia or helminths (worms) can be done using the following medicines:

Preparations for Giardia (giardia)- "Metronidazole", "Tinidazole", "Furazolidone", "Chloxin";

Preparations for helminths (worms)- mebendazole ("Vermox"), levamisole ("Decaris"), "Diethylcarbamazine".

1.3. Normalization of the pH level in the duodenum and stomach

Restoring the acid-base balance in the duodenum and stomach is a necessary measure to stop pathological inflammatory processes in the digestive organs. This is due to the fact that one of the reasons for the violation of the integrity of the intestinal mucosa is an increased level of hydrochloric acid in them. Acid levels are usually raised by Helicobacter pylori.

To normalize the acid-base balance, antisecretory drugs are used, after the use of which symptoms such as belching, bloating, heartburn, nausea are also removed, and the development of complications of the disease is minimized.

Antisecretory drugs:

Antacids: Almagel, Maalox, Keal, Phosphalugel. This group of drugs neutralizes the increased acidity of gastric juice, thereby preventing its detrimental effect on weakened intestinal walls.

Proton pump and M-cholinergic receptor blockers: Omez, Nexium, Rabelok, Gastrocepin, Pirencepin. These groups of drugs block the proton pump, and also help to reduce the level of production and concentration of hydrochloric acid in the digestive organs.

1.4. Protection of the intestinal mucosa from hydrochloric acid and pathogenic factors

Protection of the mucous membrane of the duodenum is a necessary measure to prevent the development of duodenitis complications, as well as to accelerate the recovery of this organ. Gastroprotectors are used to protect the mucosa.

Enveloping the intestinal mucosa preparations:"De-nol", "Sukralfat". This group of drugs creates a protective film on the mucosa that protects the organ from infection and increased acidity of gastric juice.

Synthetic analogues of prostaglandin E1: Misoprostol, Cytotec. This group of drugs helps to increase the production of mucus by the digestive organs, which forms the mucous membrane, and also protects it from infection and hyperacidity. In addition, they contribute to the normalization of the body's acid-base (pH) balance.

1.5. Restoration of the mucous membrane and its walls

Drugs that accelerate the recovery of the duodenal mucosa: "Biogastron", "Ventroxol", "Kaved-S".

Drugs that contribute to the restoration of damaged walls of the duodenum 12: "Entrostil".

1.6. Removal of symptoms and improvement of the activity of the digestive tract

Antispasmodics. They are used to relieve pain and spasms of the digestive organs - "Drotaverin", "No-shpa";

Prokinetics. Contribute to the improvement of the activity of the digestive tract - "Itoprid", "", "".

Probiotics. They are used in combination with antibacterial drugs, aimed at preserving the beneficial microflora in the intestines, which is necessary for the normal functioning of the digestive organs - Linex, Bifiform.

Sedatives. They are prescribed for disorders of the nervous system - Valerian, Tenoten.

1.7. Elimination of intestinal obstruction

With duodenitis against the background of duodenal obstruction, treatment is aimed at eliminating obstruction of the duodenum. To do this, probing the intestine with its washing with warm mineral water is periodically prescribed.

At the same time, drugs that bind bile ("Cholestyramine"), antiseptics ("Intestopan", "Enterosediv") and prokinetics "Motilium", "Cerukal" are prescribed.

With duodenitis, the patient is prescribed a diet, usually (according to Pevzner), which excludes the use of foods that irritate the gastric mucosa and duodenum. After the exacerbation of duodenitis subsides, the patient is transferred to or, and in case of reduced tolerance to dairy products, diet No. 4, after which they are transferred to 4B. During the period of remission, you can apply diet number 15.

What can you eat with duodenitis? Nutrition for duodenitis includes: sparing soups from cereals, preferably with the addition of milk or cream, liquid cereals, finely chopped low-fat meats and fish (chicken, turkey), low-fat dairy products (cottage cheese, sour cream, kefir, yogurt, milk, creamy oil), eggs (soft-boiled), white bread, boiled vegetables, compote, jelly, fruit juices rich in tea (especially based on medicinal herbs).

Food is best eaten warm. Cooking method - steam or boil. The number of meals - 5, in small portions.

What can not be eaten with a stomach ulcer? Alcoholic and low alcohol drinks, caffeinated drinks, strong tea, spicy (mustard, pepper), salty, fatty and fried foods, smoked meats, sausages, canned food, raw vegetables and fruits (legumes, cabbage, onions, tomatoes, radish, citrus fruits) , condiments, ketchups, mayonnaise, sauces, ice cream, sweets. Be sure to quit smoking.

3. Treatment of concomitant diseases.

Inflammatory disease of the duodenum duodenitis often develops against the background of other diseases of the digestive system - gastritis, colitis, peptic ulcers and others, therefore, their treatment is a mandatory point of therapy.

4. Surgical intervention (operation) for duodenitis

Surgical treatment of duodenitis is indicated only in some cases, for example:

Drug treatment did not lead to the necessary results;
A pathology of the structure of the duodenum was found;
There were complications of duodenitis: perforation of the walls, bleeding

Important! Before using folk remedies for duodenitis, be sure to consult your doctor!

St. John's wort. Pour 2 tbsp. tablespoons of dry chopped grass perforated with 250 ml of water, put it in a water bath, for 30 minutes. Then leave it, let it cool, strain and take 1/3 cup of the product 30 minutes before meals, 3 times a day.

Nettle and oats. Add 200 g of unpeeled oats to the pan and fill it with 1 liter of water, put on a slow fire and cook until a slimy decoction forms. Next, the broth is cooled and filtered. At this time, pour a glass of leaves with 3 cups of boiling water, cover the container for infusion and set aside for 40 minutes, after which the infusion is also filtered. Strained nettle leaves are added to the decoction of oats, and taken 100 ml 3 times a day, before meals. Nettle decoction is drunk as tea during the day.

Plantain. Mix 1 teaspoon with 1 teaspoon of juice. You need to take the remedy with an erosive form of duodenitis, 1 tbsp. spoon 3 times a day, before meals.

- Give up alcoholic beverages, smoking, do not abuse caffeinated drinks;

- Do not leave the disease of the gastrointestinal tract to chance;

- Try not to take medications without a doctor's prescription, because. many of them not only irritate the mucous membrane of the digestive organs, but also suppress the protective functions of the immune system;

- To prevent relapses, try to spend your holidays in thematic sanatoriums and resorts;

Chronic duodenitis is a disease of the duodenum, in which there is inflammation and degeneration of the mucous membrane, which is subsequently complicated by atrophy.

This disease has a polyetiological nature, and depending on the causes that cause it, doctors distinguish two types of chronic duodenitis:

primary type - an independent disease;
secondary type - a disease that develops as a complication of other diseases of the digestive tract, primarily gastritis.

According to medical statistics, most often duodenitis occurs in adult men.

Reasons for the development of primary duodenitis

First of all, you need to know that this form of duodenitis is extremely rare. The reasons for its appearance may be:

irregular eating schedule;
abuse of spicy, fatty, fiber-rich foods;
excess of carbohydrates and fats in the diet;
bad eating habits: smoking, alcoholism, regular intake of coffee and strong green tea.

Many doctors do not recognize that the above reasons could provoke the development of chronic duodenitis. They believe that these are only factors contributing to its development.

One of the likely causes of chronic primary inflammation of the duodenum is considered to be untreated acute duodenitis, which the patient had previously suffered.

The most popular version of the development of this disease is an imbalance between the factors of defense and aggression. When the factor of aggression, namely the excessive secretion of pepsin and hydrochloric acid, prevails over the protective factors - the uniform cellular regeneration of the tissues of the intestinal mucosa, all conditions are created for the manifestation of duodenitis.

Reasons for the development of secondary duodenitis

The lion's share of all clinically recorded cases of chronic duodenitis falls on the secondary type of the disease. The main reasons for its occurrence:

The role of Helicobacter pylori infection in the development of duodenitis of the secondary type is extremely large. Most patients with this disease simultaneously suffer from a chronic form of Helicobacter pylori gastritis.

It is Helicobacter pylori, which previously provoked the inflammatory process of the gastric mucosa, "occupies" the metaplastic zones of the duodenal epithelium. As a result of exposure to hydrochloric acid from gastric contents, inflammation and erosion develop in these areas.

Chronic pancreatitis and hepatitis create extremely fertile ground for the development of duodenitis:

In addition, the development of this disease is directly dependent on the state of the intestinal microflora. With Achilles of the stomach, dysbacteriosis progresses and the bacterial pathogenic flora “seeps” the small intestine and duodenum.

Symptoms of the disease

Pain is the most characteristic symptom of chronic duodenitis. Localization - the junction of the ribs under the sternum, or otherwise the zone "under the spoon". Pain with gastroduodenitis is similar to pain syndrome with peptic ulcer or bulbitis.

The intensity of pain varies (from weak, aching, to sharp, strong). Usually, the pain appears a couple of hours after eating, and disappears after eating or taking special antacids.

With distal duodenitis, the pain is concentrated on the right, and gives under the right shoulder blade. Also, the pain intensifies after eating fried and saturated foods, which often confuses the symptoms, leading to believe that the patient has cholecystitis. The pain is associated with biliary dyskinesia.

The pain can be localized in the upper epigastric zone (similar to pain in gastritis) or give to the back and under the left rib. If the pain is shingles, this indicates that in addition to duodenitis, the patient has papillitis (a disease associated with a violation of the outflow of pancreatic juice and bile from the duodenum).

No less important symptoms of the disease are various kinds of dyspeptic disorders:

bursting and heaviness in the epigastric region;
nausea and heartburn;
tongue densely coated;
bitterness in the oral cavity, bitter eructation - evidence that the patient has gastroduodenal reflux;
vomiting (appears with exacerbation of chronic duodenitis).

During the period of exacerbation, the following vegetative disorders are also characteristic:

profuse sweating;
frequent heartbeat;
weakness and tremor of the upper limbs;
sudden feeling of hunger;
frequent urge to defecate (usually loose stools).

These disorders are most commonly seen in young people.

During an objective personal examination of the patient, the attending physician fixes pain of moderate intensity on palpation of the epigastrium, muscle tension of the abdominal wall.

Patient Examination Program

The program of examination of the patient includes the following mandatory activities:

taking an anamnesis and examining the patient;
taking blood, feces and urine tests;
BAK: determination of the content of chlorides, glucose, potassium, proteins, a-amylase, urea, creatinine, sodium and amino-transferases;
duodenal sounding;
fibrogastroduodenoscopy and sampling of duodenal biopsy;
biopsy analysis for the presence of Helicobacter pylori;
fluoroscopy and ultrasound.

FEGDS is an extremely informative way to assess the state of the microrelief of the mucous surface, locate and evaluate atrophic changes in erosive-inflammatory foci. This is method No. 1, which allows you to almost accurately diagnose chronic duodenitis and promptly begin treatment.

If, for reasons of obstruction or swelling of the target area, the patient cannot undergo EGD, he is prescribed fluoroscopy. Confirmation of the disease will be chaotic peristalsis (sometimes reverse), spasms and "irritable" duodenal syndrome, detected on fluoroscopy.

Treatment of the disease

Treatment of chronic duodenitis must be carried out comprehensively, that is, with direct involvement in the process of therapy of neighboring organs. During the entire period of treatment, the patient is prescribed rest and bed rest. Be sure to follow a special therapeutic diet.

During the period of treatment and recovery from illness, the patient is prohibited from spicy, fried, fatty foods and foods, fresh vegetables rich in abrasive fiber, carbonated and alcoholic drinks, cigarettes, coffee and strong green tea. The first 2 days of the diet are preferably therapeutic fasting. The next 2-3 weeks will have to eat fractionally: 5-6 times a day, in small portions. Food should be grated or liquid: soups, liquid cereals, jelly. The diet should not contain products that mechanically or chemically irritate the mucous membrane: coarse fiber from fresh vegetables, fresh bread, chocolate, sweets based on molasses and trans fats, etc.

Therapeutic agents are necessary for the comprehensive relief of the patient's condition, elimination of all causes of inflammation of the mucous membrane and its further restoration. The complex must include:

drugs with an enveloping effect;
antibacterial drugs;
antispasmodic and choleretic agents;
enzymes that normalize digestive function;
vitamins that have a general strengthening effect on the body, and raise its immune defenses.

Before you start treating duodenitis with medication, you should also discuss with your doctor the possibility of taking auxiliary agents from the arsenal of traditional medicine. Sometimes, with a superficial form of the disease, treatment can be limited to a diet and medicinal herbal decoctions:

An infusion of tansy, cloves, dandelion flowers and wormwood. Take 10-15 grams of each of the herbs, pour 500 ml of boiling water and put in a dark place for 3 days. Ready infusion is consumed before meals, one teaspoon.
Oatmeal jelly is the best folk remedy. Due to the enveloping property, it softens the irritating effect of food on the foci of inflammation of the mucous membrane, contributing to the speedy healing. To prepare such a jelly, you will need 2 tablespoons of high-quality oatmeal, a glass of boiling water and a teaspoon of starch. Bay flakes with boiling water, they must be left to swell. After 8–10 hours, the solution is filtered through a sieve, and after adding the starch, it is brought to a boil. You need to drink jelly in a barely warm form, half a glass before meals.

The best effect of therapy can be achieved by taking a course of medicines prescribed by a doctor and following a strict therapeutic diet, supplementing and strengthening it with mild folk remedies for treating the disease.

Causes

Why does duodenitis develop, and what is it? By duodenitis is meant a systemic inflammatory disease of either the duodenal mucosa or the organ itself.

The occurrence of acute duodenitis and the following factors contribute to the duodenum:

abuse of food and drinks that irritate the mucous membrane of the digestive organs - smoked, spicy, fried, fatty, coffee, alcohol;
food poisoning;
damage to the mucosa by foreign objects, for example, ingestion of indigestible food particles;
getting into the duodenum of infections - staphylococci, Helicobacter pylori, clostridia, enterococci.

Chronic duodenitis may be primary or secondary. Primary chronic duodenitis occurs with malnutrition (eating spicy, irritating, hot food, alcohol), smoking.

Secondary chronic duodenitis is more common - it develops against the background of already existing inflammatory diseases, for example, chronic gastritis, duodenal ulcer, improper treatment of acute duodenitis.

An important role in the development of secondary duodenitis is played by duodenostasis - insufficient mobility of the duodenum as a result of obstruction or poor peristalsis.

Classification

There is no generally accepted classification of chronic duodenitis. Taking into account the peculiarities of development and predominant localization There are 4 options for the process:

chronic, predominantly bulbitis, of acidopeptic origin;
chronic, combined with atrophic gastritis or enteritis;
chronic, developed against the background of duodenostasis;
local duodenitis (papillitis, peripapillary diverticulitis).

By the prevalence of the process duodenitis is of the following types:

diffuse - the mucous membrane of the entire duodenum is inflamed;
focal - inflammation is limited to a small area;
proximal - the area of the duodenum adjacent to the stomach (bulb) is inflamed;
distal - inflammation develops at the site of transition to the small intestine.

Besides, endoscopically distinguish:

superficial chronic;
atrophic chronic;
interstitial chronic;
erosive and ulcerative chronic.

According to the duration of the flow processes are distinguished:

acute - the period of time is not more than 1 month;
chronic - the duration of the disease is more than six months, periods of improvement (remission) are replaced by exacerbation (relapse).

Accordingly, depending on the form of duodenitis, the symptoms and methods of treatment will differ. Qualified diagnostics will help to establish an accurate diagnosis.

Symptoms of duodenitis

Inflammation of the duodenum is characterized by pain in the stomach, vomiting, nausea, weakness throughout the body, pain when probing the epigastric zone. If necessary, to clarify the diagnosis, duodenofibroscopy is prescribed, with the help of which inflammatory processes occurring in the intestine are detected.

With phlegmonous duodenitis, which is very rare, the muscles of the abdominal wall are tense, the general condition of the patient deteriorates sharply, fever, neutrophilic leukocytosis are observed. In this case, duodenofibroscopy and duodenal sounding are contraindicated.

The clinical picture of chronic duodenitis is characterized by a variety and non-specificity of symptoms in adults, as well as a significant similarity of symptoms with other diseases of the digestive organs. Chronic duodenitis, as a rule, is combined with enteritis, chronic diseases of the biliary tract.

The severity and nature of other concomitant diseases of the gastrointestinal tract largely determines the clinical symptoms of chronic duodenitis. Depending on the clinical manifestations, several main forms of chronic duodenitis are distinguished: ulcer-like, gastritis-like, cholecyst-like, pancreatic-like and neurovegetative forms.

Diagnostics

It is possible to make a diagnosis of duodenitis according to the results of the endoscopic picture after gastroscopy. Other additional diagnostic methods are often used to correctly determine the form of the disease:

x-ray of the duodenum and stomach;
duodenal sounding;
coprogram;
biochemical analysis of gastric juice and pH determination;

In the case of secondary duodenitis, individual patients may additionally be prescribed floor manometry, retrograde cholangiopancreatography, CT or MRI procedures, biochemical blood tests, coprogram, assessment of fecal elastase-1, fibroileocolonoscopy, 24-hour monitoring gastric pH-metry, enterography, hepatocholecystography, electrocardiography, renography, ultrasound of the heart and other methods.

Treatment of duodenitis

With duodenitis, treatment begins with the elimination of the cause that caused inflammation of the duodenum.

First of all, with acute duodenitis, this is a diet and a strict stationary regimen. In the first two days, doctors recommend washing the stomach with a solution of potassium parchment, after which they take about thirty grams of magnesium sulfate diluted in 300 milliliters of pure water on an empty stomach.

From the second day, it is rational to take drugs that envelop the organ, and to neutralize pain - antispasmodics in the form of papaverine and drotaverine. Phlegmonous duodenitis usually requires treatment with antibiotics, a hospital stay, and sometimes surgery.

In the chronic course of duodenitis, antacid, antispasmodic, astringent, anticholinergic and ganglion blocking drugs are prescribed. You can also treat the disease with the help of vitamin therapy, which involves replenishing the body with such elements: A, B6, B12. They can also use drip infusions of protein hydrolysates intravenously.

If secondary duodenitis is diagnosed with gastritis, then it should be treated in combination with the treatment of the underlying disease. Patients with a chronic form of pathology should be constantly under the supervision of a doctor, and it is also mandatory to carry out anti-relapse treatment.

Medical therapy

How to treat duodenitis? In addition to the diet for acute duodenitis or during the period of exacerbation of its chronic form, the patient can also be prescribed medications:

Diet

In the treatment of duodenitis, proper nutrition plays a very important role, because the work of the gastrointestinal tract directly depends on what a person eats. The therapeutic diet in this case consists of avoiding the following products:

fatty, heavy food;
smoked meats;
hot spices;
pickles;
carbonated drinks;
alcohol;
coffee and strong tea;
sour fruits - apples, oranges, etc.

It is better to follow a strict diet for a month, after which the diet can be enriched with various sausages, sausages, cereals, vegetable salads, raw fruits and vegetables, and scrambled eggs. During the treatment of duodenitis, it is also important to exclude foods that are strictly prohibited for this disease. These include the products listed above.

Prevention

To prevent not only the development of inflammation of the duodenum, but also its exacerbations, it is necessary to carefully adhere to a balanced diet. It is necessary to avoid the frequent use of spicy, fried, spicy foods, dry food. Do not abuse alcohol, strong coffee and tea. It is necessary that the diet contains not only carbohydrates and fats, but also a sufficient amount of protein.

Duodenitis- This is the most common disease of the duodenum, in which inflammation of the mucous membrane of the intestinal wall develops. Acute duodenitis is characterized by symptoms of acute inflammation, which disappear after treatment and do not leave changes in the mucous membrane.

In chronic duodenitis, relapses of the disease occur, foci of inflammation form in the mucous membrane of the duodenum and pathological changes in its structure. The incidence of chronic duodenitis in men is twice as high as in women.

Causes of duodenitis

Duodenitis can develop against the background of peptic ulcer, chronic gastritis, duodenal diverticulosis, certain diseases of the liver and biliary tract, chronic pancreatitis.

Contribute to the development of duodenitis chronic infection in the oral cavity, pharynx, gallbladder, genitals, as well as tuberculosis, renal failure, ascariasis and Giardia infection, anomalies of the duodenum.

Symptoms of duodenitis

As a rule, the inflammatory process in duodenitis proceeds sluggishly, manifesting itself with such symptoms as appetite disturbances, feeling unwell, rumbling in the abdomen and flatulence. But the symptoms of duodenitis can also be acute, especially with concomitant infection with Giardia.

Symptoms of acute duodenitis

A symptom of acute duodenitis is an attack of severe abdominal pain, which occurs, as a rule, after overeating. The pain is not relieved by any medication.

Perspiration appears on the patient's face, repeated bouts of vomiting occur, and a white coating appears on the tongue. In addition, the symptoms of acute duodenitis include a feeling of fullness in the stomach, salivation, decreased appetite, fever, headache, weakness, and arterial hypotension.

Symptoms of chronic duodenitis

The course of chronic duodenitis is distinguished by a variety of clinical symptoms that make it difficult to make a correct diagnosis - chronic duodenitis is often confused with other diseases of the digestive system, most often it is mistaken for a duodenal ulcer, but with less pain and severity of exacerbations.

If chronic duodenitis is manifested by dyspeptic disorders, then it is initially misdiagnosed as gastritis.

In addition, the disease can manifest itself as pancreatitis or chronic cholecystitis - there are pains in the right hypochondrium, girdle pains in the upper abdomen, which intensify after eating fatty foods.

In young women, the neurovegetative form of duodenitis appears more often, in which vegetative disorders dominate - irritability or fatigue, headaches and weakness.

With mixed manifestations of chronic duodenitis, symptoms of various clinical forms are combined. In older people, the course of the disease may be asymptomatic.

Treatment of duodenitis

In acute catarrhal and erosive-ulcerative duodenitis, the first 1-2 days are shown gastric lavage, bed rest and hunger, then, for pain, anticholinergic and antispasmodic drugs are used, enveloping and astringent drugs, diet No. 1 is used for nutrition. With phlegmonous duodenitis, surgery is performed treatment and antibiotic therapy.

During the period of exacerbation of chronic duodenitis, the patient is treated in a hospital.

Assign antacid, antispasmodic, astringent, anticholinergic and ganglion blocking drugs. For nutrition, first use diet No. 1a, then No. 1b. To improve the processes of regeneration, vitamins A, B6, B12 are used, as well as drip infusions of protein hydrolysates intravenously.

With secondary duodenitis, the underlying disease should be treated. Patients with chronic duodenitis should be under dispensary observation, in addition, they should undergo anti-relapse treatment.

Treatment of duodenitis with folk remedies

To prepare an anti-inflammatory agent for duodenitis, grind and mix equal amounts of chamomile flowers, marshmallow root, lavender, licorice root, shepherd's purse, buckthorn bark, erect cinquefoil roots and lemon balm. A tablespoon of the collection should be poured with a glass of boiling water and heated for five minutes in a water bath so that the infusion does not boil. Then you need to strain the infusion and drink 40 minutes before meals. The procedure should be repeated three times a day.

Flax seeds can be used to treat erosive duodenitis. A teaspoon of flax seeds should be poured with a glass of boiling water and infused for 20 minutes. Then you need to mix the infusion well and strain. The remedy should be taken on an empty stomach in small sips one hour before breakfast. The procedure is repeated every day for a month.

For the treatment of chronic duodenitis, you can use plantain infusion. 50 g of dry plantain leaves should be brewed with 500 ml of boiling water and infused for 30 minutes. Then the infusion must be filtered and drunk before meals, half a cup, up to 6 times a day.

Sea buckthorn oil can be used to treat duodenitis. 500 g of sea buckthorn should be washed, crushed and poured with 500 ml of purified sunflower oil. Sea buckthorn oil must be infused for a week, in a dark place, in a tightly closed glass container. After that, the oil must be filtered, and the cake must be rubbed through a sieve and added to the oil. Oil should be taken daily, on an empty stomach, a tablespoon.

For the preparation of medicinal tea, flowering tops of Potentilla are used. A tablespoon of dried raw materials should be brewed with 500 ml of boiling water and infused for two hours. Then the infusion must be filtered and drunk in a glass three times a day before meals.

Diet for duodenitis

A diet for duodenitis must meet certain requirements, especially during an exacerbation of the disease. Compliance with the diet helps to quickly get rid of the unpleasant symptoms of duodenitis - relieve pain and reduce dyspeptic disorders.

Proper nutrition during periods of remission of the disease will help to avoid exacerbations. In addition, patients should give up alcohol and smoking.

With a sharp deterioration in the condition, the use of carbohydrate-rich foods should be reduced, enriching the diet with protein foods. Patients are advised to eat small meals, at least four times a day.

The purpose of the diet for duodenitis is to limit the use of foods that can have a negative effect on the gastric mucosa and 12 duodenal ulcer. It is useful to drink fruit juices rich in vitamin C. In addition, the diet should include pureed vegetable and cereal soups with the addition of milk or cream.

It is acceptable to eat dishes from low-fat fish and boiled meat, passed through a meat grinder. The diet can be diversified with dairy products - kefir, cottage cheese, yogurt, sour cream, butter or milk. Eggs should be cooked soft-boiled.

With duodenitis, mashed boiled fruits and boiled vegetables cooked in milk are used in the diet. It is necessary to limit the use of sweets, honey, sugar and salt. You can drink any tea. Crackers, white bread and biscuits are not prohibited.

A strict diet must be followed for a month, after which the diet can be varied with sausages, sausages, vegetable salads, cereals, raw vegetables and fruits.

When treating duodenitis, the following foods should be categorically excluded: coffee, strong tea, smoked meats, canned food, fatty meats and fish, peppers, mustard, ice cream, very cold and very hot dishes, garlic, onions, alcoholic beverages.

Questions and answers on the topic "Duodenitis"

Question:Hello! I underwent an EGD procedure, they wrote to me: "Erosive duodenitis. Superficial widespread gastritis." Explain the essence of my disease and its treatment.

Answer: This means inflammation of the mucous membrane of the stomach and duodenum. The reasons are different. And concerning treatment - in absentia nobody appoints. You need to see a doctor internally.

Question:They made a child (7 years old) endoscopy, due to pain near the navel, the diagnosis was duodenitis. Phosphalugel treatment (an hour before meals), mezim, biotroph-2 (BAA). After taking phosphalugel before meals, the pain intensifies, according to the instructions, take it after meals - we take it for three days, maybe it’s better to drink according to the instructions? Or perhaps this exacerbation in connection with the treatment? Can eat more effective preparations?

Answer: Phosphalugel should be taken 30 minutes before meals. Taking this drug cannot cause increased pain, as it envelops the mucous membrane of the duodenum and stomach and prevents the effects of acids and other adverse factors on it. Are you on a diet?

Question:I have the last 2-3 months. stomach ache, mostly on the left side. Went for FGDS, diagnosis: duodenitis of the duodenal bulb 12. The doctor said that the flow of bile was disturbed. The therapist prescribed drugs: Omez, Renitidine, Mezim. Is it possible to make a diagnosis only by the result of EGD, or do additional studies need to be done? Some acquaintances claim that they have cured various diseases of the stomach, incl. duodenitis with alcohol infusion of propolis. I also took propolis tincture for 3 days along with medication. But it seemed to me that with the intake of tincture, my stomach pains intensified in the morning. Is it possible to continue taking propolis tincture after drug treatment?

Answer: In this case, the diagnosis is made on the basis of complaints, clinical manifestations, and also on the basis of data obtained from FEGDS, as an addition, an ultrasound scan of the abdominal organs can be performed. The use of propolis, in your case, it is desirable to stop, as it provokes deterioration in you, perhaps there is an individual intolerance.

Question:Hello! According to the conclusion of FGDS of the stomach for the treatment of duodenitis and gastritis, it was prescribed: flemoxin solutab 1000, 2 tablets. 2 r / day-7 days, clarithromycin 500, 2 tablets. 2 r / day-7 days, de-nol 2 tablets. 2 r / day-month. Whether it is necessary to accept still something from a dysbacteriosis (hilak forte, lineks)? After antibiotics or while taking them?

Answer: Hello! Preparations to maintain the intestinal microflora can be taken from the very beginning of treatment. An important point - the interval between preparations for the intestinal flora and antibiotics should be 2-3 hours.

Question:Hello! When I was breastfeeding, my stomach constantly hurt, heartburn, spasms. Having made FGS, I was diagnosed with erosive duodenitis. She took omez, cerucal, ampicillin + metronidazole. At the moment, I have not been taking medication for 5 months, but at times I have pain and discomfort in the stomach area. The chair is not regular. How can the stomach be cured more effectively?

Answer: Good afternoon Only your attending physician can adequately answer these questions, since he has all the necessary information about you.

Question:Hello! I am 22 years old. For about a month I was disturbed by the intestines - I constantly had diarrhea. I went to the therapist and was told to undergo FGDS. I had an EGD and found erosive proximal duodenitis. When the feces were examined, erythrocytes were found in a small amount. Then I went to a gastroenterologist and I was prescribed a course of treatment: Sanpraz (1 t in the morning and evening), Denol (2 t in the morning and evening), clalbakt and flemoxin - 1 t in the morning and evening with meals. Now the stool is changing, sometimes normal, sometimes with blood and diarrhea. I've only been taking pills for 4 days. I'm worried about blood in my stool. It increased with the use of tablets. Is this a side effect or is it something else?

Answer: It is necessary to do a colonoscopy and pass feces for dysbacteriosis.

Duodenitis is an inflammation of the mucous layer of the duodenum. The overall prevalence of pathology among the population is 5-10%, 2 times more often the disease is found in men, which is associated with a greater adherence to addictions.

There are acute and chronic forms of the disease. Acute duodenitis often occurs with poisoning and eating spicy foods, manifested by inflammation of the mucous membrane, the development of erosion (a superficial defect of the epithelium that heals without scarring) less often - phlegmonous cavities filled with pus. The disease is manifested by digestive disorders, pain syndrome. If you follow a diet and doctor's prescription, you can recover in 1-2 weeks. With the recurrence of duodenitis, the risk of chronicity is 90%.

Chronic duodenitis develops against the background of a chronic pathology of the digestive tract (gastritis, stomach ulcers, pancreatitis), with prolonged violation of the diet. Gradually, atrophy of the mucosa (atrophic duodenitis) or its erosion (erosive duodenitis) develops. Under the action of provoking factors, an exacerbation of the disease occurs. Treatment is longer than in the acute form.

Structure

After the pylorus, the duodenum follows. She, like a horseshoe, goes around the head of the pancreas (PG), continuing into the jejunum. Its length is 25-30 cm. Fixation to the walls of the abdominal cavity is carried out due to connective tissue fibers. The duodenum is located in the projection of the XII thoracic - III lumbar vertebrae.

Divisions: upper (bulb or ampulla), descending, horizontal, ascending. The mucosa of the bulb is provided with longitudinal folds, the rest of the departments are transverse. When they contract, a lump of food moves into the jejunum.

A large or Vater's nipple opens into the duodenum cavity. It is formed by the confluence of the main pancreatic duct and the common bile duct. The papilla of Vater has a sphincter that regulates the flow of bile and pancreatic juice into the intestine. The small nipple is located in the area of the outlet of the accessory pancreatic duct.

Functions

The duodenum performs several functions:

Neutralization of acidic gastric contents. The food lump, mixed with acidic gastric juice, is neutralized in an alkaline environment. Due to this, there is no irritation of the intestinal epithelium.
Regulation of the formation of digestive enzymes, bile, pancreatic juice. In the duodenum, the contents are analyzed and the proper command is transmitted to the digestive glands.
Relationship with the stomach: the duodenum ensures the opening and closing of the pylorus, the entry of a new portion of the food bolus into the small intestine. This happens as the next amount of gastric contents is neutralized in the duodenal cavity.

What causes acute duodenitis

The reasons leading to the development of duodenitis:

Dry food, food intake that has an irritating effect on the epithelium of the digestive tract: coffee, smoked meats, fried, fatty, spicy. To process such food, an increased amount of hydrochloric acid is formed in the stomach, which reduces the protective properties of the duodenum epithelium.
Food poisoning caused by the bacterium Helicobacter pylori (which causes ulcers), staphylococci, enterococci, clostridia, as well as giardiasis, helminthiases. Pathogenic bacteria lead to the development of inflammation in the duodenal mucosa, damage to epithelial cells and their death. A large amount of fluid enters the intestinal lumen, which is manifested by diarrhea.
Diseases of the digestive system: colitis, hepatitis, cirrhosis, pancreatitis, ulcers, gastritis. Inflammation of nearby organs leads to the transition of the inflammatory process and the development of duodenitis (pancreatitis-duodenitis, gastritis-duodenitis). Another mechanism that causes inflammation of the duodenum is a violation of the production of bile and pancreatic juice, without which the normal functioning of this organ is impossible.
Reflux or backflow of the contents of the underlying segments of the intestine into the duodenum. This may be due to spasm or obstruction (due to a tumor or other causes) of the jejunum. Bacteria from the lower parts of the small intestine enter the duodenum, causing reflux duodenitis.
Alcohol consumption.
Ingestion of chemicals (acids, alkalis, chlorine-containing compounds), leading to burns of the intestinal epithelium.
Mechanical damage to the duodenal mucosa due to ingestion of foreign bodies.

What causes chronic duodenitis

Causes leading to the appearance of chronic duodenitis:

Pathology of the intestine, leading to a deterioration in peristalsis, stagnation of intestinal contents, stretching of the walls and atrophy of the duodenum mucosa: prolonged constipation, intestinal adhesions, impaired blood supply and nervous regulation of the intestine.
Chronic gastritis with high acidity causes acid damage to the intestinal epithelium with the gradual development of its atrophy. Formed gastritis-duodenitis.
An anomaly of the liver, gallbladder and pancreas leads to a violation of the release of enzymes into the lumen of the duodenum 12, which impairs its functioning.
Regular violation of the diet and diet.
food allergy.
Prolonged stress.
The use of a large number of drugs.
The presence of bad habits (drinking alcohol, smoking, substance abuse).

Clinic

Manifestations of duodenitis depend on the cause of its occurrence and the presence of concomitant pathology. Often the disease is hidden under the guise of other ailments: stomach ulcers, gastritis, cholecystitis.

Symptoms of duodenitis in adults:

Pain in the epigastric region, aggravated by palpation (palpation) of the abdomen. The pain has its own characteristics in various forms of duodenitis:
- in the chronic form - constant, aching, aggravated on an empty stomach and 1-2 hours after a meal;
- with duodenitis caused by a violation of intestinal patency, the pain is arching, paroxysmal, occurs when the intestines are full;
- with gastritis-duodenitis with high acidity - develops 10-20 minutes after eating, which is explained by the entry of acidic gastric contents into the intestine;
- for the ulcer-like form caused by Helicobacter pylori, fasting pains are characteristic;
- with local inflammation around the Vater nipple, the outflow of bile from the gallbladder is disturbed, a clinic similar to an attack of hepatic colic occurs: pain in the right hypochondrium.
Increased fatigue, weakness. This is due to the action of toxic substances formed in the process of inflammation.
Perhaps a slight increase in body temperature (up to 37-38 0).
Digestive disorders (dyspepsia):
- nausea;
- loss of appetite;
- increased gas formation (flatulence);
- belching, vomiting with a bitter taste (due to bile ingestion) - throwing food back into the stomach;
- stool disorder (diarrhea or constipation).
Yellowing of the skin and mucous membranes. Swelling of the papilla of Vater leads to a decrease in the lumen of the bile duct, stagnation of bile and its entry into the blood.
Dumping is a syndrome. Occurs after a large meal. When the duodenum overflows, a redistribution of the bloodstream occurs (blood flow to the digestive organs, outflow from the head). Manifested by dizziness, drowsiness, a feeling of fullness in the stomach, fever in the upper body.

With an asymptomatic course of the disease, there may be no complaints, the detection of pathology is an accidental finding during gastroduodenoscopy.

Diagnostics

The diagnosis of duodenitis is made in the presence of a combination of data:

Presence of characteristic complaints described above.
Inspection. On palpation (feeling) of the abdomen, there is pain in the projection of the duodenum.
Instrumental examination data:

FGDS (fibrogastroduodenoscopy) - a scopic examination of the stomach cavity, duodenum. In the presence of duodenitis, characteristic signs are determined: (mucosal edema, redness). Each form of duodenitis is characterized by its own characteristics of FGDS - pictures:
- a) with catarrhal (or superficial) duodenitis - uniform reddening of the epithelium;
- b) the presence of erosion - with an erosive form;
- c) the smoothness of the folds indicates a decrease in intestinal tone;
- d) nodules on the mucosa - about the nodular form;
- e) hemorrhages - about hemorrhagic;
- f) atrophy of the epithelium - about atrophic.
X-ray contrast study - conducting fluoroscopy or graphy after the patient has consumed a contrast agent (barium sulfate). With such a study, it is possible to identify gross violations in the structure and functioning of the organ; restructuring of the mucosa in this way cannot be detected. In the pathology of the duodenum, a number of signs are found:
- a) areas of narrowing indicate a tumor, adhesions, developmental anomalies;
- b) areas of expansion indicate a decrease in tone, blockage of the lower intestines, a violation of the passage of food, nervous regulation;
- c) a symptom of a niche is observed with erosion, ulcers;
- d) with mechanical obstruction, an accumulation of gases is detected;
- e) smoothness of folds - with edema, inflammation;
- e) reflux - reflux of contents from the duodenum back into the stomach.

Laboratory data:

in a general blood test, an increase in ESR can be determined, indicating inflammation and anemia, as a sign of internal bleeding;
biochemical blood test: in the initial stages of duodenitis, an increase in enzymes (eterokinase and alkaline phosphatase) will be noted, in the future their activity decreases;
analysis of feces for occult blood (will be positive in the presence of bleeding, may be with an erosive form).

Features in children

Young children cannot localize the pain correctly, they most often just point to the stomach and say that it hurts. The most common symptoms include malaise, weakness, abdominal pain, nausea, belching, heartburn, and constipation. Exacerbation of duodenitis is more common in autumn and spring. In older children (from 10 years of age or more), the clinical picture does not differ significantly from adults.

The treatment is complex. If helminthiasis has become the cause of duodenitis, deworming is an obligatory component.

Treatment

The main tasks in the treatment of duodenitis:

elimination of inflammation;
prevention of process chronization;
normalization of the duodenum;
restoration of normal digestion.

Most often, treatment is carried out in a clinic. For recovery, a number of conditions must be met:

stick to a diet;
observe the regime of work and rest;
avoid stress;
give up bad habits (smoking, alcohol).

Indications for inpatient treatment:

exacerbation of the disease;
suspicion of a tumor formation;
risk of bleeding (with erosive form);
severe general condition.

Treatment components:

medical nutrition;
folk remedies;
medicines;
physiotherapy;
use of mineral waters.

Nutrition

The menu for duodenitis plays a primary role in therapy. If you do not adjust the diet, relapses of the disease will occur again and again.

With an exacerbation of the chronic form or about. duodenitis for the first 3-5 days, table 1a according to Pevsner should be observed. The same diet is used to treat exacerbation of stomach ulcers. It is allowed to eat mucous cereal decoctions (rice, oatmeal), mashed soups, liquid cereals with half milk (first, the cereal is boiled in water, so it swells faster and becomes more mucous, then add milk, the ratio of water and milk is 1/1).

Basic principles of nutrition:

food should be: pureed, not hot, steamed

frequent meals - 6 times a day, in small portions

avoid overeating and long breaks in eating

For example, let's take diet 1a, scheduled for one day.

meal	Recommended meals
1st breakfast	Buckwheat porridge cooked in half milk (buckwheat - 50, milk and water - ½ cup each, butter - 10), milk - 1 cup
2nd breakfast	Milk - 1 glass
Dinner	Milk cereal soup (oatmeal - 40, milk - ¾ cup, eggs - ¼ pieces, butter - 10, sugar 2, water - 1¾ cups), meat puree (lean boiled beef - 100, milk - 1/4 cup, butter - 10), dried apple compote (water - 200, dried apples - 20, sugar - 15)
afternoon tea	Milk - 1 cup, soft-boiled egg
Dinner	Rice porridge cooked in half milk (rice - 50, milk and water - ½ cup each, butter - 10), egg "in a bag", milk - 1 cup.
2nd dinner	Milk - 1 glass

Then the diet is gradually expanded.

ulcer-like form - table number 1;

gastritis-like option - table number 2;

pancreatitis and cholecysto - a similar form - table number 5.

boiled lean meat, scrolled through a meat grinder or chopped with a blender;
dairy and lactic acid products (milk, kefir, fermented baked milk, yogurt);
boiled or baked vegetables, peeled, vegetable puree;
eggs, boiled soft-boiled or cooked in the form of an omelet;
fats (butter, vegetable oil);
juices;
yesterday's bread and crackers (easier to digest than fresh pastries);
natural sweets (honey, mousse, jelly).

Prohibited foods that stimulate gastric secretion containing indigestible fibers:

raw fruits and vegetables;
canned food, smoked meats;
spicy dishes, seasonings, onions, garlic;
saturated fish, meat, mushroom broths;
fatty meats and fish (duck, pork, carp, mackerel);
ice cream;
carbonated drinks;
alcohol.

You should eat fractionally, in small portions, 4-6 times a day. You should not wait until hunger strikes to eat, otherwise "hunger pains" may occur.
Food should be warm, but not hot or cold.
A gentle method of preparation is preferable, in order to exclude irritation of the duodenum mucosa. These are soups, cereals, steam dishes.
Avoid overeating, eating at night.

Folk methods

Treatment with folk remedies is of auxiliary importance. The main goal is to suppress the aggressive effects of hydrochloric acid, protect the duodenum epithelium.

Medicinal plants are suitable for this purpose: coltsfoot, sage, nettle, St. John's wort, peppermint, oregano, plantain, strawberry leaves, chamomile inflorescences, fennel seeds, eucalyptus leaves.

During the period of remission, fees are used: lingonberry leaves, St. John's wort, licorice root, flax seed, oregano grass, nettle, chamomile root.

Recipes for the preparation of medicinal potions for duodenitis:

2 tbsp. tablespoons of St. John's wort raw materials are poured into 200 ml of boiling water, heated in a water bath for 0.5 hours, insisted for 15 minutes, filtered, drunk 1/3 cup 3 times a day 0.5 hours before meals;
3 art. tablespoons of plantain juice are mixed with 1 teaspoon of honey, take 1 tbsp. spoon 3 times a day before meals;
50 g of propolis is poured with 2 cups of alcohol, the resulting mixture is put in a dark place for 3 weeks to infuse, taken without exacerbation, before meals, 1 tbsp. spoon, pre-mixing with 1 tbsp. a spoonful of milk;
2 tbsp. spoons of Hercules are boiled in 2 liters of water, filtered, ¼ cup of aloe juice is added to the broth. Drink ½ cup 3 times a day;
1 teaspoon of flax seeds is poured with 1 cup of boiling water, insisted for 15 minutes, consumed on an empty stomach for a month.
0.5 kg of sea buckthorn is ground, poured with unrefined sunflower oil and insisted for a week in a glass jar, take 1 tbsp. spoon on an empty stomach.

Medical therapy

How to treat duodenitis? In accordance with the form of the disease, various combinations of groups of drugs are used:

medicinal group	Mechanism of influence	Representatives	How to apply
PPI - proton pump inhibitors	Blocks the production of hydrochloric acid (HCl), thereby reducing irritation of the duodenum mucosa.	Emanera 20 mg Omeprazole 20 mg Ultop 20 mg Zulbex 20 mg	20 mg 1-2 times a day for 7-10 days.
Antibiotics, antibacterial agents	With infection, detection of Helicobacter pylori.	doxycillin	2 times a day, 7-10 days.
Antibiotics, antibacterial agents	With infection, detection of Helicobacter pylori.	Clarithromycin 500 mg Amoxicillin 1000 mg Metronidazole 500 mg	2 times a day, 7-14 days.
H2 - histamine blockers	Suppress release of HCl.	Ranitidine	0.15 - 2 times a day, course 1 - 1.5 months.
H2 - histamine blockers	Suppress release of HCl.	famotidine	0.02 g - 2 times
Antacids	Neutralize with HCl. Envelop the mucosa, have a local anesthetic effect.	Almagel Maalox Gastal	For heartburn, up to 3 times a day.
Prokinetics	Regulate peristalsis, help promote the food bolus	Itomed Ganaton	1 tablet 3 times a day.
Enzyme products	Contain pancreatic enzymes, help better digestion of food	Pancreatin Creon 10000	After every meal.
Antispasmodics	Remove spasm, relieve pain	No-shpa (drotaverine) Platifillin Duspatalin	1 tablet - 3 times.
Sedatives	Calming effect	Valerian tablets, motherwort	The course is 10-14 days.

Separately, it is worth touching on the drug De-nol. It combines antacid, antibacterial (directed against Helicobacter pylori), anti-inflammatory, astringent action, protects the duodenum mucosa, promotes its recovery. Adults take it 1 tablet 4 times a day (3 times after meals, 4th - at night). The drug is washed down with water (it is impossible to drink it with milk due to the formation of insoluble compounds). Children under 12 years of age are prescribed 1 tablet 2 times a day. The course of admission is up to 8 weeks.

In each case, the combination of drugs is selected individually. In the presence of Helicobacter pylori, antibiotics are mandatory. If the disease is provoked by exposure to stress, sedatives are connected. With an increase in acidity, one cannot do without antacids, PPIs, histamine blockers.

Physiotherapy

Apply magnetotherapy, ultrasound, phonophoresis.

Application of mineral waters

Low-mineralized alkaline waters that do not contain carbon dioxide are used: Borjomi, Essentuki No. 4, Smirnovskaya No. 1, Slavyanovskaya, Luzhanskaya, Berezovskaya. Before use, mineral water is slightly heated, gases are released. Take 1-1.5 hours after eating.

All these methods of treatment together help to remove the manifestations of inflammation, to achieve a stable remission of duodenitis.