Pathogenesis and therapy of semolina syndrome. Semolina syndrome in the duodenum

Contents of the article:

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, his quality of life will decrease significantly. 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 duodenum can be primary or secondary. If this is primary duodenitis, it develops due to the fact that the patient for a long time He didn’t eat well: he ate a lot of salty foods, he loved everything fried and fatty, he 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 long time and used certain medications in large quantities.

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

Gastritis that was caused by bacteria.
Stomach ulcer with increased acidity.
, due to which duodenostasis develops over time, which leads to a deterioration in the blood supply to the intestinal wall.
Liver diseases (hepatitis, cirrhosis), due to which the synthesis of bile acids changes in patients.
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.
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.

For chronic inflammatory disease the pain becomes constant, but it is not severe, but rather aching or “sucking.” The patient also has severe heartburn, nausea, 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 duodenitis:

Intestinal bleeding.
An ulcer in which both the duodenum and the patient’s stomach suffer.
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.
Malignant tumor of the patient's intestine.
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:

X-ray.
Determination of acidity level.
A test that shows the presence of Helicobacter pylori bacteria.
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 acute form diseases, then doctors wash the intestines and remove leftover 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 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; 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?

Although proper diet Only a doctor can choose, and it depends on the condition of the gastrointestinal tract; there are lists of products recommended for inflammation of the duodenum.

You can eat:

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.
The bread is white and dried, you can buy crackers.
Meat - in the form of chopped dishes, minced meat. Meatballs and steam cutlets are prepared from it.
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.
The patient is allowed small pasta, as well as casseroles, puddings, omelettes (steamed).
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.
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.
The patient is allowed to eat fresh cottage cheese and sour cream, mild cheeses.
If you have duodenitis, you can drink milk and fermented milk drinks, compotes, jelly, and rosehip drink. Allowed and vegetable juices, 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;
You cannot drink full-fat milk, coffee, strong tea, carbonated drinks and alcohol.

Medications

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

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

Inflammation primary department intestines or duodenitis often occurs due to Not proper 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 do not bother you much, since due to untreated duodenitis, a violation is possible digestive process and the occurrence of complications.

Mixed gastritis is a disease in which damage to the gastric mucosa manifests itself with clinical signs various forms of this disease. In most cases, it combines erosive, hemorrhagic, hypertrophic and superficial types of this pathology digestive tract.

Mixed gastritis often develops against the background of a certain pathological process - infection pathogenic microorganisms Helicobacter pylori, which causes many stomach diseases. Most often, infection with this microorganism occurs through the nutritional route, fecal-oral, although the possibility of infection from a sick person through close contact with him cannot be ruled out.

Symptoms of mixed gastritis

At the onset of the disease, an inflammatory process develops, which in most cases covers only the superficial epithelium of the stomach. In some cases, the gastric glands are damaged, but they do not die, but continue their functional activity.

Subsequently, the superficial form of mixed gastritis transforms into another form or is combined with hemorrhagic, hypertrophic or erosive changes in the mucosa.

If we talk about the development of the clinical picture, it should be said that its features depend on many factors. A constant general symptom can be called deterioration of the patient’s condition with the active progression of any form of the disease.

Stomach acidity may remain within normal limits, increase (hyperacid state) or decrease (hypoacid state).

Signs of mixed gastritis are similar to clinical manifestations chronic gastritis. The following complaints are typical:

discomfort in the epigastric (epigastric region);
feeling like pain;
feeling of “fullness” in the stomach;
nausea and vomiting;
a sharp decrease in appetite;
stupid or sharp pain in the epigastric region, which radiates to the back and the left hypochondrium;
intermittent belching of air or food;
bloating.

It must be said that chronic mixed gastritis lasts quite a long time and provokes the constant appearance of similar symptoms and significantly worsens general state sick.

Methods of diagnosis and treatment of the disease

It is important to diagnose the presence of Helicobacter pylori in the stomach. For this purpose they use various methods. Most often, fibrogastroduodenoscopy is performed, linked immunosorbent assay blood for antibodies to these microorganisms, detection of the pathogen in a scraping or washing from the surface of the stomach obtained during FGDS.

Treatment of mixed gastritis should be prescribed after identifying its characteristics and etiological factors. If an exacerbation of the disease is caused by overeating or taking certain medications that irritate the mucous membrane, then therapy in most cases is short-term - it is enough to eliminate the provoking factors.

The effectiveness of treatment depends on correct diagnosis and prescription of correct therapy. Timely detection of this pathology helps prevent complications and promotes full recovery.

How to treat mixed gastritis should be determined by a qualified gastroenterologist - attempts at self-medication can lead to the development running forms disease or its complications. In severe cases of the disease it is indicated hospital treatment. Depending on the characteristics of the disease, appropriate pharmacological therapy is prescribed. For pain, painkillers and antispasmodics are prescribed. Antibiotic therapy is indicated, the purpose of which is to destroy Helicobacter pylori. In therapy, gastric acidity is taken into account and, if necessary, correction of its disorders is carried out.

Maintaining proper nutrition is important. If a patient has mixed gastritis, the patient’s diet (diet) may have certain features depending on the nature of the stomach damage and the level of acidity. General principles Diet therapy for gastritis are:

fractional meals in small portions;
Dishes during exacerbations should be steamed or boiled, pureed, optimal temperature(neither cold nor hot);
in the morning it is advisable to drink a glass of warm boiled water;
despite certain restrictions, the menu should be designed so that the patient receives all the necessary nutrients;
it is necessary to exclude foods containing a lot of fiber, as well as anything spicy, too salty, fried or canned;
It is advisable to replace animal fats with vegetable ones;
limiting baking and completely eliminating alcohol and smoking.

In adolescents, during X-ray examination of the duodenum, the most common signs were deformation of the bulb, spastic phenomena and accelerated peristalsis of the duodenum. These radiological changes, especially in the presence of a clinical picture characteristic of duodenal ulcer and hyperchlorhydria, not without reason, guided the doctor to diagnose duodenal ulcer. However, with careful clinical examination In adolescents, using highly informative research methods (ultrasound, endoscopy, cholecystography, polarography), no ulcerative lesions of the duodenum were identified. In this case, biliary dyskinesia, cholecystitis, insufficiency and hernia were often found hiatus diaphragm.

The following clinical observation can serve as an illustration of what has been said.

Patient M., 18 years old, was admitted for examination with a syndrome characteristic of duodenal ulcer (“hungry”, night pain with localization in the epigastric region, more on the right, heartburn, belching of air). I had been ill for about a year when the pain described above appeared. An X-ray examination carried out at that time revealed no pathological changes in the upper gastrointestinal tract. Diet and antiulcer therapy (antacids, peripheral anticholinergics) brought relief. Repeated X-ray examination in the hospital revealed deformation of the duodenal bulb. A week later, endoscopic examination revealed cardiac insufficiency, axial hernia esophageal opening of the diaphragm, pyloritis, duodenal dyskinesia.

Clinical diagnosis: hyperacid gastroduodenitis (pre-ulcerative stage of duodenal ulcer), cardia insufficiency, axial hiatal hernia.

Thus, radiological signs are not pathognomonic for chronic duodenitis, since macroscopic and morphological examination data usually do not confirm duodenitis. In addition, rely on data x-ray examination carried out in a clinic is not always possible, since the study is carried out without using antispastic drugs.

What is the diagnostic value of endoscopic and histological examination for chronic duodenitis?

According to W. Haubrich, endoscopy of the duodenum resurrected the controversial diagnosis of “duodenitis”. However, so far, in his opinion, the endoscopic studies carried out are more likely to confuse than to clarify this issue.

The conclusion about duodenitis during endoscopic examination is made based on the intensity of color of the mucous membrane, the presence of edema, plaque, mucus, erosion, and its vulnerability. The above determines the degree of inflammatory changes in the mucous membrane of the duodenal bulb. In addition, the pallor of the color of the mucous membrane, the severity of the vascular pattern, and the smoothness of the folds may reflect the degree of its atrophic changes.

In adolescents with clinical symptoms characteristic of duodenal ulcer, the endoscopic picture of superficial duodenitis is observed in 63.2% of cases. In this case, the main inflammatory phenomena are limited to the mucous membrane of the duodenal bulb.

As a rule, the more distal, the intensity of hyperemia and edema decreases. Erosions occur mainly in the duodenal bulb. The presence of a whitish coating of the “semolina” type on the mucous membrane of the duodenum is characteristic of secondary duodenitis, associated mainly with pathology of the biliary tract or pancreas.

Morphological studies of the duodenal mucosa, obtained specifically during endoscopy, have significantly expanded the possibilities of studying chronic duodenitis.

Based on the study of the morphological picture of the duodenal mucosa in adolescents, we identified superficial, diffuse and atrophic duodenitis.

The morphological picture of superficial duodenitis was identified in 28.7% of adolescents with pathology of the digestive organs. In this case, dystrophic changes in the villous epithelium were noted. The cells of the surface epithelium are flattened, the nuclei are shifted to the center or towards the apical part of the cells, and vacuolization of the cytoplasm is observed. The described changes in epithelial cells often have focal character. At the base of the villi and in the crypts the number of goblet cells often increases. The secretion of mucus in them is normal or increased. In the proper layer of the mucous membrane, swelling, congestion of capillaries, and a significant increase in infiltration with a predominance of lymphocytes, plasma cells, neutrophils and eosinophils are often observed.

The most common morphological changes in adolescents are those that fit into the picture of diffuse duodenitis. In these cases, desquamation of the surface epithelium occurs, as a result of which the villi are exposed over a significant extent, and in some cases regeneration of surface epithelial cells is detected. When the surface epithelium is preserved, a flattening of its cells is noted with a displacement of the nuclei towards their center. Swelling of the stroma of the own layer of the mucous membrane and congestion of the capillaries are pronounced. The intensity of cellular infiltration of the own layer of the mucous membrane is more pronounced than with superficial duodenitis. Cellular infiltration is enhanced, plasma cells, lymphoid cells, and eosinophils predominate. Neutrophilic infiltration often occurs. There is a deepening of the crypts, an expansion of their lumen, and often the number of enterocytes with acidophilic granules (Paneth cells) in the crypts decreases. Duodenal (Brunner's) glands are usually of normal structure.

Chronic atrophic duodenitis is observed quite rarely. In this case, the uneven shortening of the villi is combined with the thinning of the crypts, their expansion and shortening, as a result of which the mucous membrane becomes thinner. Epithelial and crypt cells are slightly dystrophic, the number of goblet and Paneth cells is reduced. There are focal growths connective tissue, areas of sclerosis. Infiltration is enhanced, lymphoid and plasma cells. Mucus production is sharply suppressed. In a number of patients, microerosions are observed in the villous layer and in the crypt area, although they are more often found in acute duodenitis.

To what extent does the endoscopic picture of the mucous membrane of the duodenal bulb reflect morphological changes in it?

As we noted earlier, changes in the mucous membrane upper sections digestive tract (hyperemia, edema, size of folds, etc.) may be the result of an endoscopic examination, and not inflammatory process. Due to this important has a morphological study of biopsy samples obtained specifically during endoscopic examination.

According to E. Kogp and P. Foroczan, a normal endoscopic picture of the duodenal bulb always correlates with a normal histological structure. However, a number of authors indicate that endoscopic and histological criteria for duodenitis differ by 44-100%. What is this connected with? R. Whitehead explain this by the fact that the length of the villi of the bulb is very variable, unlike other sections small intestine. In addition, a number of authors regard duodenitis as a simple increase in mononuclear cells in the mucous membrane. It should also be noted that the violation of the histological structure is often of the same type when various diseases digestive organs. According to S. Gregg and M. Garabedian, the frequency of “nonspecific” duodenitis ranges from 1.9 to 30%.

It should be noted the importance of using duodenoscopy in the diagnosis of papillitis, which may be a manifestation of diffuse duodenitis or associated with pathology of the pancreas and biliary tract. 11 adolescents with papillitis had a clinical picture that was distinguished by severe pain localized in the pyloroduodenal region. The pain was quite persistent and occurred 2-3 hours after eating. In our observations, the occurrence of papillitis was due to chronic duodenitis.

Having studied the results of an endoscopic and morphological study of the duodenal mucosa in adolescents, we can rightfully say that the macroscopic picture of pronounced superficial duodenitis, especially in the presence of erosions, corresponds to the morphological picture of acute bulbitis, duodenitis. In this case, the degree of inflammatory changes decreases in the distal direction of the intestine. At the same time, with morphological changes such as superficial or atrophic bulbitis, the endoscopic picture often corresponds to the norm and vice versa.

Frequency divergence morphological forms duodenitis, according to various authors, is explained not only by the variability of the structure of the mucous membrane of the duodenum, but also by various criteria based on which the concept of “duodenitis” is interpreted. R. Cheli and M. Aste rightly point out that isolated leukocyte infiltration intestinal mucosa cannot be regarded as a sign of duodenitis. This may be due to the physiological state of the intestine at the time of the study. Indeed, it is very difficult to distinguish between a true inflammatory process and the so-called digestive inflammation of the duodenal mucosa.

IN clinical practice in the absence of data for ulcerative lesion duodenal bulb the term “gastroduodenitis” is used, not duodenitis. Gastroduodenitis means inflammatory or atrophic changes simultaneously in the mucous membrane of the stomach and duodenum. However, a comparison of endoscopy data and morphological studies of the mucous membrane of these organs shows that this assumption is far from the truth. Thus, in most adolescents, a correlation between the macroscopic picture of the mucous membrane of the antrum of the stomach and duodenum was observed in 39.1% of cases. Even greater discrepancies were revealed when comparing data from a morphological study of the mucous membrane of the antrum of the stomach and duodenum (a coincidence was noted only in 13.3% of cases). All this convincingly indicates that inflammatory, atrophic changes and processes of structural restructuring in the mucous membrane of the stomach and duodenum do not always occur in parallel. However, from this, we believe, one cannot draw the conclusion that R. Cheli and M. Aste came to, that gastritis and duodenitis coexist by chance. Undoubtedly, the close anatomical and physiological relationship between the stomach and duodenum also implies the interdependence of the processes occurring in the mucous membrane of these organs. However, it is not equivalent and depends on many external and internal factors, which are not always possible to take into account. This largely determines the dynamics of the development of the pathological process.

If we compare the results of a morphological study of biopsy samples of the mucous membrane of the body of the stomach and the duodenal bulb in adolescents with chronic duodenitis, then these discrepancies will be even higher, since the histological picture of the mucous membrane of the body of the stomach in more than 90% of adolescents corresponds to normal or superficial gastritis. In this respect, our data coincide with the results of similar studies in individuals young, obtained by P. F. Kryshen, Yu. V. Pruglo, V. M. Uspensky.

If we approach it from a practical point of view, the question arises whether the doctor, in the absence of data indicating a pronounced focal lesion mucous membrane of the stomach and duodenum, insist on a morphological study of biopsy samples of the mucous membrane of these sections? Of course not, since there is also no correlation between the data of a morphological study of the duodenal mucosa and the existing symptoms. This is confirmed by our data obtained during the examination of adolescents with chronic duodenitis.

The normal structure of the mucous membrane of the body of the stomach, and in some cases visually detected hyperplasia of the parietal and main cells of the fundic glands of the stomach, were reflected in the nature of its functional state. Thus, in most adolescents, the acid-forming and proteolytic functions of the stomach were increased or normal. Therefore, it is not surprising that in this category of patients the possibility of developing ulcerative lesions of the duodenal bulb is quite high. For secondary duodenitis, on the contrary, the gradual development of atrophic processes in the mucous membrane of the stomach and duodenum is more typical, which is also reflected in a decrease in acidity gastric juice. This in turn leads to dysfunction of the biliary tract, pancreas and disruption of digestive processes.

Although it is believed that secondary duodenitis often occurs with pathology of the biliary tract and pancreas, the physiological activity of the latter is largely determined by the normal secretory and motor function of the duodenum. Violations of the motor-evacuation function of the duodenum lead to pathological changes biliary tract and pancreas, which in turn can cause inflammatory and atrophic processes in the duodenum.

Pain, which is the main symptom of secondary duodenitis, can be associated both with dyskinetic disorders of the duodenum and with pathology of the biliary tract and pancreas. Their differential diagnosis presents significant difficulties, especially at the early stage of development of the pathological process in these organs. The doctor must remember about secondary chronic duodenitis with pancreatitis in cases where a teenager is bothered by constant pain in the upper abdomen or the pain is of a girdling nature. It can occur after an error in diet (fatty, fried, spicy foods) or regardless of food intake. There is a feeling of heaviness in the epigastric region, nausea. The same nature of pain can be observed in chronic primary duodenitis.

Pain in the epigastric region may periodically intensify and have the character of attacks of varying intensity. In adolescents, pain rarely radiates to the back or right hypochondrium, although with pancreatitis there is night pain, reminiscent of that of duodenal ulcer. However, it does not have a pronounced periodicity and connection with food intake, as with a duodenal ulcer.

The described clinical symptoms require a study of the endocrine and exocrine function of the pancreas (blood amylase, enzyme content in intestinal juice, sugar curve), an X-ray examination of the duodenum in conditions of its hypotension (duodeno-radiography), and echography.

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Inflammation of the duodenum 12

Reasons for the development of inflammation

abdominal trauma;
smoking and alcohol;

Symptoms of the disease

What you should be wary of:

constant belching, heartburn;
hunger nausea;
general weakness of the body.

Types of duodenitis

Diagnostics

inflammation of the gastric mucosa;
gastrointestinal cancer.

Prevention

Inflammation of the duodenum 12

Inflammation of the duodenum is called duodenitis. Often this condition is provoked by some chronic disease that the patient already has. Sometimes the cause of the inflammatory process is non-compliance food diet, love of hamburgers and fried foods.

Reasons for the development of inflammation

There are many causes of inflammation of the stomach and duodenum. This may be due to various mechanical factors or chronic diseases present in the body.

The main causes of inflammation in the duodenum:

poor nutrition, lack of diet;
abdominal trauma;
exposure to aggressive substances on the mucous membrane;
smoking and alcohol;
taking certain medications for a long time (for example, aspirin);
hereditary predisposition.

Symptoms of the disease

Symptoms of inflammation of the duodenum are mild. They are easy to miss, attributing the deterioration of well-being to general malaise or overeating. After some time, the symptoms intensify.

What you should be wary of:

indigestion – reluctance to eat or, conversely, constant hunger;
constant belching, heartburn;
flatulence, stool disorder;
hunger nausea;
periodic slight pain(often not felt at all);
general weakness of the body.

Types of duodenitis

Depending on the location and prevalence, the disease is classified into several types. Acute inflammation The 12th duodenum is felt with sharp manifestations, characterized by a rapid course. In chronic cases, as a rule, the clinical picture is erased, the symptoms are sluggish, and the disease practically does not manifest itself at all for several years.

Also, duodenitis of the duodenum can be widespread and local, which determines its extent on the mucous membrane.

Diagnostics

Diagnosis of inflammation of the duodenum consists of a survey, examination, laboratory and endoscopic examination. At the consultation, the gastroenterologist collects a complete history of life, as well as diseases, if the visit is primary.

During examination, the patient may not notice any pain. The condition of the duodenum can be more accurately diagnosed using a coprogram and stool testing for occult blood.

But the most important diagnostic method is esophagogastroduodenoscopy (EFGDS). Using a special tube with a microcamera at the end, a specialist examines all parts of the digestive tract. During the procedure, you can also take a biopsy, inject medication, or cauterize the bleeding erosion.

Treatment of inflammation that occurs in the stomach and duodenum can only be comprehensive. The effect of the medications is noticeable almost immediately, but maintaining health is only possible by following a certain diet prescribed by the doctor.

How to treat duodenal damage:

Take medications. Enveloping drugs, drugs that reduce the production of gastric secretions, wound healing and anti-inflammatory drugs are used here. If it was possible to inoculate a microorganism Helicobacter pylori, antibiotics are prescribed, and if inflammation develops due to chronic stress, sedatives are taken.
Follow a diet. Everything fried and fatty, multi-ingredient dishes cooked in oil or lard are absolutely prohibited. It is not recommended to eat raw vegetables and fruits, pickles, marinades, and dishes with excess spices. Fast food and other gastronomic garbage, sweets, and baked goods are strictly prohibited. The diet consists of ground boiled food products, moderate temperature conditions.
Refuse bad habits. Detrimental effects Alcohol has an effect on the mucous membrane, and those who like to smoke on an empty stomach also suffer from inflammation. To become healthy, it is worth reconsidering your views on this matter.
Resort to physical therapy. Treatment with light or current is indicated exclusively in the remission stage. Such procedures will help to implement general health improvement body, improve blood circulation in organs, strengthen the immune system.

It is necessary to adhere to the treatment tactics for the duodenum 12, which were prescribed by the attending physician. Only he sees the full clinical picture diseases and will be able to choose the most appropriate technique.

Possible complications and prognosis

If the patient encounters an illiterate specialist or treatment is not provided on time, the disease becomes a catalyst for the development of more serious complications, which will require even more time and effort to eliminate.

Complications after inflammation of the intestinal mucosa:

lymphangiectasia - enlargement of blood vessels and swelling of organ tissue;
erosion or ulcer of the duodenal bulb;
inflammation of the gastric mucosa;
tissue deformation, partial intestinal obstruction;
gastrointestinal cancer.

Prevention

In case of one-time inflammation of the duodenum, preventive measures must be carried out on an ongoing basis. Half the success of disease prevention depends on following the recommended diet.

Only by following these rules will it be possible to achieve stable remission of the disease and avoid various complications and forget about digestive problems.

Inflammation of the duodenum 12

Reasons for the development of inflammation

There are many causes of inflammation of the stomach and duodenum. This may be due to various mechanical factors or chronic diseases present in the body.

The main causes of inflammation in the duodenum:

poor nutrition, lack of diet;
abdominal trauma;
exposure to aggressive substances on the mucous membrane;
smoking and alcohol;
taking certain medications for a long time (for example, aspirin);
hereditary predisposition.

Symptoms of the disease

Symptoms of inflammation of the duodenum are mild. They are easy to miss, attributing deterioration in well-being to general malaise or overeating. After some time, the symptoms intensify.

What you should be wary of:

indigestion – reluctance to eat or, conversely, constant hunger;
constant belching, heartburn;
flatulence, stool disorder;
hunger nausea;
periodic mild pain (often not felt at all);
general weakness of the body.

Types of duodenitis

Depending on the location and prevalence, the disease is classified into several types. Acute inflammation of the duodenum is felt with sudden manifestations, characterized by a rapid course. In chronic cases, as a rule, the clinical picture is erased, the symptoms are sluggish, and the disease practically does not manifest itself at all for several years.

Also, duodenitis of the duodenum can be widespread and local, which determines its extent on the mucous membrane.

Diagnostics

Upon examination, the patient may not notice any pain. The condition of the duodenum can be more accurately diagnosed using a coprogram and stool testing for occult blood.

How to treat duodenal damage:

Take medications. Enveloping drugs, drugs that reduce the production of gastric secretions, wound healing and anti-inflammatory drugs are used here. If it is possible to inoculate the microorganism Helicobacter pylori, antibiotics are prescribed, and if inflammation develops due to chronic stress, sedatives are taken.
Follow a diet. Everything fried and fatty, multi-ingredient dishes cooked in oil or lard are absolutely prohibited. It is not recommended to eat raw vegetables and fruits, pickles, marinades, and dishes with excess spices. Fast food and other gastronomic garbage, sweets, and baked goods are strictly prohibited. The diet consists of ground boiled food products, moderate temperature conditions.
To refuse from bad habits. Alcohol has a detrimental effect on the mucous membrane, and smokers on an empty stomach also suffer from inflammation. To become healthy, it is worth reconsidering your views on this matter.
Resort to physical therapy. Treatment with light or current is indicated exclusively in the remission stage. Such procedures will help to improve the overall health of the body, improve blood circulation in organs, and strengthen the immune system.

It is necessary to adhere to the treatment tactics for the duodenum 12, which were prescribed by the attending physician. Only he sees the full clinical picture of the disease and will be able to select the most appropriate technique.

Possible complications and prognosis

If the patient encounters an illiterate specialist or does not receive timely treatment, the disease becomes a catalyst for the development of more serious complications, the elimination of which will require even more time and effort.

Complications after inflammation of the intestinal mucosa:

lymphangiectasia - enlargement of blood vessels and swelling of organ tissue;
erosion or ulcer of the duodenal bulb;
inflammation of the gastric mucosa;
tissue deformation, partial intestinal obstruction;
gastrointestinal cancer.

Prevention

In case of one-time inflammation of the duodenum, preventive measures must be carried out on an ongoing basis. Half the success of disease prevention depends on following the recommended diet.

Only by following these rules will it be possible to achieve stable remission of the disease, avoid various complications and forget about digestive problems.

Symptoms and treatment of chronic duodenitis: important information for patients

Duodenitis is a nonspecific inflammation of the duodenal mucosa. Despite the fact that damage to the proximal small intestine is often combined with gastritis, the symptoms and treatment of duodenitis have their own characteristics. The pathology occurs more often in men than in women, and mainly in persons suffering from inflammatory, infectious diseases stomach.

Causes of the disease

The most common cause of duodenitis is Helicobacter pylori infection. H. pylori bacteria colonize the gastric mucosa of the majority of the population and, under certain conditions, easily spread into the small intestine.

Inflammation of the inner lining of the duodenum also often occurs against the background of:

congenital anomalies of the gastrointestinal tract;
alcohol and drug abuse;
frequent or prolonged treatment with non-steroidal, hormonal anti-inflammatory drugs;
concomitant pathology of the digestive tract (reactive pancreatitis, gastritis, gastric ulcer, chronic colitis);
changes in the microflora of the intestinal tube, poor nutrition.

Forms of the disease

Depending on the time and cause of occurrence, chronic duodenitis is divided into primary and secondary. In the first case, the disease is the result of direct exposure etiological factor on 12 PC (duodenum), in the second - inflammation occurs against the background of another pathology. It could be gastritis, ulcer, acute infection etc.

The classification also implies the division of pathology according to localization and morphological changes in the mucous membrane:

Diffuse or total inflammation of the duodenum, local duodenitis. The latter - focal form, in turn, is divided into bulbitis (inflammation of the intestinal bulb), papillitis (inflammation of the papilla of Vater) and inflammation of the distal segment of the intestine.
Atrophic, follicular, erosive and erythematous duodenitis.

The atrophic form of the disease is characterized by thinning of the intestinal mucosa and functional insufficiency of the glands. Against the background of the disease, an insufficient amount of duodenal juice is released, as a result of which the digestion process suffers.

The follicular type most often occurs against the background of amoebiasis infection, giardiasis. It also occurs in children and differs in that the mucous membrane thickens focally due to the formation of false follicles. The diagnosis is confirmed only by gastroduodenoscopy.

Catarrhal duodenitis is considered a mild form of the disease and occurs with superficial inflammation of the inner wall of the duodenum. With FEGDS (gastroduodenoscopy), the doctor sees swelling and pronounced hyperemia of the duodenal mucosa.

At erosive form superficial defects of the mucous membrane come to the fore, which give a strong pain syndrome and may be complicated by bleeding.

The pathology is often combined with inflammation of the stomach wall and is called chronic gastroduodenitis.

Clinical manifestations

Chronic superficial duodenitis has a relapsing course, that is, periods of remission are replaced by phases of exacerbation. Promotes the appearance of unpleasant symptoms and complaints, disrupted diet, intake large quantity alcohol, long-term treatment some drugs, severe stress.

During the period of exacerbation, the symptoms are most pronounced, then the patient begins to pay attention to digestive problems.

Clinical signs of duodenitis in acute form:

pain in the abdomen above the navel, subsiding after eating;
feeling of heaviness in the right hypochondrium, nausea;
violation of bowel movements, constipation;
loss of appetite, bad smell from mouth;

Such symptoms are not specific and may indicate other pathologies digestive system, therefore it is necessary to carry out comprehensive examination using instrumental and laboratory methods diagnostics

Principles of treatment

Treatment begins with identifying the cause of inflammation. If the factor is Helicobacter bacteria, it must be treated with antibiotics (Clarithromycin, Amoxiclav, for example). Together with antimicrobials A gastroenterologist should prescribe medications to normalize the intestinal microflora (Linex, Bifiform) and relieve the inflammatory process.

Complex treatment includes the following activities:

Prescription of antisecretory, anti-inflammatory, antacids(Maalox, Phosphalugel, Rabeprazole, Famotidine).
The use of antispasmodics (for pain relief) and sedatives.
The use of a therapeutic diet.

Symptomatic treatment with sedatives is a mandatory stage of therapy, since the stress factor contributes to the development of inflammation. Lungs are prescribed sedatives, herbal remedies (valerian extract).

How to be treated with traditional methods

Alternative medicine also offers several options for restoring digestive health.

Symptoms that appear during pathology can be relieved with the following recipes:

Mix equal parts lemon balm, oak bark, chamomile, licorice root and pour a glass of boiling water. Leave for an hour and drink before meals.
A compress made from rhubarb leaves can be applied to the stomach area when symptoms of pain and heaviness appear.
Pour boiling water over flaxseeds, leave for half an hour and drink in small portions, which speeds up the treatment of inflammation.

Duodenitis is prone to exacerbation in spring and autumn period, because this time is most favorable for preventive measures, diet changes.

Lymphangiectasia as a complication of duodenitis

Intestinal lymphangiectasia is a congenital or acquired pathology in which significantly expanded lymphatic vessels in the lining of the small intestine.

A long and often recurrent course of duodenitis can lead to the development secondary form a disease in which blood vessels are affected locally (for example, in the area of the bulb) or diffusely. Also, secondary lymphectasia can be a consequence of intestinal tumors, Crohn's disease, nonspecific ulcerative colitis, systemic pathology.

Since the outflow in the duodenum is impaired lymph fluid, the mucous membrane becomes swollen, its hyperemia develops (due to expansion blood vessels), there is a pronounced expansion of the lumen. Against the background of this pathology, the protective function of the intestine also suffers, the absorption of proteins and fats is impaired, and edema appears.

severe diarrhea – frequent loose stool up to 10-15 times a day;
pain in the abdomen, nausea;
steatorrhea – the appearance of a large amount of neutral fats in the stool, due to which it acquires a thicker consistency and a shiny surface;
weight loss, polyhypovitaminosis, menstrual irregularities in women.

If lymphangiectasia has severe course, superficial and cavitary edema appears (edema of the legs, ascites, pleurisy). Swelling of the retina can lead to blindness. In addition, the disease is accompanied by symptoms of the pathology against which it arose (in in this case, duodenitis).

This disease should be treated comprehensively, starting with eliminating the root cause. Doctors usually prescribe a protein-enriched diet and diuretics. If ineffective, surgical excision of the most altered vessels is performed, with the formation of anastomoses.

Conclusion

It is impossible to completely cure duodenitis, since the pathological process has chronic course. Timely prescribed therapy, giving up bad habits, balanced diet and elimination causal factors will allow you to transfer the disease into a phase of stable remission.

The pathology has an ambiguous prognosis, as it often leads to the development of complications such as biliary reflux, peptic ulcer 12PC, tumor of the papilla of Vater or intestinal bulb.

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Duodenitis is a nonspecific inflammation of the duodenal mucosa. Despite the fact that damage to the proximal small intestine is often combined with gastritis, the symptoms and treatment of duodenitis differ. The pathology occurs more often in men than in women, mainly in people suffering from inflammatory and infectious diseases of the stomach.

The most common cause of duodenitis is Helicobacter pylori infection. H. pylori bacteria colonize the stomach lining of most people and, under certain conditions, can easily spread into the small intestine.

Inflammation of the inner membrane also often occurs against the background of:

congenital anomalies of the gastrointestinal tract;
alcohol and drug abuse;
frequent or prolonged treatment with non-steroidal, hormonal anti-inflammatory drugs;
concomitant pathology of the digestive tract (reactive pancreatitis, gastritis, gastric ulcer, chronic colitis);
changes in the microflora of the intestinal tube;
improper nutrition.

Forms of the disease

According to the time and causes of occurrence, chronic duodenitis is classified as primary and secondary. In the first case, the disease is the result of the direct impact of an etiological factor on the duodenum, in the second, inflammation occurs against the background of another pathology. This could be gastritis, an ulcer, an acute infection.

The classification also implies the division of pathology according to localization and morphological changes in the mucosa:

Diffuse or total inflammation of the duodenum, local duodenitis. The latter - focal - form, in turn, is divided into bulbitis (inflammation of the bulb), papillitis, inflammation of the distal segment of the intestine.
Atrophic, follicular, erosive, erythematous duodenitis.

The follicular type most often occurs against the background of amoebiasis infection, giardiasis. Occurs in children, differs in that the mucous membrane thickens focally due to the formation of false follicles. The diagnosis is confirmed only with the help of gastroduodenoscopy.

Catarrhal duodenitis is considered a mild form of the disease and occurs with superficial inflammation of the inner wall of the intestine. With FEGDS (gastroduodenoscopy), the doctor sees swelling and pronounced hyperemia of the duodenal mucosa.

In the erosive form, superficial defects of the mucous membrane come to the fore, which cause severe pain and can be complicated by bleeding.

The pathology is often combined with inflammation of the stomach wall and is called.

Distal duodenum

At distal duodenitis It is the postbulbar section of the organ that becomes inflamed. It begins behind the bulb and borders the mucosa jejunum. This form It is less common than bulbitis (isolated lesion of the 12PC bulb) and is often combined with pathologies such as chronic pancreatitis, cholecystitis, Crohn's disease.

The distal form of duodenitis does not have any specific signs and manifests itself as pain, dyspeptic syndrome. The diagnosis is confirmed only with the help of FEGDS.

Clinical manifestations

Chronic superficial duodenitis implies relapses, that is, periods of remission are replaced by phases of exacerbation. Factors such as poor diet, alcohol intake, long-term treatment with certain medications, and severe stress contribute to the appearance of unpleasant symptoms and complaints.

During the period of exacerbation, the symptoms are most pronounced, then the patient begins to pay attention to digestive problems.

Clinical signs of duodenitis in acute form:

pain in the abdomen above the navel, subsiding after eating;
feeling of heaviness in the right hypochondrium, nausea;
violation of bowel movements, constipation;
decreased appetite, bad breath;

Such symptoms are not specific and may indicate others, therefore a comprehensive examination is required using instrumental and laboratory diagnostic methods.

Principles of treatment

Treatment begins with identifying the cause of inflammation. If the factor is Helicobacter bacteria, antibiotics are used (Clarithromycin, Amoxiclav, for example). Along with antimicrobial drugs, the gastroenterologist should prescribe drugs to normalize the intestinal microflora (Linex, Bifiform) and relieve the inflammatory process.

Complex treatment includes the following activities:

Prescription of antisecretory, anti-inflammatory, antacid drugs (Maalox, Phosphalugel, Rabeprazole, Famotidine).
The use of antispasmodics (for pain relief) and sedatives.
The use of a therapeutic diet.

Symptomatic treatment with sedatives is a mandatory stage of therapy, since the stress factor contributes to the development of inflammation. Mild sedatives and herbal remedies (valerian extract) are prescribed.

Treatment with traditional methods

Alternative medicine also offers several options for restoring digestive health.

Symptoms that appear during pathology can be relieved using the following recipes:

Mix equal parts lemon balm, oak bark, chamomile, licorice root and pour a glass of boiling water. Leave for 60 minutes. Drink before meals.
A compress made from rhubarb leaves can be applied to the stomach area when symptoms of pain and heaviness appear.
Pour boiling water over flaxseeds, leave for half an hour and drink in small portions.

Exacerbations of duodenitis occur in the spring and autumn, therefore this time is most favorable for carrying out preventive measures and changing the diet.

Lymphangiectasia as a complication of duodenitis

Intestinal lymphangiectasia is a congenital or acquired pathology in which the vessels in the membranes of the small intestine significantly enlarge.

A long and often recurrent course of duodenitis leads to the development of a secondary form of the disease, in which the vessels are affected locally (for example, in the area of the bulb) or diffusely. Also, secondary lymphectasia can be a consequence of intestinal tumors, Crohn's disease, ulcerative colitis, and systemic pathology.

Since the outflow of lymphatic fluid is disrupted, the mucous membrane becomes swollen, hyperemia develops (due to dilation of blood vessels), and a pronounced expansion of the lumen occurs. Against the background of this pathology, the protective function of the intestine also suffers, the absorption of proteins and fats is impaired, and edema appears.

The term “hyperemia of the duodenum” is used by diagnosticians when conducting FEGDS (endoscopic examination of the esophagus, stomach and the initial part of the duodenum). Literally, hyperemia is translated as redness, which in this case is used to describe the condition of the mucous membrane of the organ.

Normally, the mucous membrane of the duodenum is pink, not thickened, not swollen, and without pronounced folding. Its hyperemia on FEGDS means that there is inflammation of the inner lining of the organ - duodenitis. Redness of the mucous membrane is due to cellular infiltration and expansion small vessels in response to the inflammatory process.

Signs of lymphangiectasia:

severe diarrhea – frequent loose stools up to 10-15 times a day;
pain in the abdomen, nausea;
steatorrhea – the appearance of a large amount of neutral fats in the stool, due to which it acquires a thicker consistency and a shiny surface;
weight loss, polyhypovitaminosis, menstrual irregularities in women.

If lymphangiectasia is severe, superficial and cavitary edema appears (edema of the legs, ascites, pleurisy). Swelling of the retina can lead to blindness. In addition, the disease is accompanied by symptoms of the pathology against which it arose (in this case, duodenitis).

Dilated lymphatic vessels can only be detected during gastroduodenoscopy (FEGDS). In this case, the endoscopist notes the appearance of a characteristic finely dotted white coating on the mucous membrane, which is commonly called “semolina syndrome in the duodenum.”

Conclusion

It is impossible to completely cure duodenitis, since the disease has a chronic course. Timely prescribed therapy, giving up bad habits, a balanced diet and eliminating causative factors will allow the disease to be transferred into a phase of stable remission.

The pathology has an ambiguous prognosis, as it often leads to the development of complications such as biliary reflux, peptic ulcer 12PC, tumor of the papilla of Vater or intestinal bulb.

Benign tumors of the duodenum

Primary tumors of the duodenum are extremely rare - 0.009%.

Classification of benign tumors of the duodenum.

Zollinger-Ellison syndrome.

Tumors of epithelial origin:
- adenomas,
- hyperplasiogenic polyps.
Non-epithelial tumors:
- lipomas,
- neuromas,
- fibroids,
- leiomyomas, etc.

Benign tumors can be single or multiple. No predominant localization was identified. They are asymptomatic. Clinical manifestations of complications (bleeding, obstruction).

Epithelial benign tumors. These include polyps and polypoid tumor changes in the mucous membrane of the duodenum. They have a spherical, mushroom or lobular shape. They can be, like stomach polyps, pedunculated or broad-based, easily mobile, soft or soft-elastic consistency, the color is more intense than that of the surrounding mucosa, often ulcerate, and bleed easily.

True polyps, unlike polypoid and submucosal tumors, have a clearly demarcated base, which can subsequently transform into a stalk. This is explained by the fact that the polyp is epithelial tumor, while polypoid and submucosal tumors are formed by neoplastic tissues covered with epithelium, and therefore cannot have a well-demarcated base. The diagnostic criterion However, it is not always possible to use it due to the great similarity of some submucosal tumors (for example, carcinoid) with broad-based polyps.

For a biopsy, a piece of the tumor taken with biopsy forceps is usually sufficient. If the histological picture is unclear, endoscopic removal of the entire polyp is necessary.

Polyps up to 0.5 cm are observed at least once every 6 months; polyps larger than 0.5 cm are indicated for polypectomy. A biopsy is required because 7.4% develop into cancer. Before polypectomy, it is necessary to determine the attitude towards BDS. If the polyp is located next to the BDS - shown abdominal surgery. Submucosal (nonepithelial) benign tumors. They are located in the submucosal layer, covered with normal mucosa, the boundaries are clear, but the base is not clearly demarcated. The shapes are round or oval, a positive tent symptom is noted. The consistency is soft-elastic. If there is an ulcer on the surface of the tumor, the biopsy must be performed through the ulceration or an extended biopsy.

Malignant tumors of the duodenum

Until 1976, there was not a single case of intravital diagnosis of duodenal cancer. Represents 0.3% of all malignant tumors gastrointestinal tract. There are primary and secondary duodenal cancer.

Primary cancer comes from the wall of the duodenum. It occurs very rarely - in 0.04%. It is localized mainly in the descending part, less often - in the lower horizontal and extremely rarely - in the upper horizontal branch of the duodenum. In the descending part, supra-, infra- and periampullary locations are distinguished. The latter is the most common and difficult to diagnose, because It is not always possible to differentiate the papilla of Vater from cancer. Metastasis is noted late: first to regional lymph nodes, then to the liver, pancreas, and later to other organs. Histologically, adenocarcinoma is determined in 80%.

Classification of primary duodenal cancer.

Polypous form (exophytic cancer).
Infiltrative-ulcerative form (endophytic cancer).
Scirrhosis-stenotic form (endophytic cancer).

Exophytic cancer. Occurs more often. Tumor nodes are gray-red in color, often with erosions or ulcerations at the apex. The tumor is clearly demarcated from the surrounding mucosa, there is no infiltration. It can be rigid, but it can also have a soft consistency, easily disintegrating, bleeding.

Infiltrative-ulcerative form. An irregularly shaped flat ulcerative defect is determined bright red. The bottom is rough, the edges are often with prominent papillae. On instrumental palpation - rigidity, slight contact bleeding.

Scirrhosis-stenotic form. There is a narrowing of the lumen of the duodenum. The mucous membrane is dull and pale. The relief changes: the surface is uneven, knotty, folds cannot be straightened out by air. On instrumental palpation there is pronounced rigidity. There is no peristalsis. Contact bleeding is insignificant.

Secondary duodenal cancer comes from neighboring organs (spreading from the pancreas, papilla of Vater, bile ducts).

There are 3 stages of the process propagation:

Stage I. Fusion of the tumor with the wall of the duodenum. The deformation of the lumen is slightly pronounced (swelling, pushing back of the wall). The mucous membrane is mobile, not changed. There are no fistulas. There is no intraluminal tumor growth. The biopsy gives nothing.
Stage II. Tumor invasion of the duodenal wall without involvement of the mucous membrane. Persistent deformation of the lumen. The mucous membrane is fixed, there are inflammatory changes and erosion. There are no fistulas. There is no intraluminal tumor growth. On biopsy there are inflammatory changes.
Stage III. Germination of all layers. The lumen deformation is persistent. The mucous membrane is fixed, there are growths of tumor tissue. There are fistulas. There is intraluminal tumor growth. Biopsy shows cancer.

The diagnosis is reliable when III degree, high reliability in grade II; in grade I, endoscopic diagnosis is ineffective.

Endoscopic signs of diseases of the hepatoduodenal organs

Edoscopic signs of chronic pancreatitis, diseases of the biliary system

Severe duodenitis of the descending section with changes in the mucosa like “semolina” (lymphangiectasia).
Rough folding of the postbulbar mucosa.
Severe focal duodenitis in the area of the abdominal cavity, papillitis.
Presence of duodenogastric reflux.
Deformation, narrowing of the lumen, change in bending angles.

Indirect endoscopic signs acute pancreatitis

The changes are caused by inflammation of the pancreas and its swelling.

1. Local inflammation along the posterior wall of the stomach and along the medial wall of the duodenum: hyperemia, edema, fibrin deposits, erosions, multiple hemorrhages, increased size of the abdominal cavity, papillitis.
2. An increase in the size of the pancreas causes displacement back wall stomach and duodenal bulb, straightening of the superior duodenal flexure and flattening of the lumen of the descending branch of the duodenum.