Gastroduodenitis - Causes, Symptoms And Treatment

2024 Author: Josephine Shorter | [email protected]. Last modified: 2024-01-07 17:49

Causes and symptoms of gastroduodenitis

What is gastroduodenitis?

Gastroduodenitis is an inflammation of the mucous membrane of the stomach and duodenum. In fact, this is a more severe form of gastritis, in which the pathological process passes to the underlying organ - the duodenum, which is fraught with aggravation of digestive disorders.

Most often, gastroduodenitis is diagnosed in the age group 30-35 years old, and its symptoms are more similar to the manifestations of peptic ulcer disease than gastritis.

Gastroduodenitis is divided into acute (short-term, recently appeared severe pain) and chronic (systematic aching pain in the upper abdomen). In chronic gastroduodenitis, large-scale violations of the secretory and motor-evacuation functions occur, followed by a complete restructuring of the gastric mucosa.

Content:

• How is gastroduodenitis different from gastritis?
• Causes of gastroduodenitis
• Symptoms of gastroduodenitis
• Forms of gastroduodenitis
• Diagnostic methods
• Treatment of gastroduodenitis
• What is recommended to eat with gastroduodenitis?
• List of drugs for the treatment of gastroduodenitis

How is gastroduodenitis different from gastritis?

There are no significant differences between these pathologies: both gastritis and gastroduodenitis are inflammatory diseases of the gastrointestinal tract. The only difference is that in gastroduodenitis, the area of mucosal lesions is wider than in gastritis, it also captures the duodenum. A possible cause of the development of gastroduodenitis, gastritis and stomach ulcers is infection with the bacterium Helicobacter pylori. The diagnosis and treatment regimen for these diseases is practically the same.

Causes of gastroduodenitis

There are endogenous and exogenous causes of the development of gastroduodenitis. With increased acid production and low mucus production, a violation of hormonal regulation of secretion, endogenous gastroduodenitis develops. Also, diseases of the liver and biliary tract, malfunctions of the endocrine system can cause the development of gastroduodenitis.

Exogenous developmental factors include physical ones - for example, the use of spicy, cold or hot food, exposure to chemicals (pesticides). The penetration of the Helicobacter pylori bacteria into the digestive tract is also important.

The main causes of gastroduodenitis include:

• Lean or very fatty and spicy food;
• Failure to comply with the food intake, dry food;
• Various stresses, psychological pressure;
• Helicobacter pylori infection;
• Infections that develop in the mouth and throat;
• Recently, it has been noticed that the causes of superficial gastroduodenitis may be a genetic predisposition to such diseases.

In addition, there are acute and chronic forms of gastroduodenitis, when periods of remission alternate with exacerbations.

The reasons for the development of an acute form of gastroduodenitis:

• Toxic effects of chemicals and spoiled food, irritating the mucous membrane of the stomach and intestines;
• The use of hot spices and seasonings;
• High concentration of residual pesticides in food;
• Complications of intestinal infections and chronic somatic diseases;
• Increased production of hydrochloric acid in the stomach in combination with a decrease in the protective properties of the mucous membrane, proceeding against the background of stress and a violation of the diet.

Approximately 65-70% of cases of gastroduodenitis are a chronic form of pathology.

Causes of chronic gastroduodenitis:

• Heredity;
• Helicobacter pylori infection;
• Complication of acute gastroduodenitis;
• Stay in constant stress mode;
• Malnutrition with a deficiency of protein, vitamins and minerals;
• Violation of the diet;
• Diseases of other organs of the gastrointestinal tract (intestines, pancreas, gallbladder);
• Complications of somatic diseases (autoimmune and endocrine pathologies, blood diseases, hepatic and renal failure);
• Side effects of drugs (NSAIDs, glucocorticosteroids) against the background of long-term use;
• Smoking and alcoholism.

Each case of gastroduodenitis may have not one, but several reasons for its appearance. Several decades ago, after the discovery in 1983 of the bacteria Helicobacter pylori, approaches to determining the etiology of this disease have changed dramatically.

Flagella of active strains of pathogenic bacteria are able to penetrate through the damaged epithelium of the gastric and intestinal mucosa, and its enzymes break down the membrane proteins. The urease secreted by Helicobacter pylori disrupts microcirculation in the tissues of the gastrointestinal tract, hydrochloric acid ions damage the capillaries of the blood vessels of the stomach and intestines. All of these aspects contribute to the development of inflammation.

Normally, the bacterium is found in the gastrointestinal tract of almost every person, getting there in childhood.

Helicobacter pylori exhibits its destructive function due to the combination of the following factors:

• Violation of the nervous and endocrine regulation of the gastrointestinal tract functions;
• Increased acidity of gastric juice and impaired production of its defense in the form of mucus;
• Disruption of the balance of the AKUD-system, which produces biologically active substances and hormones;
• Violation of the regenerative functions of the gastric and intestinal mucosa.

Symptoms of gastroduodenitis

Symptoms of gastroduodenitis in children and adults differ, but as a result, the disease always leads to a complex lesion of the gastrointestinal tract. This happens due to the fact that the duodenum produces hormones that have a significant effect on the secretory and evacuation activities of the remaining organs of the digestive system. As a result of the progression of the disease, the stomach, pancreas, and bile ducts suffer. Most often, with chronic gastroduodenitis, a person feels aching cramping pains in the epigastric region. Frequent gagging and regular heartburn begin to disturb.

It is possible to diagnose gastroduodenitis if a person loses weight, has a pronounced pallor of the skin, pain on palpation of the abdomen, a yellowish plaque on the tongue and teeth prints on the inner lateral surface of the cheeks. In children, the symptoms are more pronounced. In addition, the child begins to suffer from autonomic and emotional disorders.

The clinical picture of the disease depends on the phase in which it is located - remission or exacerbation. In the stage of remission, the picture is very vivid, the patient experiences intense pain for 10-14 days. With incomplete remission, pain does not bother, digestive disorders, heartburn, bloating, and heaviness are felt. During complete remission, the patient is not worried about anything, signs of gastroduodenitis are detected during endoscopic examination.

The clinical picture of gastroduodenitis is similar to the symptoms of duodenal ulcer: pain, dyspeptic and asthenovegetative syndrome.

Pain syndrome

Adults suffering from chronic gastroduodenitis feel pain in the upper abdomen, in the projection of the stomach and duodenum, children under 10 years old - in the solar plexus and in the navel.

Pain is usually associated with eating:

• "Hunger pains" - felt in the morning, on an empty stomach, disappear after breakfast;
• "Night pains" - occur during sleep, 4-5 hours after the last meal, disappear after eating;
• "Late pains" - felt 1-3 hours after eating as a result of the ingestion of a lump of food in the duodenum.

If the inflammation is localized in the intestines, "night" and "hungry" pains will be felt. With a predominant lesion of the stomach, the patient feels "late" pain. Another combination of pain syndromes practically does not occur.

The pain may be associated with psycho-emotional or physical stress, and not with food intake. The duration of the pain is different - from several minutes to 2-3 hours in a row. If to eliminate "hungry" pains it is enough to eat something, then "late" pains are eliminated much longer and more difficult.

Dyspeptic syndrome

With gastroduodenitis, digestive disorders associated with disorders of the motor function of the stomach and intestines are frequent. As a result, food remains in the stomach for too long and does not enter the small intestine in a timely manner.

A complex of symptoms of dyspeptic syndrome:

• Feeling of heaviness and distention of the stomach;
• Heartburn;
• Belching;
• Fast saturation;
• Bitterness in the mouth;
• Bloating, flatulence;
• Alternating constipation and diarrhea;
• Nausea, less often vomiting;
• Slipping syndrome is a bowel movement immediately after eating, often diagnosed in children.

Diarrhea is characteristic of inflammation of the stomach, constipation - with an inflammatory process in the duodenum. Bloating more often occurs against the background of a combination of gastroduodenitis and pancreatitis.

In children suffering from gastroduodenitis with high acidity, increased sweating is found.

Asthenovegetative syndrome

It manifests itself most strongly with severe pain and dyspeptic syndrome.

Typical signs:

• Emotional lability;
• Fatigue;
• Weakness;
• Lethargy;
• Heavy sweating in the limbs;
• Rare pulse (below 50 beats per minute);
• Low blood pressure;
• Red dermographism - the appearance of red spots on the skin with strong pressure on it, which remain visible for half an hour.

Forms of gastroduodenitis

The grounds for isolating the forms of the disease are the intensity of the inflammatory processes occurring in the mucous membrane.

Types of gastroduodenitis:

• Superficial - puffiness and thickening of the folds of the mucous membrane appear during the acute period;
• Hypertrophic - against the background of edematous and thickened mucous membranes, hyperemia, white bloom, small punctate hemorrhages are diagnosed;
• Mixed - the symptomatology is similar to the manifestations of hypertrophic gastritis, but has a brighter clinical picture, in addition, the mucous membrane atrophies due to poor nutrition, its folds flatten;
• Erosive - precedes the development of an ulcer, on the mucous membrane there are many erosions covered with mucus and a film of fibrinous plaque.

Classification of gastroduodenitis according to the degree of acidity:

• With increased secretory function (diagnosed more often than others);
• With normal secretory function;
• With reduced secretory function (accompanies stomach cancer).

Up to 40% of cases of the disease can have an atypical manifestation, be asymptomatic. The clinical picture may not coincide in the severity of symptoms with changes in the gastrointestinal tract.

Diagnostic methods

A gastroenterologist can diagnose gastroduodenitis by performing an examination or the necessary studies: esophagogastroduodenoscopy, if necessary, with a biopsy of the gastric mucosa.

It is also necessary to conduct a study of gastric secretion - pH-metry of the stomach and duodenum. According to the results of these analyzes, it is possible to determine what form gastroduodenitis has - with increased or decreased acidity, and, accordingly, prescribe the correct treatment.

Modern methods for diagnosing gastroduodenitis:

• Fibroesophagogastroduodenoscopy (FEGDS) is an accurate and informative method of endoscopic examination of the stomach and duodenum using an endoscope, which allows assessing the severity and nature of damage, the form of gastroduodenitis.
• Morphological examination of mucosal tissues taken during FEGDS - carried out using a microscope at the cellular level, allows you to diagnose the form and characteristics of the disease.
• X-ray examination with a contrast medium of the stomach and duodenum - the method is less informative than FEGDS, is rarely used.
• Intragastric pH-metry - measuring the acidity of gastric juice using electrodes inserted into the stomach, helps determine the treatment regimen.
• Bi-frequency intragastric impedance measurement - measurement of the activity of glands producing hydrochloric acid, accurately determines the acidity of gastric juice.
• Ultrasound of the stomach and intestines is a poorly informative method that allows you to determine indirect signs of gastroduodenitis.

The "gold standard" for the diagnosis of the disease is endoscopy of the stomach and duodenum, an additional informative study is the measurement of gastric acidity.

Treatment of gastroduodenitis

The main methods of treating the disease are diet therapy combined with medication. Additional methods - psychotherapy, physiotherapy, restorative procedures.

Diet treatment:

• Diet No. 1 - with exacerbations of chronic gastroduodenitis against a background of increased or normal acidity;
• Diet number 2 - with exacerbations against the background of low acidity;
• Diet number 15 - with remissions against the background of normal health;
• Diet number 3 - for constipation against the background of remission;
• Diet number 4 - with diarrhea in remission.

The treatment regimen for the disease depends on the etiology of gastroduodenitis. So, when Helicobacter pylori is detected, antibiotics are prescribed, in the absence of bacteria in the stomach, antibacterial agents are not used.

The main drugs in the treatment regimen for the disease are antisecretory drugs (proton pump inhibitors, H2-histamine blockers and M1 receptor antagonists), which reduce the production of hydrochloric acid and the acidity of gastric juice. The most effective inhibitors of the proton pump, the next most effective are H2-histamine blockers. The least effective antagonists of the M1 receptors are currently rarely used.

If the acidity of the gastric juice is lowered, it is increased by stimulating the production of hydrochloric acid with the drugs Limontar, Plantaglucid, rosehip decoction, sauerkraut juice.

For the prevention and elimination of heartburn, antacids are used, with vomiting, diarrhea and flatulence, drugs from the group of prokinetics are used, which stimulate the movement of food from the stomach into the intestines.

Gastroprotective agents accelerate the regeneration of the gastric mucosa and duodenal ulcer. They promote the production of mucus, which protects the walls of the stomach from the aggressive effects of hydrochloric acid, and restore the structure of the mucous membrane. Gastroprotective agents relieve pain, eliminate heartburn. For spasms and severe pain with gastroduodenitis, drugs from the group of antispasmodics are used.

Disease therapy takes on average 8-10 weeks; in a shorter period of time it will not be possible to achieve a stable remission. The course of treatment should not be interrupted even after the elimination of the main symptoms, it should be completed. Symptomatic agents are used as needed - the presence of diarrhea, constipation, heaviness in the abdomen, with heartburn, pain. If there are no pronounced symptoms, only antacids and antisecretory drugs are used.

For the treatment of a mild form of the disease, one course is enough; in severe cases, several courses are used. A 2-5 month break is made between them, then the treatment is repeated. The frequency of therapy courses is determined by the attending physician.

Physiotherapy methods:

• Electrophoresis with Novocaine, Papaverine, zinc sulfate - used for exacerbation;
• Mud, paraffin, ozokerite applications - used during remission.

Psychotherapy eliminates the effects of stress, nervous overload, psychoemotional disorders.

What is recommended to eat with gastroduodenitis?

• Soups cooked in vegetable, mushroom, fish broths, pureed;
• Lean meat (chopped, baked) boiled chicken;
• Steamed cutlets, stewed, fried, but without coarse crust;
• Low-fat ham;
• Boiled fish, chopped low-fat herring, pre-soaked;
• Milk (if there is no diarrhea), butter, kefir, curdled milk, cream, non-acidic sour cream, fresh non-acidic cottage cheese, non-spicy cheese;
• Soft-boiled eggs, scrambled eggs;
• Porridge, boiled or mashed (buckwheat, semolina, rice);
• Flour dishes: stale white, gray bread, uncooked crackers (exclude baking);
• Vegetables, fruits are not acidic;
• Vegetable and fruit juices;
• Weak tea, coffee, cocoa on water with milk.

List of drugs for the treatment of gastroduodenitis

Modern drugs included in the treatment regimen for gastroduodenitis:

• Antibacterial agents aimed at eliminating the bacteria Helicobacter pylori - Amoxicillin, Metronidazole, Clarithromycin, used for normal or increased secretion of gastric juice;
• Medicines that neutralize the effect of lysolecithin and bile acids, for a disease that has arisen against the background of prolonged use of NSAIDs - Cholestyramine, Magalfil-800;
• Drugs that stimulate the movement of the food lump in the stomach and intestines - Cerucal, Motilium, Metoclopramide, Raglan, are used for symptoms such as vomiting, diarrhea, a feeling of heaviness in the stomach;
• Medicines with antisecretory action that reduce the acidity of gastric juice - proton pump inhibitors: Omez, Omeprazole, Losec, Pariet, Helol, Lanzal, Nexium, Gastrozol, antagonists of M1-cholinergic receptors: Pyrene, Pirenzelin, Gastrozem, histamine H2-receptor blockers: Ranatitol, Nizatidine, Kvamatel, Roxatidine, Famotidine;
• Means for increasing the acidity of gastric juice - Limontar, Plantaglucid, tomato and sauerkraut juice, rosehip decoction;
• Antacids to reduce pain, protect the mucous membrane of the stomach and intestines from damage - Almagel, Vikalin, Vikair, Maalox, Fosfalugel, Alumag, Topalkan, Gastrofarm, Tisacid, Rutacid, Gastal, Gelusil, Megalak, Daidzhin;
• Prostaglandins for lowering gastric acidity in adults - Misoprostol;
• Gastroprotectors for the regeneration of the gastric mucosa - Actovegin, Likviriton, Sucralfat, Biogastron, Solcoseryl, Dalargin, Venter, Carbenoxolone, rosehip oil, sea buckthorn oil;
• Bismuth preparations to reduce inflammation and strengthen the protection of the gastric mucosa - De-Nol, Peptobismol, Novobismol;
• Antispasmodics for relief of pain syndrome - No-Shpa, Galidor, Papaverin, Platifillin, Buscopan, Gastrocepin;
• Means for replacement therapy in the combination of gastroduodenitis with pancreatic pathology - Abomin, Pentisal, Mezim, Creon, Pancreatin, Panzinorm.

If symptoms of gastroduodenitis appear, you should consult a gastroenterologist for diagnosis and treatment. Strict adherence to the doctor's recommendations will help to quickly cope with the disease.

The author of the article: Gorshenina Elena Ivanovna | Gastroenterologist

Education: Diploma in the specialty "General Medicine" received at the Russian State Medical University named after N. I. Pirogova (2005). Postgraduate studies in the specialty "Gastroenterology" - educational and scientific medical center.