In children, unlike adults isolated lesion stomach or duodenum relatively rarely observed in 10-15% of cases. Significantly more likely to watch a combined loss of these departments. The duodenum, being hormonally active organ, has a regulating effect on the functional activity and the evacuation of the stomach, pancreas and biliary tract.
Etiology and Pathogenesis
The leading etiologic role belongs alimentary (irregular and inadequate diet, excessive spicy food, food "dry rations") and psychogenic factors. The significance of these factors is increased in the presence of a genetic predisposition to gastroduodenal diseases. Life events in the family, school, social circle are often implemented in the form of vegetative-vascular dystonia, influences the secretion, motility, blood supply, regenerative processes and the synthesis of gastrointestinal hormones. Are also important long-term use of drugs (corticosteroids, NSAIDs), food allergies, and other factors that reduce the local specific and non-specific defense of the mucosa.
One of the main causes of chronic gastroduodenita - infection with Helicobacter pylori. Duodenitis developing against gastritis caused by Helicobacter pylori, and intestinal metaplasia of the epithelium of the duodenum to the stomach. Helicobacter pylori colonizes areas metaplazirovannogo epithelium and causes them to the same change as in the stomach. Outbreaks gastric metaplasia unstable to the contents of the duodenum, which leads to erosion. Therefore, gastro, associated with Helicobacter pylori, more often erosive.
The above etiological factors are toxic and allergic effects and induce morphological changes in the duodenal mucosa. In these conditions, the role of acid-peptic mucosal injury in the event of evacuation-motor disorders and reducing the intra-duodenal pH. Damaging factors initially cause irritation of the mucous membranes, and in the future - degenerative and atrophic changes in it. Simultaneously, the local immunity develops autoimmune aggression, impaired synthesis of hormones that regulate motor and secretory function of the pancreatobiliary system. In the latter as there are inflammatory changes. This leads to reduced synthesis of saturated sodium secretin pancreatic juice, which in turn reduces the alkalization content promotes colon and atrophic changes.
Classification
Conventional classification of chronic gastroduodenitis not. They are divided as follows:
- depending on the etiological factors - gastro primary and secondary (collateral);
- by endoscopic picture - superficial, erosive, atrophic and hyperplastic;
- by histological data - gastroduodenity with mild, moderate and severe inflammation, atrophy, gastric metaplasia;
- on the basis of the clinical manifestations of acute phase is isolated, partial and complete remission.
Chronic gastro different polymorphisms of symptoms and is often associated with other diseases of the digestive system, and therefore not always possible to distinguish the manifestations caused by gastroduodenitom from symptoms due to co-morbidities.
Gastroduodenit in acute phase appears aching cramping pains in the epigastric region, emerging after 1-2 hours after eating and often radiates to the hypochondrium (usually the right) and the umbilical region. Meal or antacids reduces or relieves pain. The pain syndrome may be accompanied by a feeling of heaviness, fullness in the epigastrium, nausea, hypersalivation. In the mechanism of pain and dyspepsia main role belongs to dyskinesia of the duodenum. Because of this increased duodenal reflux, causing bitter belching, sometimes with vomiting bile, sometimes heartburn.
On examination, patients draw attention to themselves pale skin and low body weight. Tongue coated with white and yellowish-white film, often with teeth imprints on the lateral surface. On palpation of the abdomen to determine the morbidity piloroduodenalnoy area, at least - around the navel, in the epigastric region and hypochondria. Mendel is characteristic symptom. Many patients with positive symptoms Ortner and Kera.
In children with chronic duodenitis often note vegetative and psycho-emotional disorders: recurrent headaches, dizziness, sleep disturbances, fatigue, due to the violation of the endocrine function of the duodenum. Autonomic dysfunction may manifest clinical picture of dumping syndrome: weakness, sweating, drowsiness, hypercatharsis occurring 2-3 hours after ingestion. For prolonged periods between meals can occur and symptoms of hypoglycemia in the form of muscle weakness, tremors, rapid increase in appetite.
Given the nature of development and the preferential localization of the pathological process identified a number of options for chronic gastroduodenita with characteristic clinical manifestations.
- Yazvennopodobny chronic gastro (mainly bulbitis): The most common form, is often combined with antral gastritis (antroduodenit) and gastric ulcer. At the heart of its development are factors that lead to increased aggressiveness of gastric juice and the acidification of the duodenal contents. For bulbita in acute phase is characterized by yazvennopodobny pain. Localized pain in the epigastric region, having an empty stomach or after 1.5-2 hours after meals and at night. Distinctly seasonal exacerbations.
- Gastritopodobny chronic gastro, combined with fundic atrophic gastritis and enteritis. Under this option, the diffuse atrophic process may spread to the duodenum. With the combination of chronic duodenitis with enteritis disease manifested symptoms of food intolerance, impaired digestion and absorption.
- Holetsistitopodobny chronic duodenitis, which developed against the background of duodenostasis. Cholecystitis and contributes to the progression of inflammatory and degenerative changes in the duodenum due to chronic duodenal obstruction of functional or organic origin. When duodenostasis prevail persistent or paroxysmal pain in the epigastric region and to the right of the navel, feeling of bloating, rumbling, nausea, belching bitterness, vomiting bile.
- Pankreatitopodobny local duodenitis (papillitis, okolososochkovy diverticulitis). Papillitis often develops as a consequence of a large spread of inflammation duodenal papilla with duodenitis, or may be part of inflammation localized in pancreatobiliary system. Diverticulitis - the defeat of the diverticulum, located mainly in okolososochkovoy zone. Local duodenitis is likely to disrupt the evacuation of pancreatic juice and bile in connection with the accession papillita that manifested symptoms of biliary dyskinesia. The pain is localized mainly in the right upper quadrant and is associated with a fatty meal, may be a slight icterus of the sclera and light yellow skin. Sometimes there are symptoms of pancreatitis (pain localized in the left upper quadrant, sometimes girdle, accompanied by flatulence, a violation of his chair, transient intolerance to milk).
Chronic gastro has cycled for: acute phase gives way to remission. Exacerbations occur more frequently in spring and autumn, are associated with eating disorders, congestion in the school, various stressful situations, infectious and somatic diseases. The severity of exacerbations depends on the severity and duration of pain, dyspepsia, and shared state. Spontaneous pain are on average 7-10 days, palpation pain persists 2-3 weeks. In general, acute exacerbations of chronic duodenitis lasts 1-2 months. Partial remission was characterized by the absence of complaints in the presence of moderate objective, endoscopic and morphological features of duodenitis. In remission do not show any clinical or endoscopic or morphological manifestations of inflammation in the duodenum.
Diagnostics
The diagnosis of chronic gastroduodenita based on clinical observation, the study of the functional state of the duodenum, endoscopic and histological (biopsy specimens of the mucosa) research.
- When functional duodenal sounding reveal changes characteristic of duodenitis: dystonia sphincter of Oddi, pain and nausea at the time of the introduction of the stimulus in the intestine, the reverse leakage through the probe solution of magnesium sulfate by the spasm of the duodenum. At microscopy duodenal contents reveal deflated the gut epithelium, and are often vegetative forms of Giardia. To assess the functional status of the duodenum determine the activity of enzymes enterokinase and alkaline phosphatase in the duodenal contents. The activity of the enzyme increased in the early stages of disease and reduced severity as worsening of the pathological process.
- Has a value and the study of gastric secretion. Her performance at atsidopepticheskom duodenitis (Potatoes) tend to be higher, and the combination of duodenitis with atrophic gastritis and enteritis - reduced.
- The most informative method of diagnosis gastroduodenita - FEGDS.
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