Duodenitis
Introduction
Introduction to duodenitis Duodenal inflammation refers to the inflammation of the duodenum, which is divided into primary and secondary. The primary is also called non-specific duodenitis. The clinical symptoms of this disease are lack of characteristics, mainly manifested as upper abdominal pain, nausea, vomiting, hematemesis and melena, sometimes difficult to distinguish from duodenal ulcer, simple clinical symptoms can not be diagnosed, the disease is often associated with chronic gastritis, chronic hepatitis, Liver cirrhosis, biliary tract disease or chronic pancreatitis coexist. basic knowledge The proportion of illness: 13% Susceptible people: no special people Mode of infection: non-infectious Complications: upper gastrointestinal bleeding, digestive ulcer
Cause
Cause of duodenitis
Gastric acid factor (25%):
At the beginning of inflammation, the acidity is normal. Later, due to the progress of inflammation, the inhibition process of the duodenum on the secretion of gastric juice is disturbed, resulting in the production of high acid and ulceration.
Inflammatory factors (23%):
In duodenal inflammation, the epidermal cells are lost due to inflammatory damage, but the proliferation of the glandular cells can be compensated. When the glandular cells fail to compensate for the loss due to failure, erosion can occur, followed by ulceration.
Other disease factors (30%):
Specific duodenitis is caused by Crohn's disease, intestinal tuberculosis, parasites (such as hookworm, Giardia lamblia, etc.) and fungi, eosinophilic gastroenteritis, etc., which cause specificity in the duodenum. Sexual inflammation.
Pathogenesis
Duodenal mucosa congestion, edema, erosion, hemorrhage, glandular reduction, villus atrophy; mucosal and submucosal inflammatory cells, including lymphocytes, plasma cells, monocyte infiltration, according to the degree and distribution of inflammation, shallow There are three types of phenotype, interstitial and atrophic.
Superficial
This type is the most common, accounting for about 50% to 80%. The inflammation is limited to the villi, the villi are shortened, rounded or deformed, the epithelial cells are often degraded, the cells tend to be flat, the cytoplasm is vacuolized, and the nuclear chromatin is sparse. Or pyknosis, the brush-like edge becomes thinner to disappear, the interstitial area is filled with inflammatory cells, and the mucosal muscle layer and the duodenal gland are basically normal.
Interstitial
Inflammatory cell infiltration is mainly seen in the intestinal gland close to the muscular layer of the mucosa, sometimes involving the entire lamina propria, accompanied by lymphoid follicular hyperplasia.
3. Atrophy
The mucous membrane is thinner, the villi show different degrees of atrophy, often severe epithelial cell degeneration, and see large pieces fall off, resulting in erosion, sometimes see gastric metaplasia; intestinal gland reduction or even disappear, goblet cells, mucous cells and The argyrophilic fiber hyperplasia, mucosal muscle layer rupture, hyperplasia, muscle fibers have degenerative changes; the lamina propria has extensive inflammatory cell infiltration, mainly lymphocytes, plasma cells, and lymphoid follicle hyperplasia.
Prevention
Duodenal inflammation prevention
1. Primary duodenitis with less food or no irritating food, alcohol and certain drugs (such as non-steroidal anti-inflammatory substances).
2. Specific duodenitis actively treats the primary disease, such as: Crohn's disease, intestinal tuberculosis, parasitic and fungal enteritis.
Complication
Duodenal complication Complications upper gastrointestinal bleeding digestive ulcer
Upper gastrointestinal bleeding is not uncommon. The reported rate in China is in the range of 3.4% to 35.5%. Most of them are black feces or tar-like stools, and there are also hematemesis. Some bleeding is the first symptom.
Symptom
Common symptoms of duodenal inflammation Upper gastrointestinal bleeding nausea and vomiting hernia stool abnormal abdominal pain stomach cramps fullness and weight loss
Mainly manifested as upper abdominal pain, nausea. Vomiting, often accompanied by other symptoms of dyspepsia, such as bloating, belching, acid reflux. Sometimes it resembles duodenal ulcer. It is periodic, rhythmic upper abdominal pain, fasting stomach pain, food or antacid can be relieved, and there are repeated black stools or vomiting coffee liquid, but more automatic hemostasis. Some patients may also have no symptoms.
1. Indigestion: Symptoms may have upper abdominal fullness, acid reflux, belching, nausea, vomiting and other symptoms, some patients may be asymptomatic and physical signs.
2. Upper abdominal pain: similar to duodenal ampullary ulcer, mostly hunger pain, nighttime pain, relieve after eating.
3. Upper gastrointestinal bleeding: It is a complication of erosive duodenitis, which may have nausea or hematemesis.
4. Common signs: mild tenderness in the upper abdomen, some patients may have glossitis, anemia and weight loss.
Examine
Duodenal inflammation check
Laboratory inspection:
(1) Analysis of gastric juice: The secretion of gastric acid or gastric juice is normal or high, and the gastric acid level of some cases is similar to that of duodenal ulcer.
(B) duodenal juice analysis: duodenal juice can be turbid, mucus, microscopic examination showed more epithelial cells, low gastric acid can be seen more bacteria.
(C) gastric juice analysis and blood gastrin determination: normal or high, some patients and duodenal ampullary ulcer similar, but no diagnostic value.
1. X-ray barium meal inspection
The duodenal bulb has irritability, increased movement, thickening and disorder of the folds, but it cannot be diagnosed accordingly.
2. Endoscopy can be divided into 4 types
(1) superficial type: mucosal congestion and edema, enhanced reflection, red and white, mainly red.
(2) Hemorrhage erosive type: mucosa is red, visible spots, flaky erosive lesions or hemorrhagic foci.
(3) Atrophic type: the mucous membrane is thin, pale, mainly white, and the submucosal blood vessels are exposed.
(4) Proliferative type: the mucous membrane is rough or the fine particles are nodular.
Diagnosis
Diagnosis and diagnosis of duodenitis
The diagnosis depends on endoscopic findings and endoscopic direct biopsy.
Diagnostic criteria:
Mainly relying on endoscopy to confirm the diagnosis.
1. Clinical manifestations of dyspepsia, such as abdominal distension and discomfort, hernia, pantothenic acid and pain; sometimes symptoms of peptic ulcer, such as rhythmic upper abdominal pain, temporary relief after eating; erosive hemorrhagic twelve fingers Enteritis can occur in black stools or hematemesis.
2. The amount of gastric acid secretion can be normal or increased; there are more epithelial cells in the duodenal drainage fluid, and there are white blood cells; X-ray examination has a ball irritating, a descending sputum, a large wrinkled wall, and can be a pseudopolyp Sample; endoscopy, biopsy can confirm the diagnosis.
Diagnose based on:
1. Symptoms resemble ulcer disease, although it does not cause obstruction, perforation, but can cause bleeding.
2. X-ray barium meal examination without shadow, no obvious deformation, mucosal wrinkles, but also normal.
3. The fiber endoscope sees mucosal congestion. Edema, erosion, hemorrhage, vascular exposure, rough and uneven wrinkles, nodular proliferation, etc., but no ulcers.
4. Sticky hair biopsy showed degeneration of villus epithelium, flattening, atrophy, infiltration of a large number of inflammatory cells in the lamina propria, lymphoid proliferation and gastric epithelial metaplasia.
The disease needs to be differentiated from duodenal lesions caused by chronic gastritis, duodenal gland hyperplasia, gastrinoma and intestinal tuberculosis and crohn disease.
Differential diagnosis
1. Identification with duodenal ulcer:
Duodenal and duodenal ulcers sometimes have similarities in symptoms, both of which can be associated with diet-related upper abdominal pain, discomfort, and can be alleviated by alkaline drugs. It is difficult to identify clinical symptoms alone, mainly relying on endoscopy to confirm the diagnosis.
2. Identification with chronic gastritis:
Symptoms of chronic gastritis, such as abdominal discomfort or pain, indigestion, fullness, belching, etc., are similar to duodenitis, and both often exist simultaneously. Endoscopy is the primary method of identifying both.
3. Identification with gastric neurosis:
Gastric neurosis and duodenitis can be seen in upper abdominal pain, hernia, acid reflux, nausea, vomiting and other symptoms. Gastric neurosis patients are more common in middle-aged women, and have a history of trauma, mainly manifested as intermittent upper abdominal pain, stomach cramps or discomfort, pantothenic acid, belching, sputum, etc., or vomiting. Taking antacids can reduce symptoms, but not completely. Examination of upper abdominal tenderness is more extensive and not fixed. Patients are generally in good condition, but often accompanied by neuropsychiatric symptoms such as headache, dizziness, fatigue, insomnia, depression or anxiety. There were no abnormalities in various instruments and biochemical tests.
4. Identification with the duodenum room:
Simple duodenal spleen is often used for gastrointestinal barium meal X-ray examination and other occasions, and patients are often asymptomatic. However, when you want to have inflammation or ulceration, you may have upper and lower abdominal pain. Pain often occurs after eating, and there is fixed tenderness in the upper abdomen, which is sometimes confused with duodenitis. It can be identified by X-ray barium meal examination and endoscopy.
5. Identification with chronic biliary diseases:
Biliary dysfunction can cause episodes of right upper quadrant pain. The majority of patients are middle-aged women. The pain often occurs after a full meal (especially fat meal), and the application of alkaline drugs can not be alleviated. Chronic cholecystitis, cholelithiasis can cause dyspepsia and upper abdominal pain, sometimes misdiagnosed as duodenitis. "B" type ultrasound and X-ray cholangiography can confirm the diagnosis.
