Bulbitis of the stomach and duodenum: what it is, symptoms, treatment, diet

The delicate mucous membrane of the gastrointestinal tract is exposed to the risk of damage every day from food that is too spicy or hard, insufficiently ground, aggressive chemicals in food and medicines, alcohol, pathogens and other irritants. As a result of their negative impact on the mucous membrane, limited or diffuse inflammation foci may form, on which erosions and ulcers subsequently form. If the inner surface of the stomach is affected, doctors diagnose gastritis, and if the mucous membrane of the duodenum is damaged, they diagnose duodenitis. In the latter case, when the inflammation is localized only in the initial (bulbous, bulbar) section of the duodenum, gastroenterologists talk about the development of bulbitis. Bulbit, in turn, is considered one of the most common types of duodenitis.

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Epidemiology

Among the pathologies of the duodenum, duodenitis is considered the most common disease. In turn, bulbitis is one of the most frequently diagnosed duodenitis, since in many cases it develops against the background of gastritis, the most common pathology of the gastrointestinal tract.

You can get bulbitis at any age, because some pathologies that cause stagnation in the gastrointestinal tract and disruption of the mucous structure are genetically determined, which means that the process begins at the moment of birth of the baby. Bulbit in children has the same causes and forms as in adults. Only the approach to treating the disease may differ.

As for sexual preferences, women are less fortunate than men. Most often, bulbitis is diagnosed in women aged 20-40 years.

Causes bulbitis

The causes of the development of such an unpleasant pathology as bulbitis are in many ways similar to the factors causing the appearance of one of the most frequently diagnosed diseases - gastritis. And this is not surprising, because the bulb of the duodenum is actually a continuation of the pylorus of the stomach (hence the unofficial name of the pathology - gastric bulbitis).

The most popular cause of bulbitis, as in the case of gastritis, is the negative impact of a bacterial infection. Helicobacter pylori, like any pathogenic microorganism, when it enters the gastrointestinal tract, is capable of causing an inflammatory process in any of its sections, including the bulbar, in a short time.

But in order for Helicobacter pylori to take root and actively multiply in the stomach or duodenum (DU), it is necessary to maintain an acidic environment there. Normally, the pancreas takes care of reducing the acidity of the stomach contents sent to the DU by producing special substances - bicarbonates. If there is some kind of malfunction in the gastrointestinal tract, food flavored with hydrochloric acid from gastric juice, aggressive secretions of the liver and pancreas, necessary for digestion of food, get into the bulb of the DU without correcting the acid level, and therefore can irritate the mucous membrane, causing its inflammation and erosive processes on it.

Another fairly common cause of bulbitis is considered to be stagnation in the gastrointestinal tract. Hydrochloric acid and special enzymes, which are abundantly flavored with half-digested food entering the duodenum, begin to gradually corrode not only the food lump, but also the surrounding mucous membrane, causing inflammatory and erosive processes in it. And stagnation of food in the stomach and duodenum can be caused by both weak intestinal peristalsis and congenital defects of the duodenum and intestines, contributing to the formation of loops in them, where food stagnates.

There are also risk factors for bulbitis that do not always cause the disease, but their presence makes the probability of the disease much higher. For example, emotional lability and stressful situations that lead to exhaustion of the nervous system and provoke spasms of the vessels of various organs, which disrupt the microcirculation of blood in them. This can cause ruptures of blood vessels and hemorrhages in the duodenal bulb, around which inflammation forms. In addition, stressful situations contribute to increased secretion of catecholamines, which are mediators of inflammatory reactions.

Bulbit can develop against the background of reduced immunity, which provides great opportunities for the activation of infectious and inflammatory processes. Its appearance can be facilitated by various serious diseases that reduce immunity and require the use of drugs that can have an irritating effect on the gastric mucosa. Acute attacks of bulbitis can also be provoked by regular consumption of strong alcoholic beverages, antibiotic therapy, frequent intake of solid food (and even with chemical additives). The development of acute bulbitis is sometimes observed with dysentery and salmonellosis. Viral hepatitis group A can also provoke pathology.

Less common causes of bulbitis include pathologies such as Crohn's disease, Zollinger-Ellison syndrome, hereditary celiac disease (atrophy of the intestinal mucosa), helminthic invasion, giardiasis, detection of a foreign body in the duodenal cavity, abdominal surgery, overeating, and violations of the diet and nutritional pattern.

Pathogenesis

The above factors and pathologies cannot but affect the condition of the duodenal bulb mucosa. It can be damaged by both externally incoming products and chemicals, and become a victim of digestive enzymes produced inside the body, or metabolic disorders in the organ tissues.

Bacterial infection also contributes to the development of bulbitis, since it not only irritates the duodenal mucosa due to the production of enzymes that cause inflammation, but also increases its sensitivity to the effects of other aggressive factors.

In principle, bulbitis can begin without the influence of Helicobacter pylori. After all, increased stomach acidity, if not treated, will cause irritation and inflammation not only of the gastric mucosa, but also of the duodenal bulb, located in close proximity to the pylorus. But whether Helicobacter pylori will be included in this process largely depends on the state of the immune system.

The close proximity of the stomach and duodenum causes the inflammatory process to spread from the stomach to the duodenal bulb, and bulbitis is diagnosed in most cases in parallel with gastritis. In other words, untreated gastritis can easily cause the development of bulbitis.

Factors such as the presence of bacterial infection and parasites in the body can not only cause the disease, but also make it chronic in the absence of proper therapy. But an exacerbation of bulbitis is usually provoked by alcohol and oral medications, spicy or hard food, stressful situations.

Symptoms bulbitis

Bulbit, as one of the gastrointestinal diseases, has specific symptoms common to all these diseases. These are pains in the epigastrium, a feeling of heaviness in the abdomen, nausea, sometimes with vomiting, dyspeptic symptoms (heartburn, belching, bloating), bowel disorders. Patients suffer from a deterioration in appetite or, conversely, an insatiable feeling of hunger, which makes them eat until nausea appears.

It would seem that if the symptoms of inflammatory pathologies of the gastrointestinal tract are so similar, how can a doctor make a preliminary diagnosis in order to conduct further research in a specific direction? How can one distinguish bulbitis from the same gastritis with all the variety of its manifestations or gastric and duodenal ulcers by eye?

In fact, bulbitis has certain symptoms that help the doctor recognize the disease without conducting special studies. Not so much the symptoms themselves, but the features of its manifestation.

So, the first signs of bulbitis are pains in the epigastric region. You can expect them to appear at any time of the day. Often patients complain that pain under the "spoon" torments them at night. The pain syndrome usually occurs not immediately after eating, but 1.5-3 hours after it. Although, if not only inflammation but also erosions appear on the mucous membrane, the pain can manifest itself much earlier (15-20 minutes after eating) or appear on an empty stomach.

The characteristics of pain in bulbitis do not have specific indicators. At the very beginning of the disease, these may be minor aching pains localized in the upper abdomen. However, later they begin to radiate to the right (rarely to the left) hypochondrium or concentrate in the navel area.

Patients complain of pain of different nature. Some experience severe acute or paroxysmal pain, while others have a rather nagging, unexpressed pain. When the process becomes chronic, the pain usually disappears altogether; unpleasant sensations in the epigastrium can only be felt during palpation.

The rest of the symptoms of gastrointestinal pathologies can also manifest themselves in different ways and in different combinations. Not all symptoms are necessarily present, because they largely depend on concomitant diseases. For example, with increased acidity of gastric juice, heartburn and sour belching will be mandatory symptoms. And in other cases, there may be no heartburn, but belching will acquire a bitter taste. Some patients indicate bitterness in the mouth, which is not associated with food intake, others note against the background of other symptoms an unpleasant odor from the mouth, regardless of the condition of the teeth, the appearance of plaque on the tongue, indicating problems with digestion.

Symptoms typical of inflammatory pathologies of the digestive organs may appear as early as half an hour after eating. Although sometimes their appearance is noted much earlier or later.

Other symptoms may also be observed: weakness, headaches, dizziness, hyperhidrosis, trembling in the hands and throughout the body, diarrhea against the background of disruption of the endocrine system and excitation of the vegetative centers of the central nervous system, etc. In this case, neurological symptoms are typical for a later period and appear a couple of hours after eating.

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Stages

Bulbit, like any inflammatory disease of the gastrointestinal tract, can occur in two forms: acute and chronic. The symptoms of the disease will depend on this.

Acute bulbitis usually occurs due to the intake of irritating food, alcohol, medications. Sometimes it can be provoked by dysentery or salmonellosis.

Acute erosive bulbitis begins with pain syndrome (pain can be sharp and strong, radiating to the back, or aching), which appears at night or on an empty stomach, as well as a quarter of an hour after eating. When transitioning to an ulcerative form or against the background of hemorrhagic bulbitis, streaks of blood may appear in the feces.

Chronic bulbitis is characterized mainly by the presence of neurological symptoms. Pain in chronic erosive bulbitis is not pronounced and occurs mainly at night. But in the absence of erosions, pain is often absent altogether (felt only by palpation), limited to episodes of heaviness and distension in the abdomen. However, a significant decrease in immunity is noted, symptoms of chronic fatigue appear, trembling in the body and severe weakness appear against the background of hunger.

Chronic course of the pathology is characterized by periods of exacerbation and remission. Bulbit in the remission stage may not manifest itself in any way or be limited to attacks of heartburn and dyspeptic phenomena.

At the onset of the disease, doctors usually diagnose bulbitis of the 1st degree of activity. This means that the disease affects only the upper layers of the duodenal mucosa. Scarring and hardening of the mucosal tissues are noted, which is not yet accompanied by pronounced symptoms. Sometimes there are mild pains in the epigastrium, heartburn, nausea, constipation.

Until the patient experiences paroxysmal squeezing or sharp pains radiating to the back, as with pancreatitis, bitterness in the mouth and sour belching, doctors suspect moderate bulbitis. In this case, the patient experiences signs of general malaise and discomfort in the abdomen.

When general symptoms of gastrointestinal pathologies and characteristic neurological symptoms appear, this indicates that bulbitis is moving to the next stage. For severe bulbitis, symptoms of medium and high intensity are characteristic, which requires more serious treatment with the use of painkillers.

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Forms

Like the popular gastritis, the inflammatory pathology of the bulbous part of the duodenum called "bulbitis" has many varieties, the most common of which is superficial bulbitis. This type of disease is not in vain considered the mildest, because the deep layers of the duodenal mucosa remain unaffected by inflammation and the symptoms do not imply severe pain attacks and noticeable deterioration in the general condition of the patient.

The symptoms of catarrhal bulbitis are reduced to cramping pains in the abdomen, increased gas formation, nausea, weakness. Sometimes attacks of headaches may be observed due to the disease.

The diagnosis of "focal superficial bulbitis" indicates that the inflammation does not cover the entire inner surface of the duodenal bulb, but some of its areas. At the same time, the symptoms of the diffuse and localized forms of pathology do not have any special differences (except that the localization of pain may shift slightly).

A mild form of chronic inflammation is considered to be catarrhal bulbitis. Its symptoms are similar to the manifestations of various pathologies of the duodenum, but even during an exacerbation, the disease does not have pronounced symptoms. The pain is moderately spasmodic, sometimes there is nausea and stool disorders. If the inflammatory process has a limited localization or several foci, the diagnosis will sound like focal catarrhal bulbitis.

Erythematous bulbitis is when red swollen spots, strewn with small ulcers that tend to bleed, form on the walls of the duodenal mucosa, as a result of which traces of blood can be found in feces and vomit. Focal erythematous bulbitis is characterized by the appearance of limited red oval-shaped spots, which can be located in different places of the duodenal bulb. This can be either one spot or several.

Most often, erythematous bulbitis develops as a result of the transition of a bacterial or inflammatory process from the stomach to the initial section of the duodenum. The disease very often and quickly becomes chronic.

Erosive bulbitis is another common form of inflammation of the duodenal bulb mucosa, characterized by a more severe course. In this case, shallow wounds (cracks, scratches) surrounded by edematous tissue that gathers into folds can be seen on the inflamed mucosa.

The symptoms of erosive bulbitis are similar to other types. The only difference is that the pains occur a little earlier, 1 or 2 hours after eating. Morning and night pains are quite intense. Nausea can be accompanied by vomiting and dizziness. Heartburn and belching of undigested food occur.

If ulcers (deeper wounds that affect different layers of the mucous membrane and the tissue underneath) are subsequently found at the site of the wounds, causing severe pain both on an empty stomach and after eating, bulbitis is called erosive-ulcerative. In this case, there is a great risk of bleeding in the duodenum, and then the feces and vomit are colored dark red or black.

Reflux bulbitis, similar to reflux gastritis, occurs when, for some reason, the contents of the duodenum (in gastritis - the stomach) change direction to the opposite. In a normal state, food moves down the esophagus to the stomach, and from there it enters the duodenum and other parts of the intestine. With reflux bulbitis, food can return to the stomach due to weakness (low tone) of the sphincter located at its outlet. The symptoms of this pathology are similar to the manifestations of the superficial form of bulbitis.

Granular bulbitis is diagnosed when small red bumps resembling grains are found on the inflamed mucous membrane. The bumps are no more than 5 mm in diameter. At first, the disease may not make itself known in any way, but as it spreads further to other parts of the gastrointestinal tract, it acquires pronounced symptoms: pain occurs almost immediately after eating, accompanied by nausea and vomiting.

Cicatricial bulbitis, or more precisely cicatricial-ulcerative deformation of the duodenal bulb, occurs as a result of incorrect treatment of the ulcer of the duodenum. Rough scars form on the surface of the mucosa at the site of the ulcer, which worsen peristalsis and patency of the organ.

Hyperplastic bulbitis is a pathology that occurs against the background of prolonged inflammation of the mucous membrane, which takes on a lumpy shape. Lumpiness indicates hyperplasia, i.e. tissue proliferation. The pathology itself is not so dangerous, but at the same time, the development of malignant tumors cannot be ruled out, because uncontrolled cell growth can also be caused by oncological reasons.

Atrophic bulbitis is when there is thinning of the mucous membrane with disorders of the duodenum. In this case, patients complain of frequent sour belching with pieces of undigested food, heaviness and rumbling in the stomach and intestines, pain in the epigastrium, and stool disorders. But the atrophic form of the pathology is always preceded by subatrophic bulbitis, i.e. a milder form of the disease with no symptoms of gastrointestinal diseases. Patients complain only of mild malaise. It is very difficult to detect the disease at this stage, especially since it progresses quite quickly, acquiring more pronounced forms.

An advanced form of duodenal mucosa atrophy is called hypertrophic bulbitis. If irregularities and papilloma-like growths form on the surface of the atrophic mucosa, this is called warty bulbitis.

Nodular (or nodular) bulbitis is the appearance of small nodules (granular bulbitis) or bubbles (follicular bulbitis) on the mucous membrane. This is not a separate type of pathology, but rather a characteristic of the clinical manifestation of certain types of bulbitis.

Follicular (lymphoid) bulbitis occurs against the background of an inadequate reaction of lymphoid tissue. On the surface of the duodenal mucosa, numerous small bubbles are found, which, when bursting, turn into small ulcers.

If the disease has specific symptoms of different types of bulbitis, it is called mixed bulbitis. Thus, with follicular bulbitis, not only bubbles can be found, but also ulcers, which indicates a mixed form of pathology.

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Complications and consequences

It would seem, what harm can inflammation of a small section of the intestine measuring 5 cm cause to the body, if the length of the gastrointestinal tract is about 9 meters? In fact, everything is not so simple. Any inflammation leads to disruption of the organ's functioning, which means the entire digestion process suffers: the body does not receive the nutrients it needs, but is saturated with toxins due to the delay and rotting of food, immunity decreases. A decrease in immunity entails the activation of bacterial-infectious processes in the body, allows cancer cells to develop, etc. These are the unsightly consequences of inflammation of a small section of the digestive tract.

As for the complications of bulbitis, here too, everything is far from cloudless. Firstly, in the absence of proper treatment under the influence of aggressive factors, any type of pathology at some point threatens to turn into erosive bulbitis. And from this form of bulbitis to a duodenal ulcer is just a stone's throw away.

Hemorrhages in erosive bulbitis and bleeding during exacerbation of its chronic form become dangerous not only for the health, but also for the life of the patient. And what can we say about the perforation of the ulcer, when the contents of the initial section of the intestine enter the abdominal cavity, provoking the development of inflammatory processes outside the gastrointestinal tract (peritonitis). Treatment of such a condition requires immediate surgery, because we are talking about the patient's life, a minute of delay and the person may not be saved in time.

Based on the above, we can conclude that timely treatment of bulbitis is the only real chance to avoid dangerous consequences that can not only worsen the quality of life, but also shorten it.

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Diagnostics bulbitis

Diagnosis of bulbitis can hardly be called a simple matter. After all, the symptoms of the disease are not specific. They are typical for any inflammatory pathologies of the gastrointestinal tract. Therefore, any little thing that the doctor catches during the physical examination and study of the patient's complaints is important.

Chronic bulbitis is a completely different matter. The absence of characteristic symptoms and good health during remission is not a reason to visit a doctor. The disease can be detected by chance when the patient is prescribed an X-ray examination, ultrasound of the abdominal cavity and pelvic organs, or gastroscopy for a completely different reason.

Epigastric pain during exacerbation of bulbitis is unstable in nature and localization, which can confuse even an experienced gastroenterologist. True, upon palpation, the cause of the pain is detected quite quickly by muscle tension in the duodenum. Pain in a calm state can radiate to the back, and to the right hypochondrium, and to the navel area, but when pressing on the diseased organ, the picture immediately becomes clear, and the circle of "suspects" is limited to the duodenal bulb.

Blood tests help confirm the inflammatory process in the body. A general blood test will show an excess of leukocytes, and a biochemical test will show an increase in the level of reactive protein produced by the liver, as well as a change in the level of digestive enzymes produced by the pancreas.

Along with blood and urine tests, the doctor will most likely also prescribe a stool test. The erosive and erosive-ulcerative form of bulbitis is characterized by hemorrhages into the organ cavity, which in turn will lead to the detection of red blood cells in the feces. And the blood test in this case will differ in the level of red blood cells and hemoglobin.

Since a frequent cause of gastritis and bulbitis is a bacterial infection, and in particular Helicobacter pylori, tests to determine the pathogen will be required. However, this specific analysis is carried out during an instrumental examination of the stomach and duodenum (fibrogastroduodenoscopy or FGDS for short). At the same time, the acidity level of the gastric juice is determined and, if necessary, a piece of tissue (biopsy) is taken for morphological examination (to confirm or exclude oncology).

To detect the causative agent of the disease, additional studies can be carried out: PCR analysis, breath test, ELISA analysis for antibodies to the pathogen.

In addition to the main method of instrumental diagnostics of gastrointestinal pathologies, which is considered to be FGDS, other popular methods of examination of internal organs are also prescribed. We are talking about X-ray and ultrasound examination of the gastrointestinal tract. Radiography is performed using contrast agents. With the help of fluoroscopy, you can see not only an enlarged organ, but also peristalsis disorders, congestion and spastic phenomena. Ultrasound allows you to see the state of the duodenum and related organs, determine the localization of inflammation, and identify the chronic course of bulbitis.

As for the endoscopic examination (FGDS), in case of pronounced bulbitis, an unusual picture is observed, which is known as the semolina phenomenon: against the background of a reddened edematous area of the skin, small whitish nodules, less than 1 mm in diameter, are clearly visible. They are easy to see due to the contrast of colors and due to the small tubercles of the mucous membrane at the site of the lesion.

Differential diagnosis

Differential diagnostics is performed to exclude gastrointestinal diseases with similar symptoms, primarily gastritis and pancreatitis. Erosive gastritis should be differentiated from gastric and duodenal ulcers.

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Treatment bulbitis

The digestive system provides food for many organs and systems of the human body. And in order for the system not to fail, it is necessary to maintain the health of all its organs.

Treatment of bulbitis, like any other gastrointestinal disease, involves a comprehensive approach to solving the problem. From the very beginning, the patient is offered to give up bad habits (primarily smoking, drinking alcohol, overeating, eating dry food), normalize the diet and nature of nutrition (it should be complete, regular and, if possible, fractional), normalize the psycho-emotional state. Additionally, you can start taking anti-inflammatory herbal infusions, potato juice and rice broth, which protect the gastrointestinal mucosa from the aggressive effects of adverse factors.

For mild forms of the disease, which are not caused by a bacterial infection, sometimes even this is enough. In the case of severe bulbitis, the complex treatment necessarily includes medication and physiotherapy.

Physiotherapeutic treatment of bulbitis includes the following procedures: magnetic therapy, UHF radiation, exposure to ultraviolet waves, and, in case of pain syndrome, medicinal electrophoresis. Sanatorium and resort treatment and drinking mineral waters such as Borjomi, Truskavets, etc. are also recommended.

Surgical treatment is prescribed mainly in cases of erosive bulbitis with a tendency to bleeding. This is either ligation of a blood vessel if bleeding occurs from it, or vagotomy with cutting of the vagus nerve trunks to reduce the production of hydrochloric acid.

Drug therapy

Many forms of bulbitis require not only lifestyle changes and dietary changes, but also drug treatment. Drug therapy in this case is also multifaceted, since it pursues several important goals at the same time.

Since bulbitis indicates inflammation in the duodenum, it is necessary to prescribe medications that stop the inflammatory process by reducing the acidity of the internal environment and facilitating the work of the digestive organs. For this purpose, enzyme preparations such as Wobenzym, Serox, Enzistal, etc., as well as antacids (Almagel, Phosphalugel, Gastal, Maalox, etc.) can be prescribed.

Most often, among antacids, doctors prefer the first two drugs. "Almagel", like "Phosphalugel", is very often prescribed for any pathologies of the gastrointestinal tract, including bulbitis, when it is necessary to quickly reduce the acidity of the stomach, because acid is one of the irritating factors that provoke inflammatory reactions.

The drug is available in the form of tablets, solution and suspension. It should be taken half an hour before meals 3 to 6 times a day. In the interval between meals and medication, it is not advisable to even drink water. A single dose of the drug is from 1 to 3 measuring spoons of solution (1-2 bags or tablets). The course of treatment is from 10 to 15 days.

The drug is not prescribed in case of intolerance to its components, Alzheimer's disease, severe liver and kidney pathologies, suspected acute appendicitis, ulcerative colitis, hemorrhoids, chronic diarrhea and some other pathologies. It is not recommended to use during breastfeeding. The drug is prescribed to children only according to the doctor's instructions in a limited dosage (1/3 or ½ of the adult norm).

Side effects include: stomach pain, taste disturbances, constipation, nausea, vomiting, conditions associated with excess minerals included in the drug.

Antibiotics for bulbitis are not mandatory medications, since their prescription is only advisable in the case of a bacterial infection, i.e. the microorganism Helicobacter pylori, which is a common cause of inflammatory pathologies of the gastrointestinal tract.

To combat Helicobacter pylori infection, antibiotics of various groups are used: Amoxicillin, Clarithromycin, Metronidazole, Tetracycline, etc. However, antimicrobial drugs are rarely used as part of monotherapy; most often, various antibiotic therapy regimens are used, which simultaneously involve 2 antibiotics and drugs that regulate the acidity of gastric juice.

The most popular drug in this regard is Amoxicillin, which is one of the main components of the treatment regimen for bulbitis associated with Helicobacter pylori. Most often, it is used in combination with Clarithromycin, less often with Metronidazole, since the combined use of drugs is fraught with the development of additional side effects.

A single dose of antibiotic in most regimens is 250-500 mg.

The drug is prohibited for use in infectious mononucleosis, lymphocytic leukemia, viral infections, hay fever, as well as allergic diathesis and bronchial asthma. There is no point in taking oral antibiotics if the patient has severe vomiting and diarrhea. The drug is also not prescribed for hypersensitivity to penicillin and cephalosporin drugs.

To reduce amoxicillin resistance, it is sometimes combined with clavulanic acid. This combination may worsen the condition of patients with liver pathologies.

Metronidazole regimens are not used to treat patients with nervous system pathologies and hematopoietic disorders.

Side effects include: allergic reactions, including severe ones, gastrointestinal and renal disorders (in combination with metronidazole), development of super infections.

Complex treatment regimens for bacterial and non-bacterial bulbitis necessarily include drugs that increase the pH level of gastric juice. These are antacids, histamine H2-receptor blockers ₍ Ranitidine, Famotidine, Gastrosidine, etc.), proton pump inhibitors (Omez, Omeprazole, Lansoprazole, Pantoprazole, etc.). Bismuth preparations (Novobimol, De-Nol, etc.) are also recommended.

"Omez" is one of the most prescribed drugs for inflammatory pathologies of the gastrointestinal tract. It slows down the synthesis of hydrochloric acid, as a result of which the gastric juice has a lower level of acidity and does not irritate the mucous membrane of the stomach and duodenum as much.

"Omez" for bulbitis can be prescribed in a dosage of 20-40 mg. The daily dose is taken in 1-2 doses half an hour before meals, washing down the tablets with water.

The drug has few contraindications. It is not prescribed to children, pregnant or lactating. It is also prohibited to take the drug if you are hypersensitive to its components.

Side effects are rare. These are mainly stool disorders (constipation or diarrhea) and taste perception, nausea, epigastric pain, a feeling of dry mouth, headaches and dizziness, sleep disorders. Muscle weakness and muscle pain, occasionally increased photosensitivity, visual impairment, allergic reactions may also be observed.

Painkillers are prescribed mainly for erosive bulbitis, accompanied by severe pain in the epigastrium. Both analgesics (for example, the good old "Baralgin") and antispasmodics ("No-shpa", "Spazmalgon", "Drotaverine", etc.) are suitable for relieving pain.

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Folk remedies

Bulbit is one of the inflammatory diseases of the gastrointestinal tract, and since all organs of the digestive system are interconnected, their treatment is largely similar. As for folk treatment, the same recipes that are used to treat gastritis with high acidity will be useful for bulbit.

First of all, it is freshly squeezed potato juice, which is recommended to be taken on an empty stomach 2 to 3 times a day. You need to drink ½ a glass of juice at a time.

To protect against the aggressive action of gastric juice, it is useful to take unsalted cereal decoctions. Rice and oatmeal (flakes), from which mucous decoctions are obtained, are excellent.

Propolis has a very good effect on gastrointestinal diseases. Its tincture in alcohol can be bought at a pharmacy or prepared independently (a piece of propolis weighing about 60 g is infused for a week in 350-400 g of alcohol). Before use, drip 20 drops of the tincture into water or milk (a little more than ½ a glass) and drink between meals. This should be done three times a day for a month.

Herbal treatment also gives good results. Instead of tea, it is recommended to take a decoction or infusion of mint and chamomile, instead of compote - rosehip syrup (1 kg of plant fruits and sugar, 1.5 liters of water) three times a day, 1 tablespoon.

An infusion of Japanese pagoda tree fruits also gives good results (pour a glass of boiling water over 1 teaspoon of crushed raw material and leave for 15 minutes). Pito, a glass of infusion 3 times a day.

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Homeopathy

Homeopathy also has a beneficial effect on bulbitis not associated with Helicobacter pylori, the use of which is considered safer for health than traditional medicine. True, with the caveat that the remedy is prescribed correctly and is taken in accordance with the doctor's instructions.

One of the drugs that homeopaths prescribe for bulbitis is Kalium bichromicum in 6 dilutions. It is recommended to take 5 granules in the morning and evening or with pain syndrome. Do not take during meals.

Bismuth preparations can also be purchased in homeopathic pharmacies, but they should only be taken after consultation with a doctor.

To relieve unpleasant symptoms, Agaricus (neurological symptoms), Gentiana (dyspeptic symptoms), Acidum aceticum (relief of symptoms associated with increased stomach acidity) will be useful. The latter drug is also prescribed for erosive bulbitis, since it helps stop bleeding.

Diet for bulbitis

Dietary nutrition for gastrointestinal diseases, which include bulbitis, is a kind of treatment procedure. If you ignore the dietary requirements, the treatment will not give the expected results.

The diet for bulbitis cannot be called strict. However, there are still some restrictions. The most important thing is to exclude from the diet foods and dishes that can irritate the inner surface of the stomach and duodenum or stimulate increased secretion of hydrochloric acid. Prohibited foods include: canned goods, seasonings, coffee, strong tea, alcohol, sour fruits and berries, smoked foods. You should refuse fried foods and spicy dishes. Salt consumption should be reduced to a minimum.

As with other gastrointestinal pathologies, fractional nutrition is recommended. Food should be taken in small portions 5-6 times a day.

Preference should be given to liquid first courses, jelly, mucous decoctions (decoctions of rice, oats, flax seeds). Fruits, berries and compotes from them with bulbitis help to saturate the body with vitamins, but it is necessary to ensure that they are not too sour.

During an exacerbation of the disease, you can eat mainly liquid dishes, gradually adding soft-boiled eggs, steamed omelette, viscous porridges, baked fruits to the menu. Among the permitted products for bulbitis, we can highlight: low-fat cottage cheese and sour cream, yesterday's white bread and crackers from it, biscuits, dietary meat and fish, pasta. It is not forbidden to add a little butter to food.

Milk is not only not prohibited for bulbitis, but is also useful, because it improves bowel function. You can drink up to 5 glasses of milk per day. However, it is recommended to boil it before drinking.

Example menu for bulbit:

• 1st breakfast: steamed omelette with vegetables, chamomile tea
• 2nd breakfast: baked apple, a little later green tea with milk
• Lunch: vegetable soup with rice, mashed potatoes with a steamed cutlet
• Afternoon snack: biscuits, compote
• 1st dinner: steamed fish, rice porridge, milk jelly
• 2nd dinner: pear puree, weak tea with mint

Prevention

Since bulbitis is primarily an inflammation of the mucous membrane of the initial section of the intestine, prevention of the disease should be aimed at preventing the development of inflammatory processes in the organs of the digestive system.

Very often, the pathology develops under the influence of increased acidity of gastric juice, which means that to prevent irritation of the duodenum, it is necessary to take drugs that help increase the pH level of the stomach contents moving towards the duodenum. If the acidic environment in the stomach provoked the development of gastritis, it must be treated immediately so that the pathology does not spread to nearby organs.

The presence of a bacterial infection in the body, and in particular Helicobacter pylori, requires urgent measures to irradiate it. Moreover, after completing a course of antibiotic therapy, it is mandatory to conduct a test showing the effectiveness of the treatment.

To prevent Helicobacter pylori infection from entering the body, you need to thoroughly wash not only your hands, but also, if possible, the food you eat.

Common preventive measures for many diseases include a healthy and active lifestyle, physical exercise, walks in the fresh air, giving up bad habits, and undergoing preventive medical examinations. All this helps strengthen the immune system and does not leave a chance for bacterial infection to develop.

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Forecast

The prognosis of the disease depends on how promptly the patient sought help. A large role is also given to the accuracy of following the doctor's instructions. The erosive form of bulbitis is the most difficult to treat, requiring a strict diet and all possible measures to protect the mucous membrane from irritation. Otherwise, the disease risks developing into a duodenal ulcer.

As for military service, bulbitis is not considered a pathology subject to examination under points a and b of the schedule of diseases with the possibility of deferment and exemption from military service. That is, a conscript even with a diagnosis of "erosive bulbitis" is unlikely to be exempt from military service. Unless the pathology has frequent exacerbations (more than 2 times a year), while the acid-forming function of the gastrointestinal tract is greatly increased and does not respond to treatment. Those who are prescribed long-term dispensary treatment are also subject to deferment from the army.