Chronic duodenitis - Diagnosis

Instrumental and laboratory data

X-ray examination of the stomach and duodenum

Characteristic signs of chronic duodenitis are uneven and disordered peristalsis, periodic spastic contractions of the duodenum (an "irritable" duodenum), sometimes reverse peristalsis, accelerated passage of barium through the loop of the duodenum, and an increase in the caliber of the folds. In atrophic duodenitis, the folds can be significantly reduced.

Many patients experience bulbostasis and an increase in the volume of the bulb, sometimes duodenostasis due to a sharp increase in the tone of the lower horizontal part of the duodenum.

Duodenogastric reflux is often detected. In case of erosive duodenitis, a delay of contrast in the form of a small spot on the mucous membrane of the duodenum is possible.

Fibroesophagogastroduodenoscopy

FEGDS is inferior to the X-ray method in assessing the motor function of the stomach and duodenum, but is more informative in assessing the microrelief of the mucous membrane, identifying focal atrophic changes in the mucous membrane, erosions and flat ulcers. In superficial duodenitis, endoscopy reveals uneven swelling of the mucous membrane in the bulb, upper flexure and descending part of the duodenum; significant spotted hyperemia of the mucous membrane is natural, especially in areas of edema. In cases of severe duodenitis, the swelling of the duodenal mucous membrane becomes diffuse. In the most edematous areas, multiple whitish grains up to 1 mm in diameter (“semolina”) protruding above the surface are found; in areas of spotted hyperemia, small focal hemorrhages are also common. There is a lot of mucus in the lumen of the duodenum. In atrophic duodenitis, endoscopic examination reveals, along with edema and hyperemia, areas of pale mucous membrane, in which small vascular branches are visible due to a significant decrease in its thickness. There is usually no mucus. In erosive duodenitis, multiple erosions of different sizes - from small-point to 0.2-0.5 cm in diameter - are located on the mucous membrane changed according to the type of severe duodenitis. Their bottom is flat, covered with a white coating, erosions are surrounded by a rim of hyperemia, and bleed easily during endoscopy. Morphological examination of biopsy specimens reveals inflammatory changes, areas of gastric metaplasia, dystrophic changes, an increase in the number of goblet cells, and in the progressive course - their decrease and pronounced changes in the mucous membrane of the duodenum.

Study of gastric secretion

Gastric secretion in chronic duodenitis can be normal, increased or decreased.

Duodenal intubation

Changes characteristic of chronic cholecystitis and pancreatitis are detected.

Survey program

1. General analysis of blood, urine, feces.
2. Biochemical blood test: total protein and protein fractions, aminotransferases, glucose, sodium, potassium, chlorides, cholesterol, a-amylase, urea, creatinine.
3. Duodenal intubation.
4. FEGDS with targeted biopsy of the duodenal mucosa.
5. Diagnosis of Helicobacter pylori infection.
6. X-ray examination of the duodenum.
7. Ultrasound of abdominal organs.

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