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Chronic duodenitis: diagnosis
Last reviewed: 19.10.2021
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Instrumental and laboratory data
Roentgenoscopy of the stomach and duodenum
Characteristic signs of chronic duodenitis are uneven and erratic peristalsis, periodic spastic contractions of the duodenum ("irritated" duodenum), sometimes reverse peristalsis, accelerated passage of barium along the loop of the duodenum, an increase in the size of the folds. With atrophic duodenitis, folds can be significantly reduced.
In many patients, bulbostasis and bulb bulb enlargement are observed, sometimes duodenostasis due to a sharp increase in the tone of the lower-horizontal part of the duodenum.
Often revealed duodenogastric reflux. With erosive duodenitis, a contrast can be delayed in the form of a small spot on the mucosa of the duodenum.
Fibroesophagogastroduodenoscopy
FEGDS is inferior to the X-ray method in evaluating the motor function of the stomach and duodenum, but is more informative in assessing the mucosal microrelief, revealing focal atrophic changes in the mucous membrane, erosions and flat ulcers. With superficial duodenitis, endoscopy reveals uneven edema of the mucous membrane in the bulb, the upper bend and the descending part of the duodenum; significant significant spotted hyperemia of the mucous membrane, especially in places of edema. In cases of pronounced duodenitis, the swelling of the duodenal mucosa becomes diffuse. In the most edematous zones, numerous whitish, overgrown grains up to 1 mm in diameter ("semolina") are found; In areas of spotted hyperemia, small-focal hemorrhages are also common. In the lumen of the duodenum, there is a lot of mucus. When atrophic duodenitis endoscopically, along with edema and hyperemia, areas of pale mucosa, in which due to a significant decrease in its thickness, small vascular branching is visible. Slime usually does not. With erosive duodenitis, multiple erosions of different sizes - ranging from small-to-small to 0.2-0.5 cm in diameter - are located on the mucous membrane that has been altered in type of pronounced duodenitis. The bottom of them is flat, covered with a white coating, erosions are surrounded by a rim of hyperemia, easily bleed during endoscopy. Morphological examination of biopsies reveals inflammatory changes, areas of gastric metaplasia, dystrophic changes, an increase in the number of goblet cells, and in the progressing course - their decrease and pronounced changes in the mucosa of the duodenum.
Examination of gastric secretion
Gastric secretion in chronic duodenitis can be normal, elevated or decreased.
Duodenal sounding
Changes are observed that are characteristic of chronic cholecystitis and pancreatitis.
Survey program
- General analysis of blood, urine, feces.
- Biochemical blood test: the content of total protein and protein fractions, aminotransferases, glucose, sodium, potassium, chlorides, cholesterol, a-amylase, urea, creatinine.
- Duodenal sounding.
- FEGDS with targeted biopsy of the mucosa of the duodenum.
- Diagnosis of Helicobacter pylori infection.
- X-ray of the duodenum.
- Ultrasound of the abdominal cavity organs.
[1], [2], [3], [4], [5], [6], [7], [8], [9], [10], [11], [12]