Duodenal dyskinesia - Diagnosis

The main significance in revealing motor disorders of the duodenum is the X-ray method of examination. The normal function of the intestine is so uniform and regular that any deviation from it requires the attention of a clinician. Violation of the tone and peristalsis of the intestine is radiologically manifested in the form of spasms in the area of the functional sphincters or in individual parts of the intestine, spastic deformation of the bulb, hypertension, hypo- and atony of the intestine, strengthening and weakening of its peristalsis.

Evacuation disorders include:

1. duodenal stasis, the main symptom of which is the retention of contrast agent in any section or throughout the entire intestine for 35-40 seconds or more;
2. delay in evacuation of contents from the duodenum, which is less than 35 s;
3. acceleration of evacuation;
4. increased pendulum-like movements of contents in the intestine;
5. throwing of contrast mass from the lower parts of the duodenum into the upper parts and into the stomach (reflux).

Depending on the duration of the delay in the evacuation of the contrast suspension from the duodenum, N. N. Napalkova (1982) identifies 4 degrees of duodenostasis duration:

1. more than 45 sec;
2. 1 hour after the study;
3. 2 hours;
4. 3 hours or more after the study.

Relaxation duodenography allows differential diagnostics between functional and organic (against the background of arteriomesenteric compression) duodenostasis. Other methods of studying the motor-evacuation function of the duodenum can be of great help in diagnosing motor disorders. The balloon-kymographic method can record contractions of the intestinal wall and thus allows one to judge the nature of the motor function of the duodenum.

In balloonographic recordings of the motor activity of the duodenum, several types of contractions are distinguished, differing in amplitude, duration and tone. These include:

1. monophasic contractions of small amplitude and duration (5-10 cm H2O, 5-20 s) - type I;
2. monophasic contractions of greater amplitude and duration (more than 10 cm H2O, 12-60 s) - type II;
3. tonic contractions lasting from several seconds to several minutes, on which waves of types I and II are superimposed - type III.

Waves of type I are considered to be mixing, and waves of type II and III are considered to be propulsive. However, in practice, a direct correlation between the quantity and quality of propulsive waves and the evacuation activity of the duodenum is most often not found. In our opinion, evacuation depends on the integration of a number of characteristics of the motor function of the duodenum, which contribute to the slowing down (decrease in motor activity, intestinal spasms, increase in the rhythmic component of motor activity) or acceleration (increase in motor activity, decrease in the rhythmic component of motor activity) of evacuation.

The combination of the balloon-kymographic method with multichannel intraduodenal pH-graphy, which allows one to judge the passage time through the duodenum, can provide a more complete picture of its motor-evacuation function.

The balloon-free method using an open catheter or radio telemetry capsule helps to study the average total pressure in the lumen of the duodenum, which changes depending on the plastic tone of its wall, the speed of passage of the intestinal contents. With compensated duodenostasis, the pressure in the intestinal lumen is increased, and with decompensated duodenostasis, it is decreased, but it increases sharply and inadequately during a load test, i.e., the introduction of 100 ml of isotonic sodium chloride solution into the intestinal lumen.

In recent years, electromyographic methods using intraduodenal electrodes have been developed.

The conducted studies of the motor function of the duodenum allowed A. P. Mirzaev (1976), O. B. Milonov and V. I. Sokolov (1976), M. M. Boger (1984) and others to identify the following types of curves:

1. normokinetic,
2. hyperkinetic,
3. hypokinetic and
4. akinetic.

According to K. A. Mayanskaya (1970), the nature of associated motor disorders of the duodenum depends on the type, stage, duration, and severity of the underlying process. In particular, peptic ulcer disease and duodenitis are characterized by high motor activity of the duodenum, while its decrease is observed during the remission stage of peptic ulcer disease. Calculous and acalculous cholecystitis is also often accompanied by hyperkinetic, hypermotor dyskinesia of the duodenum, while X-rays reveal intestinal spasms more often than in other diseases. During the remission stage of cholecystitis, there are no changes in the motor function of the intestine. Motor activity of the duodenum does not decrease after cholecystectomy for calculous cholecystitis. For mild forms of chronic pancreatitis, the hyperkinetic type of motor function of the duodenum is most characteristic. In chronic pancreatitis of moderate severity, hypokinesia is most often detected, and in severe forms of the disease or in the acute stage - intestinal akinesia. In this case, atony of the duodenum is most often detected radiologically. Complications in case of disorders of the motor function of the duodenum can manifest themselves in different ways, in particular, a violation of the water, mineral and protein balance in the body due to repeated vomiting.

According to some authors, duodenal dyskinesia may contribute to the development of a pathological process in the duodenum and adjacent organs. Increased intraduodenal pressure, which often occurs against the background of dyskinesia, may impede the free outflow of bile and pancreatic juice into the intestine. At the same time, disturbances in duodenal tone and intraduodenal pressure affect the function of the sphincter of the hepatopancreatic ampulla, causing its insufficiency or spasms, which also affects the timely emptying of the ducts. Numerous studies on the creation of experimental models of duodenostasis confirm the possibility of developing a pathological process in the biliary system and pancreas under these conditions. Duodenal dyskinesia can cause stagnation of aggressive gastric contents in the intestine, disrupt the supply of alkaline pancreatic juice to the proximal parts of the intestine and, thus, contribute to ulcer formation in the duodenum.

Motor-evacuation disorders of the duodenum are often accompanied by duodenogastric reflux, which is considered an important factor in the pathogenesis of chronic gastritis.

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