Erosive bulbitis: acute, chronic, superficial, focal

In gastroenterology, erosive bulbitis - an inflammation of the proximal part of the duodenum - bulb, which adjoins the sphincter of the pyloric stomach, is prominent.

In fact, erosive bulbite is a limited duodenitis with a clearly localized superficial epithelial defect (erosion) in the bulb area.

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Epidemiology

Separately, the epidemiology of erosive bulbit is not traced, but, according to clinical studies, in 95% of cases of duodenal ulcers, it is localized in its bulbar part (bulb).

According to the experts of World Gastroenterology Organization, the number of adult patients with duodenal ulcer (which begins with the erosion of its mucosa) accounts for almost two thirds of all patients with peptic ulcers of the gastrointestinal tract.

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Causes of the erosive bulbite

The most common causes of erosive bulbitis are the same as most digestive tract diseases:

• infection of the stomach with campylobacteria Helicobacter pylori, which produce cytotoxins (found in most cases);
• intestinal lambliasis (Giardia intestinalis) or ankylostomiasis (Ancylostoma duodenale);
• malnutrition (irregular intake of food, excess of fatty and acute in the diet);
• prolonged stress and psycho-emotional disorders (due to which the synthesis of neurohormones indirectly activating acid formation in the stomach is increased);
• duodenogastric reflux (when bile comes from the duodenum into the stomach, passing through the bulb);
• long-term use of drugs that affect the mucosa or disrupt the synthesis of protective factors (non-steroidal anti-inflammatory drugs, glucocorticoids);
• radiation and chemotherapy in oncology.

Risk factors

Additional risk factors include: abuse of alcohol, nicotine and psychoactive substances; immune deficiency; hereditary predisposition;

Presence of other diseases of the digestive system (Crohn's disease, liver cirrhosis), diabetes mellitus or autoimmune diseases (in which the body produces antibodies that attack mucosal cells).

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Pathogenesis

The listed reasons and factors lead to violations of the protective barrier of the duodenum. And their pathogenesis can be associated with an increase in the aggressive effects of hydrochloric acid and pepsin (impregnating the contents of the stomach, entering the duodenum directly through the bulb). Either the pathogenic effect lies in a significant decrease in the components of the mucous layer of the walls of the bulbar section and a reduction in the normal reproduction of the cellular elements of the mucous membrane, which disrupts the natural process of its regeneration.

In the mucosa of the duodenum and its bulb, there are duodenal glands (Brunner's glands) that produce an alkaline mucus secret to neutralize gastric acid, and the damage caused by one of the above causes may play a role in the development of erosive bulbitis.

In addition, the gastrointestinal mucosa is characterized by the presence in the crypts of special epithelial cells Paneth cells, which are of primary importance for the protection of other cells from microbial and fungal damage, since antibacterial enzymes such as α-defensin, lysozyme and phospholipase A2, as well as TNF-α-tumor necrosis factor-alpha, which stimulates phagocytosis. So, if these protective cells are damaged, the resistance of the mucous membrane to any pathogenic effects is reduced.

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Symptoms of the erosive bulbite

The main symptoms of erosive bulbitis are nonspecific and similar to manifestations of inflammation of the gastric mucosa.

In some patients, the first signs of the disease, especially at the initial stage, are dyspepsia and loss of appetite, others have heartburn, belching and bloating (flatulence). And how intensively these symptoms are manifested and in what order, depends on the individual characteristics of the organism.

Acute erosive bulbitis is manifested by pain in the upper part of the abdomen (in the middle), which can be both blunt and aching, and burning, with irradiation to the back and chest, and also as spasms. Pains, as a rule, occur at night or on an empty stomach. In the chronic form of pathology during the day, pain may not be present, but palpation of the initial part of the small intestine is quite painful, and after eating in the epigastric region, discomfort appears (as if the stomach is overflowed to the limit).

Also, clinical symptoms of inflammation and erosion of the duodenal bulb mucosa include nausea and vomiting.

With the stasis of gastric chyme in the bulbar part of the duodenal part of the small intestine, gastroesophageal reflux is often observed, causing acidic eructations and heartburn. A bitter taste in the mouth is evidence of duodenogastric reflux.

If there is blood in the feces, this happens most often with an erosive-ulcerative or erosive-hemorrhagic bulbite.

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Forms

Depending on the course of the disease distinguish acute erosive bulbitis (damage and inflammation of the mucosa occurs quickly, with an acute clinical picture) and chronic erosive bulbitis (the disease develops slowly - sometimes exacerbating, then calming down).

If the patient exhibits the majority of symptoms and the examination confirms their association with inflammation and the presence of erosion of the duodenal bulb mucosa, a pronounced erosive bulb can be diagnosed.

According to the results of the endoscopic examination, gastroenterologists can also determine such morphological types of the disease as:

• erosive-ulcerative bulbitis, in which erosion is deep and affects not only the surface layer of the epithelium and its own plate, but also extends to the muscular plate of the mucous membrane of the bulbar section of the duodenum;
• catarrhal-erosive bulbitis - acute surface erosive bulb, affecting goblet enterocytes of the upper layer of the intestinal epithelium and its cytoplasmic outgrowths (microvilli);
• erosive focal bulbitis - characterized by limited foci (spots) of destructured mucosa;
• erosive-hemorrhagic bulbit - extends to submucosal base with blood vessels, with the expansion and damage of which in the feces may be an impurity of blood;
• drained erosive bulbitis - is diagnosed in cases of fusion of individual foci and formation of a fibrin film on the affected surface.

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Complications and consequences

The main consequences and complications of erosive bulbitis, especially erosive-ulcerative and erosive-hemorrhagic, are associated with the formation of duodenal ulcers.

In the case of duodenal ulcers with localization in the bulb, there is a threat of perforation and bleeding.

In this case duodenal ulcers are not characterized by malignancy, which is possible in almost 5% of cases of stomach ulcers. For more information, see: Ulcer and duodenal ulcer

Diagnostics of the erosive bulbite

The key method that gives the basis for accurately diagnosing "erosive bulbitis" is an instrumental diagnosis by fibrogastroduodenoscopy. During this endoscopic examination, the mucous membrane of the duodenum and its bulbar section is clearly visualized; in addition, a tissue sample is used for histopathological examination.

Diagnosis of erosive bulbitis includes the determination of the acidity level (pH) of the stomach, as well as tests:

• general and biochemical analysis of blood,
• a blood test for antibodies to H. Pylori,
• stool analysis.

Differential diagnosis

Differential diagnosis should exclude Crohn's disease, Whipple's disease, Zollinger-Ellison syndrome, malignant lymphoma, duodenal carcinomas, infections (Salmonella, Shigella).

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Treatment of the erosive bulbite

When Helicobacter pylori is detected, the treatment of erosive bulbit begins with eradication with antibacterial drugs: Azithromycin or Amoxicillin (three days once a day for 1 g) and Clarithromycin (14 days, 0.5 g twice daily).

Pharmacological therapy of this disease also uses drugs of the pharmacological group of H2 antagonists of histamine, which reduce the production of hydrochloric acid in the stomach: Ranitidine (Acylok), Famotidine (Famosan, Gasterogen), Cimetidine (Tagamet), etc. - 0.2-0 , 4 g two to three times during the day (during meals). Drugs of this group can cause side effects: headache, fatigue, dizziness, decreased heart rate, ringing in the ears, and others.

With normal liver function, gastroenterologists also prescribe drugs to inhibit acid formation - proton pump inhibitors Omeprazole (Omega, Omipix, Pepticum, Helicid), Rabeprazole, Pantoprozole (Nolpasa), etc. The dosage and duration of treatment will depend on the individual manifestation of erosive bulbitis. Side effects of these drugs are quite numerous: from headaches and hives to sleep disorders, jade and increased lipid levels in the blood.

Can use antisecretory drug Misoprostol (Saitotec) - three times a day, one tablet (0.2 mg); there may be side effects in the form of dyspepsia, edema, a decrease or increase in blood pressure, as well as pain in the stomach.

The antacid and covering agent Relzer (with aluminum hydroxide, simethicone and licorice root extract) is recommended for patients over 12 years - one or two tablets twice a day (in powdered form, drinking glasses of water); durability of application - two weeks. There may be side effects: a change in taste, nausea, diarrhea.

It is possible to use tablets or suspension Adjiflux

Spasmolytics, best of all - No-sppa (Drotaverin, Spasmol), will help with severe pain: one tablet (40 mg) three times a day. But it should not be taken with atherosclerosis, enlarged prostate, glaucoma and pregnancy.

And for better healing of the erosion of the bulb of the duodenum, vitamins C, E, B6, B12, PP are recommended.

Homeopathy offers sublingual tablets Gastricumel - three times a day for one tablet (reduce belching, heartburn and increased gas formation in the intestine). And also tablets Duodenogel (taken in the same way and in the same dosage) - against inflammation, pain and spasms and as an antacid. However, it should be borne in mind that homeopathic remedies often cause allergic reactions.

In the remission phase, it is possible to physiotherapeutic treatment of erosive bulbite, which consists in the use of natural mineral water - bicarbonate-sodium.

Alternative treatment of erosive bulbit

In addition to drug treatment, an alternative treatment with the use of decoctions and infusions of medicinal plants, used inward after consultation with the doctor in charge, is possible.

Most often, herbal treatments are carried out using the St. John's wort, which is prepared from a tablespoon of dry grass for a half cup of water; takes 80 ml each half an hour before meals (no more than four times during the day).

It helps to use a mixture of decoctions of nettle dioecious (a tablespoon per cup of boiling water) and oats (in a similar proportion). Prepare the broths separately, mix (1: 1) and drink half a cup of minutes for 30-40 before each meal.

Phytotherapists recommend taking juice of fresh plantain (on a tablespoon three times a day) or a decoction of dried leaves - half the glass (with the addition of 15 g of honey). Also used decoction of oak bark and infusions of ivan-tea, calendula, veronica, orchis, goose, melanus vulgaris.

Diet and lifestyle

The success of the treatment of erosive bulbit, as well as all diseases of the digestive system, largely ensures a correct lifestyle - with regular nutrition (without harmful products), with refusal of alcohol and smoking, etc. By the way, in a healthy diet and lack of bad habits is prevention.

Both chronic and acute forms of the disease are recommended for erosive bulbitis - detailed information in the materials Diet for duodenitis, as well as Diet for erosive gastritis

During an exacerbation of the disease it is recommended to drink only (for two 24-48 hours), then the food is consumed in a very crushed or ground form - in small portions up to six times a day. It is important to use liquid (not hot and not cold).

It is clear that in the menu with erosive bulbite there is no place for sharp and fatty dishes, sauces and confectionery products, preserves and semi-finished products. Preferred vegetable soups and mashed potatoes, steamed meatballs and meatballs from lean meat and fish, boiled porridge with a little oil, baked fruit, jelly.

Forecast

Erosive bulbitis is a complex disease, but it does not pose a threat to life. However, a favorable prognosis for this pathology depends on its treatment, as well as on the treatment of background diseases of the gastrointestinal tract - gastritis, cholecystitis, pancreatitis, etc., which are often included in the "bouquet" of digestive system problems.

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