Dyskinesia of the duodenum: diagnosis

The main significance in the detection of motor disorders of the duodenum has an x-ray method of investigation. The normally observed intestinal function is so uniform and regular that any deviation from it requires the attention of the clinician. Violation of the tone and peristalsis of the intestine radiographically manifests in the form of spasms in the area of functional sphincters or in some parts of the intestine, spastic deformation of the bulb, hypertension, hypo- and atony of the bowel, strengthening and weakening of its peristalsis.

Evacuation disorders include:

1. duodenal stasis, the main feature of which is the delay of the contrast agent in any of the departments or throughout the entire gut for 35-40 seconds or more;
2. delay in evacuation of contents from the duodenum, less than 35 s;
3. acceleration of evacuation;
4. strengthened pendulum-shaped movements of the contents in the gut;
5. throwing the contrast mass from the underlying parts of the duodenum into the overlying and into the stomach (reflux).

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

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

Relaxation duodenography allows differential diagnosis between functional and organic (against arteriomesentral compression) duodenosis. A great help in the diagnosis of motor disorders can be provided by other methods of investigation of the motor and evacuation function of the duodenum. The balloon method can record the contractions of the intestinal wall and thus allows us to judge the nature of the motor function of the duodenum.

In the records of the balloonographic method of 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) - I type;
2. monophasic contractions of greater amplitude and duration (more than 10 cm H2O, 12-60 s) - type II;
3. Tonic shortening lasting from a few seconds to several minutes, on which waves of types I and II are superimposed - type III.

Type I waves are considered to be agitating, type II and type III are 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 help slow down (decrease in motor activity, intestinal cramps, increase in the rhythmic component of motor activity) or acceleration (increase in motor activity, decrease in the rhythmic component of motor activity) evacuation.

The combination of balloon kymography method with multichannel intraduodenal pH-graph, which allows to judge the passage time in the duodenum, can give a more complete picture of its motor-evacuation function.

A non-balloon method using an open catheter or radiotelemetry capsule helps to investigate the average total pressure in the lumen of the duodenum, which varies depending on the plastic tone of its wall, the speed of passage of the contents of the gut. With compensated duodenostasis, the pressure in the lumen of the gut is increased, and when decompensated, it is lowered, but sharply and inadequately increases when carrying out the loading test, i.e. Introducing 100 ml of isotonic sodium chloride solution into the luminal gut.

In recent years, the development of electromyographic methods using intraduodenal electrodes.

The performed studies of the motor function of the duodenum allowed AP Mirzaeva (1976), OB Milonov and VI Sokolov (1976), MM Boger (1984) and others to distinguish the following types of curves:

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

In the opinion of KA Mayanskaya (1970), the nature of the associated motor disorders of the duodenum depends on the type, stage, prescription, severity of the underlying process. In particular, for duodenal ulcer, duodenitis is characterized by high motor activity of the duodenum, in the stage of remission of peptic ulcer it is noted its decrease. Calculous and acalculous cholecystitis is also often accompanied by hyperkinetic, hypermotor dyskinesia of the duodenum, with radiographically more frequent than in other diseases, spasm of the intestine. In the stage of remission of cholecystitis there is no change in the motor function of the gut. The motor activity of the duodenum does not decrease, and after cholecystectomy for calculous cholecystitis. For the mild forms of chronic pancreatitis, the hyperkinetic type of motor function of the duodenum is most typical. In chronic pancreatitis of moderate severity, hypokinesia is more often detected, and in severe forms of the disease or in the stage of exacerbation, gut akinesia. At the same time, X-rays are most often detected atony of the duodenum. Complications of violations of motor function of the duodenum can manifest themselves in different ways, in particular, the violation of water, mineral and protein balance in the body due to repeated vomiting.

According to several authors, duodenal dyskinesia can contribute to the development of the pathological process in the duodenum and adjacent organs. Increased intraduodenal pressure, often associated with dyskinesia, may prevent free outflow of bile and pancreatic juice into the gut. At the same time, violations of duodenal tone and intra-duodenal pressure affect the function of the sphincter of the hepatic pancreatic ampulla, causing its insufficiency or spasms, which also affects the timely emptying of the ducts. Numerous studies on the development of experimental models of duodenostasis confirm the possibility of developing in these conditions a pathological process in the biliary system and the pancreas. Duodenal dyskinesia can cause stagnation in the intestine of aggressive gastric contents, disrupt the supply of alkaline pancreatic juice to the proximal parts of the intestine and, thus, contribute to ulceration 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.

[1], [2], [3], [4], [5], [6], [7]