Chronic duodenitis

Chronic duodenitis is more common than was previously thought. It can be the main and concomitant diseases. After the introduction into clinical practice of the method aspiration biopsy was now possible with sufficient reliability to confirm the existence of morphological changes of the mucous membrane duodenal ulcer, characteristic of this disease. Turned Out To Be So Called. Sadkova, 1967)that chronic duodenitis accompanies ulcers with localization ulcers in the duodenum in 81 % of cases. In addition, he is usually diagnosed in patients with the presence of the symptom complex of ulcers, in the absence of x-ray symptoms of "niches". In such cases, chronic duodenitis can be considered as the underlying disease. Chronic duodenitis may accompany and a number of other diseases of digestive apparatus (chronic pancreatitis, cholecystitis, gastritis, enteritis, hepatitis, liver cirrhosis). This dissemination of this disease convincingly testifies that the view that chronic duodenitis meets not less than chronic gastritis (Century A. Yefremov and K. D. Eristavi, 1969), ranging from 22% to 30% in therapeutic hospitals, true.
The etiology and pathogenesis. One of the major direct causes of chronic duodenitis is the effect on the mucous membrane duodenal ulcer proteolytic enzymes acidic gastric contents. In a healthy person, pH duodenal bulb fasting is 7.0, and after effects on the mucous membrane of the stomach such a strong stimulus, as histamine, not increased more than 5.0. Accordingly, total acidity of duodenal content does not exceed 12-15 titration units (L. M. brown, 1969). The localization of ulcers in the duodenum and morphologically proved duodenitis pH in the content of the duodenal bulb, both before and after injecting histamine was significantly higher and reached some patients values 2,0-1,5. In the content duodenal determined by the free hydrochloric acid and total acidity in relatively high concentrations (up to 50 title, units and above). Increases significantly and the concentration of pepsin. This increase peptic activity content of the duodenal bulb is connected not only with high secretory activity of the apparatus of the stomach, but with its motor function. The acidic contents of the stomach enters the duodenum not portions at least neutralize him in the beginning of its Department and continuously. Monitoring B. C. Tarkovsky (1970), in descending Department duodenum (below the layout am Vateri) these indicators in most of these cases dramatically changed by neutralizing content pancreatic juice and a high content of bicarbonate. Confirms the high prevalence of lesions duodenal ulcer in the interval from the janitor to large duodenal papilla, i.e., the area of the bulb (E. I. Chaika, 1935).
Consequently, the development of chronic duodenitis is associated with increased secretory function of the major glands of the stomach, impaired motor function gatekeeper and the decreased secretion of substances in the initial section of the duodenum, which contribute to the neutralization of acidic gastric contents. It should be added, and lower resistance to peptic impact of the mucosa of the duodenum, directly associated with trophic processes in it.
Thus, the etiology and pathogenesis of such primary chronic duodenitis has much in common with those with ulcers (irregular, poor nutrition, frequent and prolonged mental stress, hormonal changes, etc.). In accordance with this most often chronic duodenitis accompanied by ulcers, and, according to many researchers, and contributed to its development (C. M RISS and E. C. Russ, 1968).
The next reason of development of primary chronic duodenitis is a direct effect on the mucous membrane duodenal ulcer parasites (Giardia, hookworms, shadow, Ascaris - B. A. Ovchinnikov and K. A. Treskunov, 1965). It is important observation Brandborg with co-authors (1967), according to which Giardia infestation occurs directly in the mucosal epithelium and in its own layer (according to research of the drugs obtained by aspiration biopsy). This observation explains the reason known resistance to the therapy giardiasis duodenitis. Using the method of aspiration biopsy, I. N. Sadkova (1969) showed the presence of duodenitis, most patients opisthorchiasis.
A large group consists of so-called ancillary or secondary chronic duodenitis, observed in a number of diseases, mainly of digestive apparatus (chronic gastritis, pancreatitis, hepatitis, liver cirrhosis). Held lifetime morphological studies of the mucous membrane duodenal ulcers in patients with chronic hepatitis and liver cirrhosis (C. W. Shulman, 1969) showed that it dystrophic changes epithelium with the phenomena of its restructuring, i.e., the processes that modify the tissue trophic. It is possible that in the development of secondary or related chronic duodenitis play an important role reflex influence altering trophic mucous membrane type "nerve degeneration", proved in respect of the mucous membrane of the stomach works With. Century Anichkov and I. S. Factory (1965).