Bulbit
The content of the article:
- Causes and risk factors
- Forms of the disease
- Symptoms
- Diagnostics
- Treatment
- Possible complications and consequences
- Forecast
- Prevention
Bulbit is an inflammation of the mucous membrane of the duodenal bulb, a special case of duodenitis.
The frequency of occurrence of duodenitis, the prevailing proportion of which is represented by inflammation of the initial part of the duodenum (bulbitoma), among the adult population is approximately 20%.
Bulbit can lead to peptic ulcer disease of the duodenal bulb
Causes and risk factors
The main cause of the disease is currently considered to be infection with Helicobacter pylori bacteria, which invade the intestinal wall, colonizing it and causing inflammation. In addition, the causative factors of the disease include:
- neuropsychic overstrain (chronic stress), entailing a violation of the neuro-humoral regulation of the duodenum;
- violation of the food stereotype (regular consumption of excessively fatty, spicy food, strong coffee, food with a high content of unnatural dyes, flavors);
- chronic diseases of other organs of the gastrointestinal tract (gastritis, pathology of the biliary tract, liver, gallbladder, pancreas, various dyskinesias);
- alcohol abuse;
- smoking;
- foodborne diseases;
- infectious and inflammatory diseases of the gastrointestinal tract (giardiasis, opisthorchiasis, etc.);
- intoxication with local irritating substances;
- damage to the mucous membrane by foreign bodies;
- hereditary predisposition;
- autoimmune lesions of the mucous membrane.
Irregular, poor nutrition can lead to the development of bulbit
The main risk factors are:
- irregular, poor nutrition;
- food allergy;
- non-compliance with personal hygiene measures;
- the presence of chronic diseases of the digestive tract.
Forms of the disease
According to the severity of the current, there are:
- acute bulbit;
- chronic bulbitis (with the development of structural changes in the mucous membrane of an inflammatory-dystrophic nature, leading to atrophy of the digestive glands and dysfunction of the organ).
During chronic bulbitis, phases of exacerbation and remission alternate.
According to the depth of penetration of inflammatory changes into the thickness of the intestinal mucosa, their severity and prevalence, chronic bulbitis can be of the following forms:
- surface. It is manifested by the involvement of the surface layers of the mucous membrane in the inflammatory process, dystrophic disorders;
- diffuse, or interstitial. The entire thickness of the mucous membrane is affected, the phenomena of lymphostasis and stagnant excess blood filling are added to the dystrophic;
- atrophic. The mucous membrane becomes thinner, the number of its structural elements decreases. Excessive proliferation of connective tissue is characteristic (they emit a weak, moderate or severe degree of atrophy).
Bulbit classification according to the endoscopic picture:
- erythematous (hyperemia of the mucous membrane of the bulb);
- hemorrhagic (accompanied by hemorrhages of varying intensity);
- atrophic;
- erosive (in the presence of surface defects of the mucous membrane up to 0.8 cm in size);
- nodular (nodular).
Clinical course options:
- ulcerative (the most common variant is about 80% of cases);
- gastritis-like;
- cholecystitis;
- pancreatic;
- neuro-vegetative;
- mixed;
- latent (hidden).
Ulcerative bulbitis is the most common form of the disease
Etiological classification divides chronic inflammation of the duodenum, the most frequent manifestation of which is bulbitis, into primary (independently arising) and secondary, which developed against the background of the underlying pathology.
1. Primary duodenitis:
- alimentary;
- infectious (bacterial, viral, fungal, parasitic);
- allergic;
- immune (autoimmune);
- toxic-chemical;
- neuroendocrine;
- hereditary;
- idiopathic;
- multifactorial (mixed).
2. Secondary duodenitis, which develops against the background of diseases of various organs and systems (gastrointestinal tract, urinary, cardiovascular, hematopoietic systems, etc.), immunodeficiencies, exposure to ionizing radiation, etc.
According to its morphological characteristics, bulbit is classified as follows:
- weak, 1st degree (the structure of the mucous membrane is preserved, infiltration with lymphocytes and plasma cells is noted);
- moderate, 2nd degree (damage to the superficial epithelium, structural changes in the microvilli of the mucous membrane join);
- severe, 3rd degree (pronounced deformation of the villi, intense lymphoplasmacytic infiltration, possibly the presence of erosions).
Symptoms
The main manifestations of acute bulbite:
- intense pain in the epigastric region;
- nausea, vomiting;
- pain on palpation in the stomach;
- general weakness, drowsiness;
- decreased appetite;
- increased body temperature.
Intense epigastric pain is the main manifestation of acute bulbitis
The most common symptoms of chronic inflammation are:
- recurring pain ("hungry", night, early or late, diffuse encircling or clearly localized, in the epigastric region or in the hypochondrium, which depends on the clinical course of the bulbitis), removed by eating, antacid or antisecretory drugs;
- belching sour or rotten, belching with air is possible;
- a tendency to constipation or diarrhea, unstable stools are also possible, manifested by alternating constipation and diarrhea;
- pain on palpation in the epigastric zone;
- heaviness in the epigastrium after eating;
- flatulence, spastic pain in the abdomen;
- weight loss;
- additional symptoms in the form of general weakness, sweating, palpitations, shortness of breath, tremor (possible with the neuroendocrine variant of bulbitis).
In some cases, bulbitis may be asymptomatic, being detected accidentally during endoscopic examination for other diseases or at the stage of complications.
Diagnostics
In addition to the mandatory blood tests (general and biochemical) and urine, the results of which will reflect signs of nonspecific inflammation, the following studies are necessary to confirm the bulbite:
- fractional duodenal intubation (currently rarely performed);
- EGD with targeted biopsy and subsequent histological examination of the biopsy;
- identification of Helicobacter pylori infection;
- X-ray examination with a contrast agent;
- Ultrasound of the abdominal organs;
- study of the motor function of the duodenum using peripheral computed gastroenterography and (or) floor manometry.
Fibrogastroduodenoscopy is indicated for the diagnosis of bulbitis
Treatment
Treatment is as follows:
- diet therapy (table number 1a, 1b, 2, 4 or 5), with an acute or erosive-ulcerative process, hunger is shown for 1-2 days;
- eradication of Helicobacter pylori (antibiotic therapy, antimicrobial agents);
- antisecretory drugs (including H2-histamine blockers);
- gastroprotective agents;
- antacids;
- alginates;
- regulators of the motor function of the gastrointestinal tract.
With bulbit, diet therapy is indicated
Possible complications and consequences
Bulbit can lead to:
- to erosive bulbite;
- to peptic ulcer of the duodenal bulb;
- to intractable pain and dyspeptic syndromes, accompanied by a persistent decrease in body weight;
- to the development of maldigestion and malabsorption syndromes;
- to reactive inflammation of the tissues of the pancreas;
- to duodenogastric reflux;
- to gastrointestinal bleeding;
- to progressive duodenal obstruction.
Malignant degeneration can also occur.
Forecast
With timely diagnosis and complex treatment, the prognosis is favorable. Patients with atrophic duodenitis, impaired duodenal patency, chronic pancreatitis, and pathology of the biliary tract are subject to dynamic dispensary observation once a year.
Prevention
The following preventive measures must be adhered to:
- observe a rational diet;
- give up alcohol abuse, smoking;
- timely treat diseases that cause secondary chronic bulbitis;
- patients who are forced to take drugs for a long time (non-steroidal anti-inflammatory drugs, glucocorticosteroid hormones) that cause pathologies of the stomach and duodenum, to take specific preventive measures.
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Olesya Smolnyakova Therapy, clinical pharmacology and pharmacotherapy About the author
Education: higher, 2004 (GOU VPO "Kursk State Medical University"), specialty "General Medicine", qualification "Doctor". 2008-2012 - Postgraduate student of the Department of Clinical Pharmacology, KSMU, Candidate of Medical Sciences (2013, specialty "Pharmacology, Clinical Pharmacology"). 2014-2015 - professional retraining, specialty "Management in education", FSBEI HPE "KSU".
The information is generalized and provided for informational purposes only. At the first sign of illness, see your doctor. Self-medication is hazardous to health!
