Erosive bulbit
The content of the article:
- Causes and risk factors
- Forms of the disease
- Symptoms
- Diagnostics
- Treatment of erosive bulbit
- Diet for erosive bulbite
- Possible complications and consequences
- Forecast
- Prevention
Erosive bulbitis is an inflammatory disease in which a lesion of the duodenal ampulla is observed with the occurrence of single or multiple erosions on the mucous membrane. The disease is found in 1–3% of persons during gastroscopy for epigastric pain. Erosive bulbitis affects men and women with approximately the same frequency. The chronic form of the disease is more often recorded in the age group over forty. In the structure of all bleeding in the upper gastrointestinal tract, the share of erosive bulbitis is 4%.
With erosive bulbitis, erosions are observed on the mucous membrane of the duodenum
Causes and risk factors
In some cases, the development of erosive bulbit does not have an obvious relationship with any pathological effect. Single erosions on the mucous membrane of the bulbar section of the duodenum are also found in clinically healthy individuals. As a rule, primary erosive bulbitis is usually formed as a result of exposure to pathogenic microflora (Helicobacter pylori).
Secondary erosive bulbitis can develop as a result of the action of certain drugs (long-term use of corticosteroids, nonsteroidal anti-inflammatory drugs, etc.), as well as against the background of injury, burns, exposure to toxic substances, including the use of alcoholic beverages, in the postoperative period, and also in patients with pathologies of the urinary tract, respiratory tract, cardiovascular system, liver.
Primary erosive bulbitis due to infection with Helicobacter pylori
Risk factors include:
- genetic predisposition;
- immune disorders;
- disorders of the endocrine and nervous systems;
- infectious processes;
- foreign body entering the stomach;
- poor nutrition;
- chronic stress;
- radiation and chemotherapy.
These factors cause disturbances in the functioning of the protective barrier of the duodenum. Against this background, an increase in the aggressive action of pepsin and hydrochloric acid, which enter the duodenum with the contents of the stomach, give rise to the pathological process. In addition, the development of the disease is facilitated by a decrease in the components of the mucous membrane of the walls of the bulbar part of the duodenum and a violation of the normal processes of its regeneration.
Forms of the disease
Depending on the etiological factor, erosive bulbitis is subdivided into primary, i.e., inflammation first developed in the duodenal bulb and secondary, in which inflammation of the duodenal bulb is one of the symptoms of a general disease.
By the nature of the course, erosive bulbitis is divided into acute and chronic.
According to the results of endoscopy, the following morphological forms of the disease are distinguished:
- erosive focal bulbitis - limited lesions on the mucous membrane of the bulbar section of the duodenum;
- catarrhal-erosive bulbitis - a superficial lesion in which the goblet cells of the upper layer of the intestinal epithelium and its cytoplasmic outgrowths, or microvilli, are involved in the pathological process;
- erosive-ulcerative bulbitis - deep erosion, while not only the epithelium and its own plate are affected, but also the muscle plate of the mucous membrane of the bulbar part of the duodenum;
- erosive-hemorrhagic bulbitis - the pathological process extends to the submucosal layer with blood vessels;
- drain erosive bulbit - there is a fusion of individual lesions with the formation of a fibrin film on the affected area.
Symptoms
The main symptom of acute erosive bulbitis is pain in the epigastric region, which can occur both on an empty stomach (during the day and / or at night), and some time after a meal, can radiate to the navel, back or chest. In addition to pain, nausea, sour belching, bloating, flatulence, a feeling of fullness in the abdomen, and unstable stools are observed. Heartburn occurs after eating.
The first symptom of erosive bulbitis is pain in the epigastric region
When bleeding from erosions, the feces acquire a dark color (melena), it is possible to open vomit, which looks like coffee grounds. Profuse internal bleeding is manifested by pallor of the skin, increasing weakness, dizziness.
With the development of a secondary erosive bulbit with single lesions, its signs, as a rule, are masked by the symptoms of the main pathological process.
In chronic erosive bulbitis, the symptoms of the concomitant pathological process dominate, with which this form of the disease is usually combined. There is a tendency to constipation, nausea may disturb. Bleeding is not typical for chronic erosive bulbitis.
Diagnostics
A careful history taking is important for the diagnosis of erosive bulbitis. Attention is paid to the presence of concomitant diseases, medications taken, the presence of bad habits, as well as signs of gastrointestinal bleeding in history.
With bleeding from erosions in the general blood test, changes are possible, indicating anemia. A laboratory study of feces for occult blood is carried out. If erosive bulbitis is suspected, a breath test for Helicobacter pylori, an enzyme-linked immunosorbent assay, as well as a PCR study to identify a possible pathogen are shown. In addition, the level of acidity of gastric juice is determined, a biochemical blood test is performed.
Gastroscopy of the stomach - the main method for diagnosing erosive bulbitis
The main instrumental method in the diagnosis of erosive bulbitis is esophagogastroduodenoscopy. In the acute form of the disease, during endoscopic examination, erosion is found in the form of a defect in the mucous membrane of a round or irregular shape with a fibrinous or hemorrhagic plaque, with a zone of hyperemia along the periphery. With chronic bulbitis, multiple lesions are most often found, resembling plaque-covered polyps with a defect in the central part. Usually such defects are up to 1.5 cm in size. The mucous membrane around the erosion is not changed or hyperemic. During the period of remission, the defects become flatter, with mild hyperemia, the plaque disappears. In the course of esophagogastroduodenoscopy, a biopsy is mandatory, followed by a morphological study of the material obtained for differentiation with malignant and benign neoplasms, including ulcerated polyps.
If it is impossible to perform esophagogastroduodenoscopy, they resort to X-ray examination with contrasting, but this method is less informative.
Differential diagnosis is required with lipophagic intestinal granulomatosis, Crohn's disease, malignant lymphoma, duodenal carcinomas, Salmonella and Shigella infection, Zollinger-Ellison syndrome.
Treatment of erosive bulbit
Treatment of uncomplicated erosive bulbitis is carried out on an outpatient basis or in the department of gastroenterology. With the development of bleeding, the patient is hospitalized in the surgical department.
Profuse bleeding in a patient with erosive bulbitis is an indication for emergency esophagogastroduodenoscopy, during which coagulation or clipping of the affected blood vessel is performed. In addition, hemodynamic disorders are corrected and blood products are transfused.
Symptomatic therapy of erosive bulbitis includes taking antispasmodic drugs, gastroprotectors, prokinetics and vitamin complexes. When Helicobacter pylori is detected, antibiotic therapy is prescribed.
With erosive bulbitis caused by the bacterium Helicobacter pylori, antibiotics are indicated
With erosive bulbitis, which has developed against the background of other diseases of the gastrointestinal tract (secondary), the primary pathological process is treated.
If conservative therapy is ineffective, surgical removal of non-epithelizing tissue using a polypectomy loop may be required. After the operation, the removed tissue is sent to the laboratory for morphological examination.
Diet for erosive bulbite
Diet therapy is of great importance in the treatment of erosive bulbitis. Foods that increase the acidity of gastric juice are excluded from the diet. These are fried, spicy, fatty foods, smoked meats, marinades, alcohol, coffee, strong tea, carbonated drinks, raw vegetables. It is recommended fractional meals with grated food, as well as drinking plenty of fluids. It is necessary to completely exclude dry food and strictly adhere to the food intake regimen.
An important role in the treatment of erosive bulbitis is played by diet therapy
Patients should avoid strenuous physical activity, especially after eating.
Possible complications and consequences
Erosive bulbitis, especially erosive-ulcerative and erosive-hemorrhagic forms of the disease, can be complicated by the development of duodenal ulcer.
Erosion in the chronic form of the disease is capable of malignancy, i.e., degenerate into a malignant tumor.
Forecast
With timely diagnosis and properly selected treatment, the prognosis is favorable. If the etiological factor is eliminated, erosion is completely epithelized.
Patients with a chronic form of the disease are subject to dispensary observation with an annual endoscopic examination.
Prevention
In order to prevent the development of erosive bulbitis, it is recommended:
- timely treatment of diseases that can cause the development of erosive bulbitis;
- avoidance of stressful situations and mental overstrain;
- balanced diet;
- rejection of bad habits.
Anna Aksenova Medical journalist About the author
Education: 2004-2007 "First Kiev Medical College" specialty "Laboratory Diagnostics".
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!
