Surgical treatment of biliary dyskinesia. Dyskinesia of the gallbladder. Causes, symptoms, diagnosis and treatment of the disease. Fluid and salt intake

Dyskinesia is not at all an inflection, not a curvature of the paths or the gallbladder itself, as most people believe. This term, translated from Greek, stands for “movement” and “violation”. Thus, we can conclude that biliary dyskinesia is a pathological condition of the body in which the motility or tone of the system that carries bile to the duodenum from the liver is disturbed. This condition results in pain in the right iliac region, there are problems with the stool, in some cases there is bitterness in the mouth, however, during the examination, no damage to these organs is found.

In most cases, dyskinesia develops in people who have abnormalities in the development of the biliary organs, and are also adherents of an unbalanced diet. Also, dyskinesia can appear in people who are exposed to severe stressful and traumatic situations. In addition, there are other reasons for the development of this condition. Women are especially susceptible to this disease. Treatment of dyskinesia is to eliminate the manifestations, and also, if the biliary tract has poor contractility and slow movement speed, to ensure the prevention of stone formation.

A little about physiology and anatomy

Bile is a brownish-yellow liquid that is needed by the body during digestion. The main function of bile is the division of fats ingested with food into small fractions, due to which their surface area increases. In this state, fats are better processed by the enzyme lipase and, after decomposition, the components of fats - fatty acids - are absorbed into the blood. In addition, bile is involved in the absorption of carbohydrates and proteins. Three-quarters of bile is produced by the liver and one-fourth by the liver passages, and thanks to it small intestine can function normally: suction processes are carried out in it nutrients, division and death of their own cells.

To ensure the normal operation of all the described processes, bile must be in normal concentration. The normalization process is carried out by the gallbladder, which gives excess water vessels. If bile enters the intestines in a diluted form (does not linger in the bladder), then the intestinal walls are irritated, which leads to diarrhea. Also, with a long stay of bile in the gallbladder, its concentration increases, this state of affairs also has its consequences.

The formation of bile occurs in the liver, after which it reaches the gallbladder through special ducts, and from there it enters the duodenum. The movement of the secret is ensured by pressure drops in the biliary tract, which is pumped with the help of sphincters - special circular muscles.

Thus, with a closed sphincter that passes bile into gallbladder, it drains from the liver. After its opening, the secret penetrates into the bladder, which was in an almost empty state, and, accordingly, the pressure in it was significantly lower than in the duct itself. When fatty foods enter the duodenum from the stomach, the gallbladder contracts due to the muscles, and the sphincter opens, bile passes through the duct to the circular muscle, which closes the entrance to the duodenum. After the first sphincter is closed, the second sphincter (leading to the intestine) opens, and bile enters the intestine. The sympathetic nervous system is responsible for the contraction of the bile ducts, as well as some substances that are produced by the pancreas and stomach.

Dyskinesia and its types

Having an understanding of anatomy biliary system the basic principles of pathology can be explained in detail. Thus, dyskinesia is a condition in which:

one or more sphincters located in the bile ducts do not relax in a timely manner;

or, on the contrary, regardless of the meal, they refuse to relax;

there may be a very strong contraction of the gallbladder;

the rate of outflow of bile decreases due to sluggish contractions of the bile duct and bladder.

Depending on the nature of the violation of tone and motor function, dyskinesia can be:

hyperkinetic: active outflow of bile, accompanied by sharp emissions of bile;

hypokinetic: bile is ejected slowly, and movement in the biliary tract slows down;

hypotonic: the tone of the sphincters is significantly reduced;

hypertonic: the tone of the circular muscles, on the contrary, is increased.

In most cases, the hypertonic state is combined with increased motor skills, and a spastic, or hypertonic-hyperkinetic type of dyskinesia is formed. In the case of the opposite situation, almost the same thing happens: the tone of the pathways is weakened and an atonic or hypotonic-hypokinetic type appears. A mixed type may also be present.

Spasmodic dyskinesia is most characteristic in the case of an increase in steam tone. sympathetic department. The atonic type of pathology develops in the case of the predominance of the sympathetic division of the autonomic part of the central nervous system.

Causes of the disease

The following reasons lead to a violation of the movement or tone of the biliary tract:

Congenital malformations of the gallbladder and biliary tract:

abnormally located gallbladder;

movable bubble;

accessory gallbladder;

valves in the gastric duct;

the presence of a dividing septum in the gallbladder;

inflection of the gallbladder;

intrahepatic gallbladder;

congenital weakness of the gallbladder wall;

doubling bile ducts.

Such pathologies lead to the development of the so-called primary dyskinesia.

transferred intestinal infections;

dysbacteriosis;

the period of menopause, in which there is a violation of the regulation of contractility of the bile ducts;

giardiasis, in which the colonization of the gallbladder by protozoan flagellar organisms occurs;

helminthic diseases;

transferred viral hepatitis;

food allergies;

diseases endocrine system: thyrotoxicosis, diabetes mellitus, obesity;

persistently present in the body foci of infection ( chronic tonsillitis, caries);

neurocircular dystonia, in which there is a violation of the normal sequence during the contraction of the muscles of the biliary tract;

chronic cholecystitis;

psychotraumatic situations or constant stress;

eating habits: consumption of a significant amount of spicy, smoked, fatty foods, rejection or emphasis on vegetable fats, long periods of fasting.

Signs of the disease

Symptoms of biliary dyskinesia may differ depending on the type of pathology, that is, it is hypokinetic or hyperkinetic.

The main difference for the main types of dyskinesia is the nature of the pain.

With both types of dyskinesia, the following symptoms may appear:

violation of the menstrual cycle - in some women;

decreased libido in men;

the appearance of a yellow coating on the tongue;

bitterness in the mouth;

loss of appetite;

bloating;

bad breath;

recurrent headaches;

increased sweating;

irritability.

An extreme variant of the manifestation of the hyperkinetic variant of the disease is the formation of biliary colic. Its manifestation occurs suddenly, in the form severe pain in the right region of the body, under the ribs, which is accompanied by numbness of the limbs, panic attacks, palpitations.

The maximum degree of manifestation of hypokinetic dyskinesia is a pathological condition called choleostasis - that is, stagnation of bile in the bile ducts. It is evidenced by the following symptoms:

feces acquire a grayish or most often light yellow color;

dark urine;

yellowing of the whites of the eyes and skin;

severe itching all over the skin.

Diagnosis of the disease

Symptoms alone are not enough to make a diagnosis because similar signs may also appear with more severe pathologies liver. In addition, it is necessary to establish the exact cause (for example, a malformation of the biliary tract), which led to the disease, for its subsequent elimination.

Biliary dyskinesia is a condition in which the structure of these organs is not disturbed. Therefore, the diagnosis is made in the presence of violations of contractility or disproportion of tone on the path of bile from the liver to the duodenum. How can this be diagnosed?

Performing an ultrasound examination of the gallbladder after a choleretic breakfast. Initially, a three-day diet is observed, which ends with a “clean” ultrasound of the abdominal cavity. With the help of the study, an assessment of the size of the volumes of deformation is carried out, as well as an inspection is carried out for the presence of gallstones and anomalies of the biliary tract. After that, a person begins to take foods that contribute to the release of bile into the duodenum (the menu may be as follows: a couple of bananas, chocolate, full-fat yogurt, 10 grams of fatty sour cream or cream), after which the doctor can observe in what order and how the promotion of bile works along the way.

duodenal sounding

By assessing portions of the contents of the duodenum. To do this, perform a study called duodenal sounding: a person swallows a thin probe, which, upon reaching the duodenum, takes its contents.

The study should be carried out on an empty stomach. First, a portion of the contents of the intestine is obtained through the probe, which is the standard medium of the intestine, consisting of the juice of the duodenum itself, pancreatic juice and bile. After that, magnesium sulfate is introduced into the intestine, which causes the gallbladder to contract, and bile from the gallbladder itself enters the intestine. It is taken for research, after which the bile, which during this time is glass, and intrahepatic bile ducts are taken for analysis. To establish the diagnosis of dyskinesia, the time during which the process of obtaining the second analysis takes place is important, after the administration of the drug, and after the third analysis. An important informative component is also the content of lipids, which are presented in the last two portions.

Cholecystography

Cholangiography (examination of the intrahepatic ducts) and cholecystography (examination of the intrahepatic bile ducts) are methods of contrast radiography. With cholecystography, the patient must take the contrast agent orally, after which, with the help of an x-ray, the path of the contrast agent is traced before it reaches the gallbladder and after its removal. The work and sequence of contraction of the sphincters of the gallbladder and ducts are analyzed. When executing the second method radiopaque agent is administered by injection directly into the duct itself, after which the doctor observes the progress of the substance along the biliary tract on the x-ray machine.

ERCP

Endoscopic retrograde cholangiopancreatography, or ERCP, is an instrumental method in which a probe is inserted into the duodenum, which is equipped with an optical fiber. Through it, a contrast agent is injected into the bile ducts, the reverse of the normal current (retrograde), the progress of which is observed on x-rays.

Cholescintigraphy

Cholescintigraphy is a radiological examination, during which a radioisotope preparation is injected into the body. Thanks to a special radiation, it becomes possible to visualize the process of its passage to the liver, excretion into the bile ducts, the path to the gallbladder and reaching the duodenum.

Magnetic resonance cholangiography

In complex cases of the disease, it is necessary to perform the method of magnetic resonance cholangiography, which is a non-invasive study in which a contrast agent is introduced into the body, and the path of its progress is viewed on a magnetic resonance tomograph. To undergo such a diagnosis, the patient must be in the tomography chamber for about 40-50 minutes, keeping still.

A blood test for bilirubin with fractions and lipids, a coprogram and an analysis of feces for helminth eggs and dysbacteriosis are methods that allow you to determine the degree of preservation of the functions of the biliary tract, as well as studies that allow you to determine the presence of a cause in the body possible occurrence diseases - worms. It is impossible to make a definitive diagnosis on the basis of these tests alone.

Treatment

Treatment of biliary dyskinesia is:

drug therapy: prescribed courses to ensure relief of an attack and prevent its further occurrences, as well as to prevent complications;

taking infusions and decoctions of various herbs: is prescribed by a gastroenterologist depending on the type of disease and is an integral part of the treatment;

diet therapy: is different for hyperkinetic and hypokinetic forms of pathology.

diet therapy

Nutrition is the cornerstone of treatment for dyskinesia. Only through strict adherence to the rules can you avoid the occurrence of seizures and carry out prevention surgical complications such as cholelithiasis and acute cholecystitis.

Diet for dyskinesia implies compliance general rules nutrition, however, there are points that differ significantly depending on the type of disease (hyperkinetic and hypokinetic).

General rules

It is necessary to conduct a meal in such a way that the gallbladder is completely emptied so that a pain attack is not caused. For this:

do not heat up food on trans and animal fats: lamb, goose, pork, margarine;

avoid taking too hot or cold foods;

in the morning and in the evening, eat low-fat dairy products;

have dinner 2-3 hours before bedtime, while not overeating meat;

observe intervals of 3-4 hours between meals;

eat small meals;

eat little by little, 4-5 times a day.

Features of nutrition in hypomotor dyskinesia

The diet should consist of products that stimulate the motility of the biliary tract:

• black bread;

• vegetable and butter;

  vegetables (boiled, stewed, baked);

Features of nutrition in hypermotor dyskinesia

In the presence of this form of pathology, it is imperative to exclude from daily diet products that stimulate bile secretion and bile formation: soda, broths, fresh vegetables, fatty sour-milk and dairy products, black bread, animal fats.

Medical therapy

It has general purpose and is based on the type of dyskinesia present.

Since dyskinesia refers to diseases caused by a violation nervous regulation, directly depends on the state of the psyche, then before starting the treatment of disorders motor activity in the biliary tract when using choleretic drugs, it is necessary to restore the mental background of the patient. If the pathology appeared on the background depression, it is necessary to prescribe a course of light antidepressants. If the violation of the process of bile secretion was caused by severe anxiety, neuroses, then it is advisable to start with neuroleptics and tranquilizers.

Such drugs can be prescribed by a psychiatrist or a psychotherapist.

In addition, the causes of dyskinesia are treated: correction of dysbacteriosis, elimination of hypovitaminosis, treatment of allergies, antihelminthic therapy.

Hypotonic-hypokinetic form

In this case, choleretic drugs are needed, which:

improve motility of the biliary tract: for example, pancreozymin, cholecystokinin;

increase the tone of the gallbladder: xylitol, magnesium sulfate.

In addition to choleretic drugs, tonics are also required: lemongrass tincture, eleutherococcus extract, ginseng tuning.

Hypertonic-hyperkinetic form

In this case, drugs are needed that stimulate an increase in the formation of bile: with a larger volume of bile, the ducts work longer, and do not contract quickly, causing a pain attack. These are medicines: Nicodin, Flamin, Okafenamide.

Also, when overstraining the sphincters, it is necessary to relax them. This effect is achieved by taking antispasmodics: "Buscopan", "No-shpy".

In addition, drugs are needed that normalize the balance of sympathetic and parasympathetic systems: motherwort tincture, potassium bromide, valerian tincture.

Treatment with folk methods

Biliary dyskinesia refers to those pathologies in which treatment with folk remedies is an excellent addition to the main treatment with medications, and in some cases is completely the only way(in the treatment of dyskinesia in children).

If the results of the analyzes confirm the presence of bile stasis, but there is no damage to the liver tissue (the level of AST and ALT is not elevated in the analysis of "liver tests"), then it is necessary to carry out blind zoning. To do this, on an empty stomach, you should drink a solution of magnesium sulfate, mineral water with a high degree of mineralization or a solution of sorbitol. After that, you should lie on your right side, before placing a warm heating pad under it. In this position, you should lie for about 20-30 minutes.

Additional therapies

For the treatment of biliary dyskinesia use:

treatment in gastroenterological sanatoriums, where therapy is carried out with the help of mineral waters;

treatment with leeches (hirudotherapy);

acupressure;

acupuncture;

physiotherapy: microwave, electrophoresis, diadynamic currents.

Complications of biliary dyskinesia

Similar functional impairment can cause the following effects:

metabolic disorders and weight loss, which occurs due to malabsorption essential substances without their proper bile processing;

allergization of the body, which manifests itself in the form of a skin rash;

gastritis and gastroduodenitis - inflammation of the stomach or duodenum. This is due to the fact that in the presence of this disease, unconcentrated bile is quite often thrown into the duodenum and stomach, which leads to subsequent inflammation;

inflammation of the pancreas;

cholelithiasis;

cholangitis - inflammation of the intrahepatic bile ducts;

formation chronic cholecystitis(inflammation of the gallbladder wall).

Disease prevention and prognosis

To prevent the development of pathology, certain rules must be observed:

exclude psychotraumatic situations;

eat fully: eat more vegetable fiber, boiled animal products, cereals, less - fried fish or meat;

walk outdoors;

alternate physical and mental labor;

go to bed no later than 11 pm;

sleep at least 8 hours a day.

If the pathology is already taking place, then it is worth following all the recommendations of the gastroenterologist, as well as paying attention to the psycho-emotional background.

Biliary dyskinesia cannot reduce life expectancy, but it can affect its quality.

Dyskinesia in children

The cause of biliary dyskinesia that develops in children younger age, is the anomalous structure of these very paths. In most cases, this is an inflection of the gallbladder or the presence of additional partitions in it, and an abnormal location or duplication of the bile ducts may also be present.

In older children, the cause of the development of pathology is emotional load. This is a large study load, a team at a school or kindergarten, family relocation, parental quarrels and other factors.

Other causes of biliary dyskinesia are:

neuro-arthritic diathesis;

• vegetative-vascular dystonia;

  allergic diseases;

  helminthic invasions: ascaris, giardiasis;

  transferred salmonellosis, dysentery, hepatitis A;

  chronic tonsillitis, frequent sinusitis;

  asphyxia or hypoxia during childbirth;

  birth injury.

Childhood dyskinesia is a more dangerous disease: without normal emulsification of fats, absorption does not occur. enough necessary for the body substances and fatty acids, as well as fat soluble vitamins- K, E, D, A, each of which is very important for a growing organism.

If parents began to notice that the child began to cry for the slightest reason, quickly gets tired, became irritable, withdrawn, then it is necessary to contact a gastroenterologist to exclude the presence of biliary dyskinesia. If at the moment it is not detected, then this is not a reason to think that the danger has passed. This result indicates that there is a predisposition to the disease, but the pathology has not yet appeared. In this case, it is necessary to pay attention to the daily routine and diet of the child in order to prevent the formation of the disease.

The following symptoms may indicate the development of pathology:

itching of the skin, the cause of which is unknown, not as a result of taking a new medication or food, not after a bite, not after an injection;

periodic - especially if fried or fatty foods were consumed, manifestations of pain in the right hypochondrium;

alternating diarrhea and constipation.

Diagnosis of the disease is carried out by ultrasound with a choleretic breakfast. X-ray contrast, and even more so, radioisotope techniques can be performed in children only if there are strict indications, and since the advent of magnetic resonance cholangiography, they have practically ceased to be performed.

Treatment of pathology in children

For the treatment of the disease in children, special preference is given to drugs plant origin. Their selection is carried out depending on the type of pathology.

Thus, in the presence of hypomotor dyskinesia, the following is prescribed:

mineral waters "Essentuki 17";

blind probing with xylitol or sorbitol;

herbal therapy: decoctions of mint, corn stigmas, wild rose, dandelion;

medicines that increase the tone of the biliary tract: xylitol, sorbitol or magnesium sulfate;

drugs that stimulate the process of bile formation: Liobil, Allochol, Holosas, Cholagol.

With hypermotor dyskinesia, therapy is as follows:

electrophoresis with novocaine in the gallbladder area;

mineral waters: "Smirnovskaya", "Slavyanovskaya";

herbal therapy: decoctions of nettle, chamomile, St. John's wort;

antispasmodic drugs: "Riabal", "Eufillin".

After stopping the attack, the child should be rehabilitated in a sanatorium, which has mineral water therapy and other physiotherapy:

to improve the motor activity of the biliary tract: magnesium sulfate electrophoresis, SMT therapy;

with a sedative purpose: bromelectrosleep, coniferous baths;

to eliminate spasm of the biliary tract: electrophoresis of antispasmodics (papaverine, no-shpa) in the area of ​​the biliary tract, magnetotherapy;

sodium chloride baths;

galvanic collar according to Shcherbak;

microwave therapy.

The diet described above can be fully applied to children. A strict diet should be observed for a year, after which an examination is carried out for the presence of attacks of biliary colic, if the symptom is not confirmed, you can gradually expand the diet.

Children with biliary dyskinesia are registered with a pediatrician, neurologist, gastroenterologist. Twice a year they should undergo a routine ultrasound. Also, every 6 months, courses of choleretic therapy should be carried out. Once or twice a year, the child should receive a referral for therapy in sanitary-resort complexes.

Biliary dyskinesia is a disease of the gastrointestinal tract, due to the progression of which the functioning of the bile ducts is disrupted. As a result, bile enters the duodenum incorrectly, which is why the work of the digestive tract is unbalanced. In the human body, the disease usually progresses secondarily, against the background of damage to other inflammatory processes of the gallbladder. Remarkable is the fact that it can manifest itself from an unstable mental state person.

Such a disease of the gallbladder does not pose a threat to human life. However, it can significantly reduce its level and comfort. But at untimely treatment creates favorable conditions for the occurrence and development of other diseases or disorders of the gastrointestinal tract. In children, the disease often appears due to inflammatory processes or abnormal development of the biliary tract and organons of the digestive tract.

Etiology

Various factors or causes can lead to the progression of this disease. Depending on this, clinicians divide the disease into:

• primary;
• secondary.

In primary biliary dyskinesia, only changes in functional work organs. The main reasons for the progression of this form of the disease:

• the constant impact of stressful situations on the human body;
• strict diets or improper diet, which provides for a deficiency in the body of vitamins and nutrients, overeating and eating fatty foods;
• insufficient amount of physical activity in a person's life;
• sedentary working conditions;
• genetic muscle abnormalities that lead to chronic muscle weakness;
• allergic reactions or disease.

The secondary form of pathology is caused by diseases already existing in the human body, such as:

• chronic disorders of the digestive tract (, etc.);
• inflammation of the abdominal cavity, biliary tract, gallbladder and small pelvis;
• congenital anomalies organ structures;
• excess body weight;
• lack of hormones in the body;
• cessation of menstruation in women.

Most of these reasons provoke the development of this disease in children.

Varieties

In medicine, there is a classification of the disease associated with the amount of bile secreted:

• hypotonic type - characterized by insufficient flow of bile. With this type of dyskinesia, a person feels a constant dull pain in the abdomen, with an indefinite place of manifestation;
• according to the hypertonic type - bile enters in excess. The patient has a sharp and sharp pain in the right hypochondrium, which gives to the shoulder;
• mixed type - a person shows signs of both types of the disease with varying degrees expressiveness.

Symptoms

The symptoms of biliary dyskinesia for children and adults are almost the same, only the intensity of their expression differs. The main symptoms of such a disease according to the hypotonic type include:

• pain in the abdomen, aggravated during eating;
• belching, accompanied by an unpleasant odor;
• bouts of nausea, which can cause vomiting;
• feeling of bitterness in the oral cavity;
• sudden bloating;
• diarrhea;
• sharp rise body weight;
• decline heart rate and blood pressure;
• increased excretion saliva and sweat.

Signs of the hypertensive type of the disease are:

• severe pain spreading through the abdomen, right side of the arm, back and moving to the shoulder blades;
• decrease or complete absence appetite
• weight loss of a sick person;
• gagging;
• stomach upset;
• blood pressure level is increased;
• irritability of the patient, which arose against the background of sleep disturbance;
• pain in the heart and

To general symptoms, regardless of the type of disease, include:

• acquisition of a yellowish skin color;
• plaque on the tongue, usually white color;
• body weakness;
• decrease in working capacity;
• being depressed or apathetic.

Diagnostics

Diagnosis of biliary dyskinesia is based on the assessment external signs and discomfort patient. During the initial examination, the disease can be determined by:

• pallor and dryness of the patient's skin;
• complaints of pain and nausea.

To additional diagnostic measures relate:

• (including);
• probing, followed by the study of the contents;
• analysis of feces for the presence of particles of worms;
• to detect bile particles.

Treatment

Treatment of biliary dyskinesia consists of several stages:

• drug treatment of symptoms of all types of the disease;
• physiotherapy;
• therapy of diseases that led to the appearance of dyskinesia;
• treatment during the remission of the disease;
• the use of folk remedies;
• appointment of a specialized diet;
• spa treatment.

So the treatment hypertensive dyskinesia includes:

• consultations of a gastroenterologist and a psychotherapist;
• normalization of the level of bile secretion with the help of pharmaceuticals;
• exclusion of mental problems that affect the course of the disease;
• prescription of sedatives and sleeping pills;
• hormonal injections (only for women during the cessation of menstruation);
• electrophoresis;
• laser therapy.

The hypotonic type of the disease is treated with:

• recovery correct mode sleep, work and rest;
• prescribing medications aimed at improving the outflow of bile;
• duodenal sounding for this type of dyskinesia is not only a diagnostic method, but also a treatment method.

After reducing the intensity or completely eliminating the signs and symptoms of the disease, treatment begins. internal processes, which became its causative agents. This includes dealing with:

During remission of dyskinesia, treatment can be carried out with mineral water:

• With low content minerals - in the hypertonic form;
• with a high concentration - with hypotension.

It will be better for the patient to be in a sanatorium at this time.

Folk remedies for the treatment of biliary dyskinesia will be a good addition to drug therapy. The most effective in the hypotonic form of the disease are decoctions and tinctures from:

• immortelle flowers;
• corn fibers;
• oregano.

These funds are aimed at:

• increase in the outflow of bile;
• improvement of the digestive tract;
• normalization of the nervous system;
• increased intestinal activity.

With hypertensive dyskinesia useful properties possess infusions from:

• peppermint;
• licorice root.

They are characterized by:

• improvement in appetite;
• elimination of pain spasms and nausea;
• promote the flow of bile.

An additional beneficial effect, with these types of illness, has chamomile tea, which normalizes the functioning of the gastrointestinal tract and the nervous system, eliminates bloating, and accelerates the healing of ulcers.

The diet for biliary dyskinesia consists of eating:

• fruits and vegetables;
• any kind of cereals;
• rye and bran bread;
• first courses cooked on water, and not on fatty broth;
• meat, only boiled;
• dairy products;
• all kinds of juices, preferably freshly squeezed;
• tea, with the addition of honey, instead of sugar.

With a specialized diet, the use of:

• fried fatty meat or fat;
• hot spices;
• legumes;
• desserts;
• strong drinks (tea or coffee);
• alcohol;
• smoked sausages.

Prevention

Principles of prevention for dyskinesia:

• normalization of the diet. Eat small meals five or six times a day. Monitor food temperature. They should not be very hot;
• give up alcohol and nicotine;
• timely treat not only diseases of the gastrointestinal tract, but also any infectious processes in the body;
• complete clinical examination at least twice a year.

Dyskinesia is a collective name for disorders of coordinated motor acts (usually smooth muscles of internal organs).

Esophageal dyskinesia is a violation of its motor function, which can lead to a slowdown in the movement of food from the pharynx into the stomach or its retrograde, i.e., reverse movement. Esophageal dyskinesia is a fairly common pathology, one or another of its forms is detected in about 3% of patients who undergo esophagogastroduodenoscopy. To a greater extent, esophageal dyskinesia affects females (approximately 79% of cases) older than 30 years.

Gastric dyskinesia is a functional disorder of the contractile function of the stomach, which is one of the most common gastroenterological pathologies. Dyskinesia of the stomach is most often diagnosed in young people, as well as in patients with organic or functional diseases of the central nervous system.

Both exogenous and endogenous causes can lead to gastric dyskinesia. Risk factors include:

• diseases of the central nervous system;
• diseases of the gastrointestinal tract;
• cardiovascular pathologies;
• beriberi;
• irrational nutrition (systemic dry food, too fast food intake, the predominance of carbohydrates, spicy and fatty foods in the diet, etc.);
• bad habits;
• stress;
• heat environment(living in a hot climate);
• impact on the body of ionizing radiation;
• taking some medicines.

With dyskinesia of the esophagus, it is not recommended to eat foods high in fiber, spicy and spicy dishes, alcoholic drinks.

The etiological factors of biliary dyskinesia include:

• congenital malformations;
• endocrine disorders;
• diseases of the digestive system;
• susceptibility to stress;
• sexual disorders;
• food allergy;
• overweight.

Source: online.org

The main cause of intestinal dyskinesia is acute or chronic stress. Risk factors: genetic predisposition, acute infections gastrointestinal tract, neurotic temperament, increased anxiety.

Forms of dyskinesia

Esophageal dyskinesia can be primary and secondary, as well as hypomotor and hypermotor.

Depending on the type of motility disorder, gastric dyskinesia is divided into hypertonic, hypotonic and atonic forms. Depending on the etiological factor pathological process may be exogenous or endogenous.

Biliary dyskinesias are divided into primary (developing against the background of violations of the neurohumoral regulation of the hepatobiliary system) and secondary (due to other diseases of the gastrointestinal tract), as well as hypokinetic (atonic) and hyperkinetic (spastic).

Depending on the change in the consistency of the feces, intestinal dyskinesias are classified into the following forms:

• with constipation (more than 25% of all defecation acts occur with constipation, less than 25% with diarrhea);
• with diarrhea (more than 25% of bowel movements occur with diarrhea, less than 25% with constipation);
• mixed (defecation with both diarrhea and constipation occurs in more than 25% of cases);
• unclassified.

With intestinal dyskinesia, the prognosis for life is also favorable, but it is possible to achieve long-term remission only in 10% of cases.

Depending on the etiological factor, intestinal dyskinesia is divided into stress-related, post-infectious, consumption-related. certain products nutrition.

Hypomotor dyskinesias of the esophagus are asymptomatic in about 20% of cases. In other cases, their main symptoms are: belching, swallowing disorder (dysphagia), a feeling of heaviness in epigastric region after eating, aspiration of the contents of the stomach into the respiratory tract, inflammatory processes in the mucous membrane of the esophagus.

Hypermotor esophageal dyskinesia is usually manifested by difficulty in swallowing, pain behind the sternum, which can radiate to the scapula, left half chest and left hand. Pain behind the sternum resembles an attack of angina pectoris, however, unlike the latter, they are not associated with physical exertion, and in some cases are stopped with a sip of water. With a pronounced spasm, the patient has a sensation of a foreign body in the esophagus, which increases with excitement and / or swallowing, accompanied by a lack of air and a burning sensation behind the sternum. An increase in motor activity and tone in hypermotor dyskinesia of the esophagus is noted not only when swallowing food, but also outside the act of swallowing.

Symptoms of esophageal dyskinesia are exacerbated by alcohol abuse, smoking, frequent stress, and eating too hot food.

With gastric dyskinesia, patients experience abdominal pain without a clear localization. Duration pain attack it can range from several minutes to several weeks. The pain can be cramping, aching, pressing.

In all forms of dyskinesia, a sparing diet is indicated, frequent fractional nutrition overeating should be avoided.

The appearance of pain is usually associated not with meals, but with emotional and psychological factors. In the presence of antiperistaltic contractions and the reflux of the contents of the stomach into the esophagus, patients complain of heartburn, sour belching. In the event of a decrease contractile activity stomach occurs belching rotten. With dyskinesia of the stomach, caused by pathologies of the central nervous system, repeated vomiting is observed, which does not bring relief. Symptoms of gastric dyskinesia usually subside at night.

Among the main symptoms of biliary dyskinesia, there are pains in the epigastrium, as well as in the right hypochondrium, which radiate to the right shoulder and shoulder blade. With hyperkinetic biliary dyskinesia, pain, as a rule, is acute, occurs during physical exertion, stress, diet errors. Patients with this form of pathology may experience sleep disturbances, headaches, excessive sweating, irritability, fatigue.

Pain in the hypokinetic form of biliary dyskinesia is usually constant and not intense, may be dull, aching, accompanied by a feeling of heaviness. Patients complain of bitterness and/or dry mouth, bad breath, belching, loss of appetite, nausea, vomiting, flatulence, constipation, or diarrhea. With dyskinesia in children, intolerance to sweet and fatty foods is noted, the use of which is accompanied by nausea and vomiting.

With intestinal dyskinesia, flatulence occurs (increases in evening time, after eating), diarrhea and constipation, feeling incomplete emptying intestines, pain in the abdomen, usually localized in the iliac region, which can be sharp or aching, dull.

The first signs of intestinal dyskinesia may appear already in childhood, but more often occur after 15 years.

The pain intensifies after eating, subsides after defecation and gas discharge. There is an admixture of mucus in the stools. With constipation, semi-liquid stools come out behind dense stools. Patients with intestinal dyskinesia complain of persistent headaches, a feeling of lack of air, dissatisfaction with inspiration, tremor.

Source: myshared.ru

Diagnostics

Diagnosis of dyskinesias is based on data obtained during the collection of complaints and anamnesis, objective examination, as well as instrumental and laboratory research, the volume of which depends on the existing clinical manifestations.

If esophageal dyskinesia is suspected, esophagoscopy, esophagomanometry, daily intraesophageal pH monitoring, and esophageal radiography are indicated. To detect complications or concomitant diseases conduct a stool test for occult blood.

When diagnosing gastric dyskinesia, first of all, organic pathology should be excluded. Gastric motility disorders can be detected by electrogastrography. With the aim of differential diagnosis fluoroscopy of the stomach, esophagogastroduodenoscopy with a mandatory biopsy is performed.

Source: gastroscan.ru

To diagnose biliary dyskinesia, duodenal sounding, radiography, ultrasound, and, if necessary, hepatobiliary scintigraphy and magnetic resonance imaging of the liver and biliary tract are prescribed.

With dyskinesia in children, radiopaque studies are carried out relatively rarely and only under strict indications.

Of the laboratory diagnostic methods, a biochemical blood test is used (in particular, the determination of the concentration of cholesterol, high, low and very low density lipoproteins) .. Biliary dyskinesia is differentiated from inflammatory diseases gallbladder and biliary tract, neoplasms, cholelithiasis. Intestinal dyskinesia must be differentiated from infectious diseases organs of the digestive tract, neoplasms of the intestine, endocrine disorders, urogenital pathology.

Treatment of dyskinesia

In the treatment of esophageal dyskinesia, antispasmodic and sedatives. With inefficiency conservative therapy and the development of complications may require surgical treatment.

Treatment of gastric dyskinesia is also carried out using sedatives, and in case of violations secretory function stomach is shown replacement therapy(enzymes are prescribed). Physiotherapy is effective: electrophoresis, ozokeritotherapy, paraffin therapy, mud applications.

Correction of biliary dyskinesia begins with the establishment and elimination of the cause of its development. Drug therapy consists in the appointment of choleretic, enzyme preparations, neurotropic drugs. Physiotherapeutic procedures are used: electrophoresis, microwave therapy, paraffin and ozokerite applications, massage.

Biliary dyskinesia is one of the most common disorders of the hepatobiliary system, more often develops in women aged 20–40 years with an asthenic body type.

Therapy for intestinal dyskinesia depends on the form. With the predominance of constipation, laxatives are prescribed, in the case of a predominance in clinical picture diarrhea - antidiarrheal drugs. With a mixed form of intestinal dyskinesia, anticholinergic and antispasmodic drugs. In some cases, work with a psychologist or psychiatrist, taking antipsychotics or antidepressants is required.

In all forms of dyskinesia, a sparing diet is indicated, frequent fractional meals are recommended, and overeating should be avoided.

According to the World Health Organization, diseases of the gastrointestinal tract are among the most common. And biliary dyskinesia in this list is in the first lines. Despite this, few people think about how much this disease affects the general condition of the body and where it comes from. But forewarned is forearmed.

What is dyskinesia

According to the omnipresent statistics, dyskinesia is very common - it accounts for almost 70% of all diseases of the bile ducts. Both adults and children suffer from this scourge. But still, among women, biliary dyskinesia is much more common than among men.

By and large, the term dyskinesia refers to a violation of the motility of any organ. AT this case the contractile functions of the gallbladder and ducts are disrupted and the work of the sphincter of Oddi is disrupted.

The sphincter of Oddi regulates the flow of bile into the intestines. It is believed that dysmotility of the ducts occurs due to the fact that at some point the sphincter, gallbladder ducts begin to work inconsistently. The strength of the contractions becomes either too strong or too small. And, accordingly, bile enters the intestine either in excess or in insufficient quantities. From here - various problems and symptoms of dyskinesia.

Sphincter biopsy in 60% of cases shows that there is inflammation, fibrosis or muscle hypertrophy in the sphincter area - excessive development of muscle tissue. But in 40% there are no special changes, but there are simply motor disorders. We offer an economical vacation in the Crimea on the Black Sea coast!

Causes

Today, this disease has been studied far and wide. And yet, much remains unclear. The reasons that lead to its development, on the one hand, are known. But on the other hand, not all of these factors lead to the development of dyskinesia. So, it was revealed that dyskinesia can be primary or secondary. Moreover, in an independent form, primary dyskinesia occurs much less frequently - only in 1 case out of 10.

Primary disorders are caused by a wide range of factors. Very often in this case, dyskinesia can develop with systematic malnutrition. If fatty, spicy, fried foods are your favorite dishes, then dyskinesia may not be long in coming. Especially if at the same time food is consumed irregularly during the day and long hunger strikes are replaced by plentiful meals in the evening. Also, vegetovascular dystonia (neurocircular dystonia) can lead to the development of dyskinesia. But there are other points of view here as well. A number of researchers, on the contrary, believe that it is not vegetovascular dystonia that causes biliary dyskinesia, but, on the contrary, dyskinesia and gastroduodenitis cause the development of symptoms that are attributed to vegetative dystonia. And medical measures from dyskinesia lead to the fact that the signs of migraine and VVD disappear, which we already wrote about on our website.

Many researchers agree that the trigger that triggers the process of violation of the outflow of bile is various neurotic reactions. Neurosis, stress, constant anxiety very quickly lead to the fact that the motor functions of the ducts are disturbed. Due to constant internal stress proper contraction of the ducts is blocked and dyskinesia develops. In a word, as always, all diseases are from nerves. Tibetan medicine and claim that dyskinesia affects people who often become angry.

Secondary dysfunctions may be the result of hormonal disorders, various systemic diseases, hepatitis and cirrhosis of the liver, diabetes, gallstones and so on. Atopic dermatitis, food allergies can provoke the development of dyskinesias.

Biliary dyskinesia may well be the result of hormonal imbalance and endocrine disorders. Diabetes mellitus, thyrotoxicosis, violations of the production of sex hormones may well lead to dyskinesia. Few people know about this.

And almost never take into account the connections between chronic diseases ear, throat, nose and dyskinesia. In the meantime, it also exists.

It's interesting that wrong image life has a very strong meaning. Addiction to semi-finished products, freeze-dried food and all kinds of canned food often leads to a violation of the flow of bile. If we add physical inactivity and sitting for hours at the computer, then there is little doubt that sooner or later the doctor will diagnose biliary dyskinesia. Especially if there is a predisposition to this - and doctors do not discount the hereditary factor.

Much less often, the cause of dyskinesia is objective reasons- anomalies in the development of the gallbladder and biliary tract.

Dyskinesia can be hyperkinetic and hypokinetic. With a hyperkinetic form of bile, too much enters the intestine. This happens because the tone of the gallbladder increases, and it begins to contract too much and quickly. The sphincter does not open enough, which provokes pain. Most often, young people suffer from this form. Here, stress and neurosis can be a key factor in the development of the disease.

But the hypokinetic form is more common in people of age. In this case, the gallbladder does not contract sufficiently intensively.

Symptoms of dyskinesia

As already mentioned, there are two forms of biliary dyskinesia. And since each of them is caused by completely different causes, the symptoms of different forms of dyskinesia are completely different.

Of course, pain is the main symptom. But the pain in both cases will be completely different. Hyperkinetic dyskinesia is characterized by paroxysmal pain in the form of biliary colic. It can come on suddenly and not last very long. In this case, pain can be given under the shoulder blade, collarbone, back with right side. And, as a rule, they occur after eating or at night. The disease may be accompanied by bradycardia, spastic constipation.

With hypokinetic dyskinesia, pain in the right side cannot be called acute - it has the character of a dull, bursting one. With this form, causeless nausea, a feeling of heaviness in the stomach are often noted. Pain can last for a long time, for months, subsiding after eating and choleretic drugs.

In general, seizures are characteristic of the course of the disease. The pain comes and goes.

What indicates a problem

Not only pain in the right side can say that it's time to see a gastroenterologist. There are many more signs by which one can suspect biliary dyskinesia.

If a breakdown bad dream and appetite without any visible reasons become frequent guests, and in the morning an unpleasant bitter taste is felt in the mouth, then it's time to check the bile ducts. Other warning signs include unstable stools - again, for no reason, constipation is replaced by diarrhea.

Almost certainly none of the men will connect the decrease in sexual desire with the work of the bile ducts. And few women will think that irregular menstrual cycle something to do with dyskinesia. Meanwhile, this is also one of the signs of the presence of dyskinesia.

How to find

You can identify the problem by symptoms. But to be sure of the diagnosis, it is necessary to carry out complete diagnostics. First of all, the doctor will prescribe a biochemical blood test, which will detect if the level of liver enzymes is elevated. It will be necessary to do an ultrasound of the liver and gallbladder, which will help assess the condition of the ducts. Their expansion over 2 mm indicates an existing pathological process.

The doctor may additionally prescribe duodenal sounding and tests using special preparations. At the same time, special medicinal substances are introduced that increase the production of bile. Changes are recorded on ultrasound.

In order for the treatment to be effective, it is necessary to establish exactly what form it is - hyperkinetic or hypokinetic. Each form is treated differently.

Treatment

With any form of dyskinesia, the main thing is to follow a certain diet and the principles of proper nutrition. You will have to forget about fasting and all kinds of weight loss diets. And it's time to start treating diseases of the gastrointestinal tract - and others like it.

In the hyperkinetic form, it is important to observe fractional meals with meals 4-5 times a day, limiting fatty and meat foods that cause gallbladder contractions. Any carbonated drinks, cakes and pastries, beer and chips should disappear from the table along with fried cutlets. And change to pureed and boiled dishes, fruits and berries. Treatment consists in taking antispasmodics such as no-shpa and choleretic drugs, herbs corn stigmas, rose hips, peppermint. Highly a good remedy Tubage is considered - washing the biliary tract.

In the hypokinetic form, you need to switch to products that have choleretic properties, - sour cream, soft-boiled eggs, creamy and vegetable oil, cream, black bread. Such products stimulate the activity of the biliary tract. Aloe extract, eleutherococcus, ginseng and herbal extracts have the same properties. choleretic fees- immortelle flowers, yarrow, mint leaves, coriander fruits, parsley, dandelion, common yarrow, calamus, barberry. In this case, tubage with Karlovy Vary salt, magnesium sulfate or sorbitol works well.

Hydrotherapy, laser, acupuncture, spa treatment are widely used for the treatment of dyskinesia.

In any case, the last meal for dyskinesia should be right before bedtime. In this case, the bile ducts are regularly released, and stagnation of bile does not occur. So you can safely forget about the assurances of glossy magazines that you can’t eat after six.

In particular serious cases a sphincterotomy (sphincter incision) is performed. After that, the pain usually stops and you can forget about the disease.

How not to reach such a life

Prevention of dyskinesia is simple - do not be nervous over trifles, do not eat when you have to, and do not lean on fatty cutlets and fast food.

Biliary dyskinesia is a common disease. But often this disease is called any disease, accompanied by pain in the right hypochondrium. And this is fraught with the fact that you can not notice the development of a serious disease. Therefore, it is necessary to take the diagnosis and treatment seriously.

The bile produced in the liver enters the duodenum through ducts called the bile ducts. When the functioning of these ducts is disturbed, they speak of biliary dyskinesia. Almost 15% of patients who have any pathologies in the work of the gallbladder suffer from this particular disease.

Causes of biliary dyskinesia

Depending on the cause, primary and secondary form diseases.

The following factors can contribute to the occurrence of a primary dysmotility of the bile ducts:

• , depression and other mental disorders;
• malnutrition and violation of its regimen (poor chewing, eating dry food, constant consumption of fatty foods and fast food, overeating, etc.);
• sedentary lifestyle (including in the elderly and bedridden patients);
• diseases, often congenital, accompanied by a decrease in muscle tone.

Secondary disorders of the functions of the bile ducts can occur for the following reasons:

• diseases of the liver and the gallbladder itself (,);
• chronic diseases organs of the digestive system (, etc.);
• intestinal infections ( typhoid fever, yersiniosis, brucellosis, cholera, etc.) and;
• hormonal disorders in the body;
• congenital anatomical disorders in the structure of the gallbladder and bile ducts.

Disease types

There are three types of this disease:

• hypertensive - more common in young age and is associated with an increase in the contractile function of the gallbladder and its ducts;
• hypotonic - usually diagnosed in patients over 40 years of age, occurs as a result of a decrease in the motility of the organs of the gastrointestinal tract;
• mixed - in different time there are symptoms of both types of dyskinesia, their signs, although very similar, still have differences.

Symptoms of biliary dyskinesia

Pain. At hypotonic dyskinesia stupid It's a dull pain in the right hypochondrium is present almost constantly, subsides at night, increases after eating. With hypertensive disease pain syndrome quite intense, gives in right hand and shoulder blade, occurs as a result of eating fatty foods, physical activity, stressful situation lasts up to half an hour. And between attacks, patients may complain of heaviness and slight discomfort in the left hypochondrium, the general state of health is quite satisfactory.

A bitter taste in the mouth and a white or yellowish coating on the tongue. These symptoms are more characteristic of the hypotonic type of dyskinesia, but may also be present in hypertensive. Bitterness is more often felt after sleep, some time after a normal meal or physical activity, and may be present all the time.

Nausea and vomiting. This symptom is necessarily provoked by something, most often it appears when abundant reception fatty foods, overeating, or eating too fast. With biliary dyskinesia, vomiting undigested food with an admixture of bitter bile occurs at the peak of pain.

Chair disorders. With dyskinesia of the bile ducts, the flow of bile into the intestine is disrupted. With a hypotonic type of disorder, a lack of bile leads to a deterioration in intestinal motility, digestion of fats, as a result of which the passage of food bolus on digestive tract, arise and over-education gases in the intestines. With a hypertensive type of dyskinesia, bile in the intestine may be sufficient, but it can be thrown out both during meals and into an empty intestine. As a result, peristalsis increases, water absorption slows down and occurs. Often this happens after an attack.

. With any type of biliary dyskinesia, digestion is disturbed, the absorption of nutrients worsens, and fat metabolism is especially affected. In addition, with a lack of bile, appetite decreases. With a long course of the disease, patients begin to slowly lose weight.

Treatment of biliary dyskinesia

If the disease is secondary, then first of all it is necessary to treat the disease that led to a disruption in the functioning of the gallbladder and ducts through which bile flows. Symptoms of dyskinesia may resolve on their own with proper treatment underlying pathology.

The causes of primary biliary dyskinesia are also corrected. If the violations are of a psycho-emotional nature, then a psychotherapist's consultation and the appointment, and if necessary, antidepressants and tranquilizers, may be required.

Diet

For any type of dyskinesia, treatment must begin with a diet, usually the diet corresponds to table No. 5 according to Pevzner. Any fried, fatty, smoked, salty, sour food is excluded, whole milk, alcohol, as well as any other products that stimulate digestive processes. With hypertensive type of dyskinesia

and additionally excluded fresh fruit.

During the period of exacerbation, especially in the early days, it is better to cook food in a double boiler, grind it additionally, eat 5-6 times a day in small portions of 200-300 g. After the symptoms disappear, stick to strict diet a few more months to come.

During the period of remission with biliary dyskinesia, the diet becomes less strict, but it is still not worth abusing fatty and fried foods.

For any diseases of the liver and gallbladder, it is recommended to adhere to the diet constantly.

Drugs for biliary dyskinesia

The appointment of drug therapy should be done by a doctor. If the diet for any type of disease is not fundamentally different, then drug therapy with hyper- and hypotonic type of dyskinesia has significant differences.

Antispasmodics are prescribed only for the hypertensive form of the disease. They are necessary to reduce the tone of the biliary tract and relax the sphincters that prevent the outflow of bile. The most commonly prescribed drugs active substance which is drotaverine. Papaverine can also be used in the treatment of this disease; in its effect, it is several times inferior to drotaverine and is prescribed for mild attacks.

Cholagogue widely used for biliary dyskinesia, but if the patient has concomitant cholelithiasis, they are contraindicated. These drugs increase the amount of bile discharge, increase the tone of the gallbladder, and reduce the tone of the ducts and sphincters that occur along the path of bile to the intestines. It is better to entrust the choice of the drug to the doctor, since the group of drugs is very large, and they contain different active ingredients.

For example, the drug Gepabene, containing extracts of milk thistle and fumes, is prescribed for hypertensive dyskinesia, and Hofitol, the main active ingredient of which is field artichoke extract, is more often recommended for hypotonic type of disease. Both drugs belong to the group of choleretic, but differently affect the body.

The autonomic nervous system has a direct impact on the regulation of motility of the gallbladder and biliary tract, therefore, complex therapy includes agents that tonic or relax it.

In hypertensive dyskinesia are prescribed sedatives plant origin (infusion of valerian, motherwort, Persen, etc.), as well as drugs that inhibit the processes of excitation in the central nervous system (for example, ankylosing spondylitis). Hypotonic type of disease requires an appointment means tonic the autonomic nervous system(ginseng, eleutherococcus, Schisandra chinensis, etc.).

Mineral water

Treatment with mineral waters is carried out only during remission. For diseases of the liver and biliary tract, sulfate and bicarbonate-sodium waters are used (Smirnovskaya, Slavyanovskaya, Izhevskaya, Essentuki No. 4 and No. 17, Borjomi, etc.). Before starting such treatment, it is necessary to carefully study the composition and properties of mineral waters, since they all affect the digestive system as a whole, and as unwanted effect you can get diarrhea.

Physiotherapy

At increased tone bile ducts, electrophoresis with papaverine or platyfillin, paraffin baths, magnetotherapy, coniferous baths are prescribed.
In the hypotonic form of dyskinesia, electrophoresis with pilocarpine, diadynamic therapy and pulsed magnetotherapy are recommended.

Surgical treatment for biliary dyskinesia is not indicated.

Which doctor to contact

Treatment of biliary dyskinesia is done by a gastroenterologist. Additionally, you may need to consult a psychotherapist, surgeon, nutritionist, infectious disease specialist. The examination includes ultrasound of the hepatobiliary zone, duodenal sounding, sometimes cholecystography and cholangiography are necessary.