Chronic superficial gastritis duodeno gastric reflux. Symptoms and treatment of duodeno gastric reflux

Under the abbreviation DGR, the stomach hides chronic condition digestive tract duodenogastric reflux. It is rarely an independent pathology, being a symptom of other disorders in the gastrointestinal tract, such as gastritis and ulcers. GDR is accompanied by vomiting, abdominal pain, stool instability and other unpleasant symptoms. The pathology is diagnosed by a therapist and a gastroenterologist. In this article, you will learn about GDR of the stomach: what is it?

Duodenogastric reflux is a disorder in which the contents of the duodenum are thrown into the gastric cavity. A similar condition without a serious effect on the body is detected in 15% of patients, while they never complain about the work of the gastrointestinal tract or other discomfort.

We are talking about a violation of the functioning of the digestive tract if the level of daily acidity of the contents of the stomach rises above 5 and there is a clear cyclical nature of such an increase. As individual disease GHD is seen in only 25-30% of all diagnosed cases.

The symptomatology of the pathology intensifies after sports loads, as well as at night, when relaxation of all muscles is observed and the gastrointestinal tract is straightened. The risk group for GDR includes inactive people who have sedentary work, as well as those who consume a large amount of food, its quality does not matter this case no value.

Attention! The disease does not have a specific gender. Duodenogastric reflux is recorded equally in men and women.

Causes of duodenogastric reflux

Several factors can provoke the disease, which should be avoided if possible.

• Unhealthy food. Especially dangerous addiction to fast food, rich in fat and simple carbohydrates.
• An unbalanced diet in which the patient consumes large portions of food at a time.
• Long breaks between meals.
• Lack of physical activity or a large number of them immediately after eating.

• Sleep after eating. At the same time, even a simple horizontal position within the first 30 minutes after leaving the table. At this time, it is better to take a leisurely walk or sit.
• The development of chronic, transferred operations on the digestive tract.
• Often DGR is provoked under the influence of duodenitis and gastroduodenitis.
• Insufficient tone of food sphincters, due to which the contents of the intestine are thrown back into the stomach cavity.
• Diagnosis of a hernia in the diaphragmatic region.
• Use alcoholic beverages, including beer. At risk are chronic alcoholics, as well as those who have abused in large quantities before.
• The use of any medicines without medical supervision. Pregnant women are at risk, as they have weakness of the digestive tract due to the growing fetus pressing on the digestive tract.
• Smoking. Most often, GHD affects patients who smoke a cigarette immediately after eating or more than 10-15 per day.

Attention! If before diagnosis duodenogastric reflux the patients had no other chronic diseases of the gastrointestinal tract, the likelihood of their occurrence in the future is high. They develop due to the constant impact on the walls of the stomach of pancreatic enzymes, bile and its salts. Most often, patients experience ulcers and reflux gastritis because of this.

Symptoms of duodenogastric reflux

The symptomatology of the disease is blurred, as it is similar to signs of other pathologies of the digestive tract. But after diagnostic manipulations, the doctor will be able to make an accurate diagnosis. Characteristic features DGR are as follows:

• heartburn, it occurs in almost 90% of cases immediately after eating or in the first two hours after that;
• periodic occurrence of eructations with large quantity air, after it there may be a taste of acid;
• frequent bloating and flatulence, appear in the first hour after eating;
• sharp and spasmodic pain in the abdomen;
• periodically in oral cavity there is a taste of bitterness;
• sometimes patients complain of bouts of nausea, which can turn into vomiting with a splash of bile;
• there is a large amount of yellow coating on the tongue.

Depending on which area of ​​the tongue is plaque, one can judge problems with a certain internal organ

Attention! Duodenogastric reflux should be suspected if the symptoms described above appear at night and after physical labor. In other cases, the disease can be diagnosed only after it goes into the stage of exacerbation and the use of a large amount of medication is required.

Stages of DGR of the stomach

Experts distinguish three stages of the development of the disease.

Types of duodenogastric reflux

Given the damage to the gastric mucosa, four types of duodenogastric reflux are distinguished:

• with superficial GDR, only not most of mucous, glandular epithelium is not touched by alkali;
• with catarrhal DGR is noted inflammatory process mucous with severe swelling and redness;
• at erosive GDR atrophy of a small or extensive area of ​​the stomach lining is noted;
• with biliary DGR, not only severe inflammation mucous walls of the stomach, but there is also a failure in the flow of bile into the 12 duodenal process of the intestine.

Attention! It is possible to determine the exact type of duodenogastric reflux only after passing instrumental examination methods. This is not possible with a normal survey.

Diagnosis of duodenogastric reflux

In addition to the full-time examination of the patient and the collection of anamnesis after the survey, the doctor may refer the patient to a functional examination.

Tables 1. Types of functionalsurveys

Treatment options for GHD

Diet for DGR of the stomach

The success of therapy depends on how the patient adheres to the rules of nutrition for duodenogastric reflux. You need to eat often and in small portions, ideally the size of one serving should not be much larger than your palm. Spicy, salty, fatty and smoked foods should be completely abandoned. The same rule applies to alcoholic beverages and cigarettes.

Harmful to patients suffering from GHD, foods such as garlic seasoning, tomatoes, green onion, sweet desserts, rich pastries and bread, strong coffee and tea, citrus fruit. They have a negative effect on the sphincter that connects the stomach and duodenum 12. It becomes weak, due to which the intestinal contents enter the stomach.

Useful mineral water rich in magnesium. It is enough to drink 100-200 ml of such water daily, including after the exacerbation stage has been removed. Be sure to include bran in the diet, they are added to soups, salads, eaten with yogurt.

Useful fish and meat with a low fat content. They can be baked and cooked in soups. It is required to include cottage cheese products, kefir, low-fat milk and sour cream in the menu. You should not eat sour berries and fruits, sour juices or those with a high sugar content are also harmful. Packaged juice-containing products are completely excluded.

Conventional therapy for gastric GHD

Medicines are used to relieve irritation from the gastric mucosa and direct the work of the gastrointestinal tract into right direction, that is, to strengthen the tone of the sphincter and prevent the intestinal contents from being thrown into the gastric cavity.

The drug allows you to get rid of heartburn, a feeling of fullness in the stomach, flatulence and bloating. For treatment, it is required to take 10-20 mg up to four times a day. Tablets are taken 20 minutes before meals.

The duration of treatment depends on the condition of the patient. Do not take Motilium with severe and moderate liver damage.

Preparation for complex impact, is administered in the form of chewable tablets. It can relieve pain, irritation of the mucous membrane, heartburn, and improve stool. Passazhik is taken no later than 10 minutes before a meal.

A single dose cannot exceed 20 mg, 80 mg can be taken per day active substance. The duration of treatment is determined taking into account the patient's history.

Tablets are aimed at restoring the natural acidity of the stomach and eliminating the consequences of malnutrition and the use of alcoholic beverages. Protects mucous from erosive lesions. Tablets must be chewed thoroughly in the mouth and washed down with plenty of water.

Single dose - no more than two tablets 30 minutes before meals. You can take 6 doses of Gastrofarm per day.

The drug restores normal acidity stomach, relieves heartburn and relieves pain. Omeprazole is taken daily at a dose of 40-80 mg, it is recommended to do this in morning time on empty stomach.

The duration of treatment is 21 days. According to the same scheme, Omez and Omitox are taken.

Almagel

An enveloping medication that protects the mucosa from further erosive destruction. Included with the drug is a spoon for dosing the active substance. Adult patients are required to take 1-3 parts of Almagel no more than four times in 24 hours.

A maximum of 16 doses can be drunk per day. At the maximum dosage, therapy lasts no more than 14 days, in other cases, its duration is determined by the doctor.

A complex preparation allows you to get rid of heartburn and abdominal pain. Gastal normalizes the microflora of the stomach and relieves acute symptoms. It is necessary to take the medication 1-2 tablets 45-60 minutes after the meal.

Three doses of Gastal are carried out per day. Treatment is continued for no more than 14 days.

Tablets relieve pain, most often caused by spasm smooth muscle. Taking into account the degree of pain, the patient can take 1-2 tablets of Spasmalgon.

Do not take more than 6 doses of the drug per day. Since the medication is quite strong, you should not drink it for more than five days.

The drug improves the work of the pancreas, and also protects the stomach from negative impact organ enzymes.

A single dose of Somilase is no more than two tablets, taken 45-60 minutes after a meal. The duration of therapy is selected separately for each patient.

This drug does not harmful acids bile to destroy the epithelium of the stomach, healing erosion and relieving pain.

With duodenogastric reflux, it is required to take 300 mg of Choludexan one hour before going to bed. The minimum duration of therapy is 10 days, the maximum is six months.

No-Shpa

This is an anesthetic drug that helps with pain of any type, and not just spasms. It is recommended to take No-Shpu in a single dose of 40-80 mg of the drug, but not more than 0.24 g per day.

For best effectiveness, the reception should be postponed to a time after a meal or an hour before it. The duration of treatment is 1-7 days.

Home treatment for duodenogastric reflux

Home treatment can be used as aid. Also unconventional recipes allow for therapy after the use of traditional drugs in order to consolidate the result.

To prepare a medicinal product, herbs such as St. John's wort, chamomile, yarrow. It is recommended to grind them beforehand in order to get more useful substances during steaming. A teaspoon of raw materials is poured into 250 ml of boiling water and wait 15 minutes. As soon as the infusion has become a pleasant temperature for drinking, it should be drunk.

Drink herbal tea in the morning and evening for two weeks. It allows you to eliminate heartburn, prevent the development of dysbacteriosis, relieve abdominal pain.

Flax seeds

For cooking, one tablespoon of seeds is taken and 100 ml of cold water is poured. Flax should be kept in liquid until it secretes mucus. It is necessary to eat seeds without straining a tablespoon daily in the morning before breakfast.

The course of treatment is 7 days. Flaxseed mucus coats the walls of the stomach, protecting against the harmful effects of alkali thrown from the intestines.

For the treatment of DGR, you need to take two tablespoons of smoky infusion and combine it with 0.5 liters of boiling water. The tool is required to infuse for six hours. Store the solution in the refrigerator. Treatment involves taking 50 ml of infusion every two hours. The course of treatment is not more than three days. Used to prevent vomiting with bile impurities. As soon as nausea and vomiting go away, treatment is stopped.

According to the same scheme, you can take marshmallow rhizomes. An infusion of fumes and the second ingredient can be bought at any pharmacy.

It is used in fresh immediately after eating. To avoid heartburn, abdominal pain, vomiting, diarrhea, and other unpleasant symptoms, it is recommended to slowly chew 1-2 leaves 10 minutes after eating.

Treatment can be continued for two weeks.

Sage and calamus rhizomes

To prepare the medicine, mix 50 g of crushed sage and calamus rhizomes. To enhance their effect, 25 g of angelica root can also be added to the mixture. After thoroughly mixing the ingredients, one teaspoon of the substance is poured into 250 ml of boiling water. Infuse the remedy should be within an hour.

Take 30 minutes after meals, 50-100 ml three times a day. The duration of therapy is 10 days.

Prevention of DGR of the stomach

To reduce the risk of recurrence in the future after an exacerbation of duodenogastric reflux and to prevent its occurrence in healthy people, the following guidelines must be observed:

• eat small meals every 3-4 hours;
• prioritize healthy food the minimum amount fast food, fatty and fried foods;
• avoid physical activity for the first 1-2 hours after eating;
• prevent exacerbation of chronic gastrointestinal diseases, especially ulcers and gastritis;
• try not to eat before going to bed;
• maintain optimal body weight and engage in feasible sports loads;
• refuse fresh bread, it is better to eat a product made 1-2 days ago, bread or crackers.

Attention! All described preventive methods required for people with chronic pathologies GIT. This will avoid their complications and reduce the risk of duodenogastric reflux in the future.

DGR of the stomach requires the patient to constantly adhere to the diet. If exacerbation could not be avoided, without fail held symptomatic therapy, which includes several drugs. Treatment requires constant medical supervision and strict adherence to the prescribed regimen, which is developed individually for each patient.

Video - Duodenogastric reflux of the stomach

Duodenogastric reflux (DGR) is a syndrome associated with diseases of the digestive system such as gastritis, peptic ulcer stomach, duodenitis. It manifests itself by throwing bile located in the duodenum into the stomach cavity.

As such, DGR has been found in about 50% of people. And only in 30% of cases is independent disease, and 15% of healthy people are not aware of its presence at all, since it is asymptomatic. In this case, duodenogastric reflux is not considered a disease.

Causes of DGR

Duodenogastric reflux occurs when duodenal patency is disturbed, as a result of which an increase in pressure occurs in the duodenum, and a weakening of the closing function of the pylorus occurs. The causes of this disease can be:

• smoking;
• dysbacteriosis and inflammation localized in the pancreas or gallbladder;
• loss of tone of the esophageal muscles that separate the stomach from the duodenum;
• hernia of the diaphragm;
• pregnancy;
• taking reducing muscle tone smooth muscle preparations of the esophagus.

With a long course of GHD, the gastric mucosa is damaged by pancreatic enzymes, bile acids, lysolecithin, and bile salts. This leads to the appearance of gastric ulcer, reflux gastritis, gastroesophageal reflux disease.

Symptoms of the disease

The symptoms of GHD are similar to other diseases of the digestive system, due to their interdependence. But this similarity is only superficial. The main symptoms of this disease are few:

• heartburn that occurs after eating;
• belching with ordinary air or with a taste of sourness;
• bloating after eating, a feeling of fullness;
• cramps and spasmodic pain that appear after eating epigastric region;
• a bitter taste is felt in the mouth;
• feeling of nausea followed by possible vomiting bile;
• coating of the tongue with a yellow coating.

Often, when performing fibrogastroduodenoscopy (FGDS) to diagnose a third-party disease, the doctor can detect duodenogastric reflux in a patient. At the same time, the disease does not manifest itself in everyday life. In such cases, it is periodically activated during sleep or during certain physical activities. Wherein negative impact does not affect the patient's digestive system.

Diagnosis of the disease

For a qualified specialist, the diagnosis of this disease is not difficult, since the symptoms of the disease are very specific. If duodenogastric reflux is suspected, the patient is referred for such studies:

• fibrogastroduodenoscopy (FGDS);
• study of the acidity of the cardia of the stomach, the lower third of the esophagus, as well as the body of the stomach - daily pH-metry;
• Ultrasound of the abdominal organs;
• electrogastroenterography;
• radiography of the stomach, as well as the duodenum using a contrast agent.

A comprehensive study of acidity for a doctor is the most informative, as it allows you to accurately recognize the symptoms of GHD in a patient and the severity of the syndrome. For greater reliability, monitoring is carried out at night. This eliminates the effect on the acidity index of the medications and food taken. If the pH of the stomach rises to 3 units or more, then we can talk about the presence of GHD in a patient.

Conducting electrogastroenterography allows you to obtain information about the contractile function of the duodenum and stomach. But fibrogastroduodenoscopy is currently being used less frequently, since such a study can provoke duodenogastric reflux.

Treatment of the disease

The direction of the treatment of the disease is the organization of the proper functioning of the motility of the stomach, duodenum and the normalization of the binding of bile acids. To improve motor skills, the patient is usually prescribed "Trimedat". The action of the contents of the duodenum on the gastric mucosa is neutralized with Nexium and Omez preparations. For better assimilation food and activating its promotion along small intestine the doctor prescribes Domperidone or Cerucal. And to eliminate heartburn - "Almagel", "Phosphalugel" or "Gaviscon".

Important for successful treatment proper diet. It is also necessary to change the diet: eat often, but in small portions; limit the consumption of "rough" food; exclude alcohol and smoking. Long leisurely walks in the open air are useful.

The diet for GHD is based on:

• exclusion from the diet of spicy, fried, salty and fatty foods;
• deletion from the diet of foods that reduce the tone of the pyloric sphincter: garlic, tomatoes, onions, chocolate, fresh bread, coffee, citrus fruits, etc .;
• avoiding the use of cabbage and apples, as they contribute to an increase in the acidity of gastric juice;
• drink rich in magnesium mineral water;
• the use of bran.

The diet for complication of GHD is somewhat different:

• it is allowed to eat low-fat fish and meat;
• you can use cottage cheese, yogurt, milk and non-sour sour cream;
• the intake of sour berries with fruits is contraindicated;
• do not eat acidic foods and juices;
• porridge should be well rubbed, and the soup should be crushed to a puree state.

Traditional medicine for DGR

Treatment of DGR with folk remedies often gives the same positive effect as well as medication. In addition, the frequency of manifestations side effects when it is carried out - much lower. The most famous folk remedies for the treatment of this disease are the following:

• brew St. John's wort, chamomile and yarrow, taken in any proportion, with boiling water and add to tea. You need to drink a decoction 2 times a day. It will relieve heartburn, relieve the symptoms of gastritis, minimize duodenogastric reflux, eliminate dysbacteriosis;
• 1 st. l. flaxseed is poured 100 ml cool water, infused until the seeds secrete mucus. Consume - on an empty stomach;
• 2 tbsp. l. dymyanka herbs in 500 ml of boiling water. Set aside for an hour, take 50 ml every 2 hours. Infusion of 2 tbsp. l. marshmallow roots per 500 ml of water, infused for 5-6 hours, taken in small portions throughout the day. Using these folk remedies, you can prevent bilious vomiting;
• effective folk remedies for the establishment of intestinal motility are rue leaves. They need to be chewed after eating 1-2 sheets;
• mix 50 g of sage and calamus root with 25 g of angelica root; 1 tsp mix pour 1 tbsp. boiling water, stand for 20 minutes. Drink 1 hour after eating 3 times a day.

Treatment of duodenogastric reflux is important to start on early stages. The benefits of folk remedies therapy are undeniable, but it would be better to consult a doctor. This will determine the successful and speedy outcome of the disease. Folk remedies can successfully carry out the prevention of the disease. And the right diet will ease the course of the disease.

Duodenogastric reflux (DGR) is a pathological process during which there is a return of bile (regurgitation) from duodenum into the cavity of the stomach.

DGR of the stomach can be a symptom of any disease of the digestive tract or act as an independent pathology. Not always the transition of bile contents into the cavity of the stomach is accompanied by discomfort.

About a quarter of the entire population is not even aware that they have such a problem.

In people who do not suffer from diseases of the digestive tract, a partial reflux of contents into the stomach cavity may also be observed.

In this case, the occurrence of this phenomenon is associated with a late meal at night or the impossibility of the pyloric sphincter (the place where the stomach passes into the intestines) to relax as much as possible.

Given pathological condition manifested by 2 main syndromes: dyspeptic and pain. About what it is, what are the causes and the main aspects of treatment, will be described below.

Causes of duodenogastric reflux

Duodenal reflux can cause a number of reasons. It becomes a consequence of such diseases of the digestive tract as:

• peptic ulcer of the stomach and intestines (duodenal) in the stage of chronicity;
• stomach cancer;
• postcholecystectomy syndrome (people who have undergone surgery to remove the gallbladder);
• resection or suturing ulcerative lesion stomach;
• operations performed on the biliary tract;
• duodenostasis - a violation of the motor activity of the duodenum up to its complete cessation;
• dysfunction of the sphincter of Oddi;
• uncontrolled intake of choleretic drugs and;
• gaping pylorus of organic or physiological origin.

Causing factors for the development of the disease

There are a number of reasons that are not an independent etiological factor, but only create favorable conditions for the development of bile reflux. These include:

• state of pregnancy;
• sharp and;
• diaphragmatic hernia (especially esophageal opening);
• (both acute and chronic);
• irrational nutrition;
• obesity;
• endoscopic examination of the gastrointestinal tract (rarely);
• improper laying of the food tube in the fetus during embryogenesis.

Symptoms of duodenogastric reflux

Duodeno-gastric reflux is manifested by 2 syndromes:

• painful, including: diffuse, without a clear localization of pain in the epigastric region (in the upper abdomen). They have a spastic (paroxysmal) character. Associated with food intake: occur 30-40 minutes after eating. Character pain syndrome it is individual for each person, mostly the patient is disturbed by pains of average and high intensity;
• dyspeptic, which consists of:
  • eructations of sharp sour contents or empty air;
  • heartburn, the appearance of which does not depend on the general acidity of gastric juice;
  • regurgitation of undigested food or acidic stomach juice;
  • feelings of bitterness in the mouth;
  • vomiting, in which, as the disease progresses, in addition to food boluses bile contents appear;
  • change in the nature of the stool according to the type of diarrhea;

Classification

During such a pathology as duodeno gastric reflux of bile, it is customary to distinguish 3 main degrees:

1. 1 degree- characterized by a small amount pathological changes from the side of the stomach due to slight regurgitation of the bile contents of the duodenum;
2. 2 degree- the amount of thrown bile increases significantly, which provokes the development of inflammatory processes in the mucous layer of the stomach - the appearance and progression of gastritis;
3. 3 degree- has a bright clinical symptoms: frequent urges on vomiting, belching, heaviness in the epigastric region, sharp bad smell from the mouth, diarrhea - all signs of gastritis.

Depending on how deep the inflammation caused by bile contents penetrates into the walls of the organ, duodenal reflux can be divided into the following types:

• surface- the most common and most dangerous view. It is characterized by damage to cellular structures only at the level of the gastric mucosa;
• catarrhal- the mucosa is affected deeper than in the first type, with FGDS, signs of damage are clearly visible: swelling, hyperemia, inflammatory infiltrates;
• erosive- there are deep lesions - erosion;
• biliary- occurs .

Diagnostics

It is possible to diagnose DGR of the stomach only on the basis of laboratory and instrumental methods of examining the patient. It is not possible to make a final diagnosis after collecting anamnesis due to the extensive differential diagnostic search and a large number of diseases of the digestive tract that have similar symptoms.

The diagnostic algorithm includes such studies as:

• intragastric pH-metry (round-the-clock) - this method allows you to fix even minimal changes in acidity that are not related to food intake;
• esophagogastroduodenoscopy (EFGDS) - allows not only to see signs of bile reflux into the stomach, but also to assess the degree and nature (benign or malignant) of damage to its membrane at the histological and cytological levels;
• chemical analysis of gastric juice - duodenal reflux can be diagnosed based on the presence of bile or pancreatic enzymes in gastric juice, identified by titration;
• Ultrasound of the abdominal organs;
• electrogastrography - allows you to graphically record the electrical potentials that occur in the gastric wall. Next, assess the motor activity of the stomach. Evaluation of the data is highly indirect;
• antroduodenal manometry - evaluates intragastric pressure in dynamics;
• survey radiography, examination of the stomach using contrast.

What can a doctor note during a physical examination of a patient with duodenal reflux:

• soreness of the abdomen in the epigastric region with deep palpation;
• hyperesthesia of the skin hypersensitivity) at superficial palpation. This phenomenon is not always present;
• rumbling of the intestine, as well as pathologically increased noises of its peristalsis, which are noted during regurgitation.

Treatment of duodenogastric reflux

Depending on the root cause of the disease, the degree of its severity and the rate of progression, the doctor prescribes a rational scheme for influencing the pathological process and the etiological factor.

Treatment can be either medical (conservative) when applied various medicines, and surgical (radical), when the patient needs surgery.

Treatment with folk remedies can complement traditional methods impact on the disease.

Medication (drugs)

Medical treatment is aimed not only at eliminating clinical symptoms diseases, but also to get rid of the root cause, which provoked the development of GDR of the stomach.

At the core pharmacological effects The disease is based on the use of such groups of drugs as:

• bile acid neutralizers (Choludexan, Ovenson);
• prokinetics, mostly selective (Domperidone, Motilium, Passagix) - help to improve the movement of food to the lower lying sections and reduce the risk of reverse reflux;
• proton pump inhibitors (Pantap, Omeprazole):
• means with an enveloping effect (Phosphalugel, Almagel) - are used in the presence of erosive damage.

Only a doctor can determine which drugs and in what dosages will be prescribed to a particular patient.

Surgery

Surgical treatment is used when conservative methods effects do not have the desired result or are ineffective due to the characteristics of the disease. So, when the gatekeeper gapes, it is applied Plastic surgery, the purpose of which is its plastic reduction.

With the help of laparoscopic equipment, the anterior part of the pylorus is, as it were, placed deep into the duodenal bulb, thus forming a functionally active prepyloric pocket. This pocket takes over the contractile and peristaltic function of the damaged pylorus.

Complementary and Alternative Treatments at Home

Treatment with folk remedies can only be used as additional therapy to traditional methods.

Define set medicinal herbs and plants for a particular patient can only be a qualified specialist.

For the treatment of gastroduodenal reflux, traditional medicines such as:

• dandelion syrup. To prepare it, it is necessary to fill a three-liter container with dandelion flowers so tightly that the plants secrete juice. Sprinkle well with sugar. Use syrup for 1 tbsp. spoon before meals several times a day;
• celery root juice, which is consumed in 1 tbsp. spoon before meals (half an hour);
• flax decoction. 1 st. spoon flax seeds pour 100 ml of cold water and let them swell. Drain cold water and pour boiling water over it, strain and take before meals;
• herbal decoction of motherwort, lemon balm, licorice root, flax seeds and chamomile. Mix the crushed ingredients in equal proportions (2 tablespoons each). 2 tbsp. spoons of the mixture pour 500 ml of boiling water and put on water bath for 10 minutes. Allow the broth to cool and take chilled 100 ml 4 times a day;
• vegetable decoction. It is necessary to mix chamomile flowers, wormwood and myta in proportions of 1 part: 2: 2, respectively. Pour the resulting crushed mixture with 1 liter of boiling water and let it brew for at least 2 hours. Strain well and consume liquid part before meals in the amount of 100 ml.

Nutrition for duodenogastric reflux

Comprehensive treatment of a disease such as gastroduodenal reflux includes a special treatment menu.

The diet is based on following a few simple rules:

• eating in small portions with intervals between meals not exceeding 3 hours;
• inclusion in the diet of boiled dishes, all kinds of dairy products, low-fat varieties meat and fish, as well as products with high content vegetable fiber;
• complete exclusion of smoked meats, pickles;
• refusal of coffee, alcohol and carbonated sugary drinks;
• exclusion of fresh fruits and berries during periods clinical exacerbations diseases of the digestive tract.

With and with a duodenal ulcer, mineral water may be present in the drinking diet. But its choice must be approached very carefully, because for the treatment of diseases of the digestive tract with increased and low acidity different waters with excellent electrolyte composition are used.

Prevention

Prevention of the disease is based primarily on the rational and treatment of chronic diseases of the digestive tract.

Taking medications only on the recommendation of a doctor in appropriate dosages and prescribed courses, the lack of self-medication is also one of the preventive measures to prevent reflux.

Prognosis for patients

In general, the disease has a benign course and a favorable prognosis if it is diagnosed at an early stage of development and undergoes rational therapy.

Running cases lead to the development of more formidable complications which greatly impair the quality of human life. These include:, toxic-chemical gastritis C, adenocarcinoma, etc.

Related videos

Duodeno gastric reflux is manifested by throwing alkaline contents from the 12th duodenum into the acidic environment of the stomach, which causes an imbalance in the gastric environment. Pathology mostly does not have severe symptoms, occurs in most cases during sleep, as a result of a late dinner or relaxation of the pyloric sphincter at night, sometimes during physical activity.

Experts consider the condition to be a pathology if the acidity of gastric juice, determined during daily pH-metry, is more than 5, which indicates a shift alkaline environment not related to food intake. The disease accompanies chronic diseases digestive system (gastritis and peptic ulcers). Pathology is quite common, often manifests itself as a sign of other diseases of the gastrointestinal tract, rarely considered as an independent pathology with a separate nosology.

The danger of the disease is that almost all varieties can develop against its background. gastric pathology: ulcerative, inflammatory, tumor. Pathology can develop after surgery on the gastrointestinal tract, mainly after removal of the gallbladder, suturing of the 12th duodenal ulcer, surgical treatment of the pancreas, surgery associated with the bile ducts.

According to statistics, gastroduodenal reflux is found in more than 15% of the world's population. With DGR, the contents of the duodenum are thrown into the stomach cavity. Each section of the digestive tract is separated by sphincters (pylorus). The function of the sphincters is to open only in one direction; in the normal state, the reverse process is impossible. Such a mechanism should also separate the stomach from the intestines. Reflux duodenitis is a process when the contents of the intestine are thrown into the cavity of the stomach, as a result of dysfunction of the sphincter. The disease appears due to inflammation of the duodenal mucosa, as well as as a result of anatomical changes in the pylorus itself.

The merging of two different environments (intestinal contents are alkaline, stomach contents are acidic) causes conflict. Isolated cases are not dangerous for the body, however, when the disease is aggravated by improper diet, physical inactivity, overeating and eating fast foods, the pathological condition can recur regularly and lead to inflammation of the gastric mucosa. The condition is accompanied by a change in the level of acidity in the stomach, which complicates the process of digestion and negatively affects the mucous membrane.

Causes of duodeno gastric reflux are conventionally divided into external and internal. Human behavior, his diet, the pace of life are related to external factors. GHD often occurs as a result of physical inactivity, malnutrition, smoking and regular alcohol consumption, medication during pregnancy, and other circumstances, resulting in damage to the tissue structures of the stomach, despite the mucous barrier that protects them. Such conditions include decreased muscle tone in the openings of the stomach, diaphragmatic hernia, high blood pressure 12 - duodenal ulcer, cholecystitis, pancreatitis and Botkin's disease.

Pathology also develops as a result of:

1. Incomplete closure of the pylorus on the border 12 - rings of the intestine and stomach;
2. Chronic form of duodenitis;
3. Increased pressure in the cavity of the duodenum;
4. Chronic or prolonged gastritis.

Specialists identify functional and anatomical reasons appearance of DGR. Functional include disorders that are directly related to the work of the sphincter and give the appropriate symptoms. Anatomical neoplasms include neoplasms that are localized at the junction of the duodenum and the digestive organ.

What it looks like, photo

Pathological changes in the gastric mucosa in GHD depend on the type of pathology. With a superficial form of duodeno-gastric reflux, destruction of the mucosa can be observed, without damage to the glandular exocrine epithelium. When detected catarrhal appearance pathology, an inflammatory process is observed, in the photo you can see swelling and redness of the mucosa.

The erosive appearance is expressed by the initial processes of atrophy, the mucous membrane atrophies in places. With biliary duodeno-gastric reflux, there is an inferior transmission the right amount bile in department 12 - duodenum.

Symptoms

Duodeno gastric reflux is quite difficult to detect, since the symptoms of the disease are similar to various diseases digestive system. Characteristic of DGR are sharp and intense pains in the epigastric zone during the process of digestion. The patient complains of constant heartburn, flatulence. appears on the surface of the tongue yellow coating. When bile acids enter from the 12-rings of the intestine through the stomach into the esophagus, belching and bitterness appear in the oral cavity. Girdle and hunger pains, nausea are possible.

When a patient's diet includes a large amount of carbohydrates, GHD is manifested by halitosis. The condition is caused by the penetration of bile into the stomach from 12 - the rings of the intestine through the pylorus.

When the disease manifests such indirect symptoms as dry hair, brittle nails, pale skin.

Stages and types

With the typology of the course of destructive processes, 4 types of reflux are distinguished:

1. superficial, only the cells of the mucous membrane are affected;
2. catarrhal, accompanied by an inflammatory process;
3. erosive, foci of atrophy form on the mucosa;
4. biliary, when the outflow of bile from the gallbladder at 12 - the duodenum is disturbed.

There are 3 degrees of development of duodeno gastric reflux:

1. The first degree GDR is a moderate process. This phase is characterized by the casting of a small amount of the contents of the duodenum. Irritation of the gastric mucosa manifests itself in an unexpressed way. About 50% of people may experience this problem.
2. The second degree is characterized by the casting of a large amount of alkaline medium. At this stage, the development of an inflammatory process is often observed, which leads to new diseases of the gastrointestinal tract. This degree of disease occurs in 10% of people.
3. The third degree is a pronounced process, which is accompanied by pain, nausea, vomiting. There is an unpleasant smell from the mouth, the patient complains of heaviness in the stomach. Examination by a specialist gives the opportunity to fix a bright clinical picture development of pathology.

The danger of duodeno gastric reflux is that the disease can cause ulcers on the gastric mucosa. This happens as a result of mixing bile and pancreatic juice, which form an aggressive environment, destroying the mucosa.

Launched duodeno gastric reflux can lead to serious consequences (gastric ulcer, digestive system disorders).

ICD code 10

According to ICD 10, diseases of the digestive system are listed under the code K 00 - K 93. Duodenitis gastric reflux, according to the generally accepted classification medical diagnoses, developed by the World Health Organization, is defined under the code K 29.

Treatment

Treatment for GHD starts after accurate diagnosis. The doctor initially probes the patient's abdomen. Palpation of different parts of the abdomen helps to find out the cause of the pain syndrome and determine the focus of inflammation of the digestive tract. Special attention is given to the epigastric zone, which is located below the sternum and just above the navel. In the inflammatory process caused by reflux, the patient feels pain in this particular area.

For a more accurate diagnosis, an instrumental study is prescribed:

1. FGDS. During the examination, a probe equipped with video equipment is used. In the course of the study, the symptoms of the disease are revealed, the degree of pathology is specified.
2. Radiography. Allows you to identify inflammation and changes in the size of the digestive organs, as well as to determine the reflux of food mass from the duodenum into the stomach, narrowing or expansion of the intestine, and the presence of edema of the esophagus.
3. Manometry. It is used to obtain data on the motility of organs.
4. Ultrasound of the abdominal organs. Helps to find out the nature and sources of failure of the stomach, gallbladder, pancreas or duodenum.
5. Biopsy. During the examination, a tissue scraping sample is taken to determine the presence of malignant neoplasms in the organs.

Laboratory tests are also important:

1. pH - metric. Gives the opportunity to determine the level of secretion. The procedure is carried out using a rubber probe, which is used to take gastric juice for analysis.
2. Blood analysis. Helps identify elevated ESR and anemia.
3. Fecal analysis. It is necessary to clarify possible internal hemorrhages that indicate ulcers or erosion.

Treatment of reflux - duodenitis involves complex therapy, which is aimed at eliminating one or more causes that provoke pathology. Apply certain groups of drugs:

• painkillers;
• enveloping;
• proton pump inhibitors;
• antacites;
• cholinomimetics;
• prokinetics, which help to normalize the movement of food in a progressive manner and provide a tone to the circular muscle muscles of the digestive tract.

In some cases, drugs are prescribed to improve bowel movements.

Duodeno gastric reflux of bile

This pathology is expressed by spontaneous reflux of liver secretions into the stomach. In most cases, the disease accompanies other pathologies of the gastrointestinal tract (duodenitis, ulcers, gastritis). Basically, the disease is asymptomatic, some doctors do not attribute it to pathologies. Usually the reverse flow of bile occurs at night, when a person is lying.

DGR of bile can occur after ulcer surgery, cholecystectomy. The problem can be provoked as a result of chronic duodenitis, weakening of the sphincter of the bile duct, with an increase in pressure in the duodenum. Pathologies of the gastrointestinal tract, in particular problems with the gallbladder, hernia of the diaphragm, chronic inflammatory pathologies digestive system, defective work of the muscles that separate the intestines from the stomach. The cause of the development of DGR of bile can be bad habits, dysbacteriosis, prolonged use of drugs that help weaken the smooth muscles of the digestive system, pregnancy. Treatment of DGR of bile is carried out in accordance with the cause that provokes the disease.

The disease proceeds with certain symptoms: after eating, a spasm appears in the epigastric zone, appetite decreases. The patient feels a feeling of fullness in the stomach after eating, even if he had a bite, there is a yellow coating on the tongue, bitterness is felt in the mouth. Disturbed by heartburn, nausea, belching with air or acid. Skin become pale, if an inflammatory process occurs in the stomach, an increase in body temperature is possible.

There are three degrees of development of DGR of bile:

• initial phase. A small amount of bile enters the stomach. Signs of the disease are either absent or unexpressed.
• Second phase. It is expressed by the reflux of a significant amount of liver secretion, as a result of which the walls of the stomach become inflamed.
• Third phase. Symptoms are pronounced. There is pain in the epigastric zone and a violation of the digestion of food.

There are types of bile GDR depending on the degree of damage to the mucous membrane:

• Surface. The integrity of the mucous membrane is broken.
• catarrhal. The entire mucous membrane of the stomach is affected. Puffiness is observed, the inflammatory process begins. May be a consequence of prolonged use of certain drugs or allergies to certain products.
• Erosive. It is characterized by the appearance of ulcers or erosion on the mucous membrane. Can fade in the background mental disorders, excessive drinking.
• Biliary. It manifests itself as a result of pathological changes in the process of excretion of bile.

Bile reflux can occur without clear symptoms and is often found during examination of other gastroenterological diseases. For diagnosis, similar studies are carried out as with DGR. Studies of the contents of the stomach are carried out in order to identify traces of bile.

Treatment for DGR of bile is complex. Therapy is based on the treatment of underlying pathologies that provoke the reflux of bile into the stomach cavity. Apply drugs that contribute to the normalization of the digestive tract. It is important to follow a special diet, normalize weight and get rid of bad habits(smoking, drinking alcohol).

The treatment course includes drugs that help normalize peristalsis in the upper zones of the digestive system (Trimedat), drugs that neutralize the negative effect of bile on the walls of the stomach (capsules Omez, Rabeprazole).

Prescribe prokinetics that stimulate the motor activity of the stomach, which helps to move food to the intestines (Tserukal tablets, Domperidone), medications that reduce the acidity of gastric juice (Maalox tablets and Almagel syrup).

As additional funds take enzymatic preparations that promote the digestion process (Festal, Creon).

The complex treatment of bile DGR also includes physiotherapy procedures that allow you to normalize blood flow. internal organs and eliminate changes in the stomach.

Medicines for treatment

Conservative therapy includes:

1. Reception of anthracites, which are used to eliminate heartburn, belching and bad taste in the mouth. Assign Smecta, Almagel, Gevikson, Phosphalugel.
2. Prokinetics. Regulate and strengthen the motility of the stomach, accelerating its emptying. These drugs include Cerucal, Domperidone, Raglan, Motilium.
3. Antisecretory drugs. They suppress the formation of hydrochloric acid, and activate the restoration of damaged mucosa. Assign Famotidine, Ranitidine, Omeprazole.
4. Enzyme agents are prescribed for the combination of GDR with diseases of the pancreas. These drugs include Creon, Festal.
5. Stimulants of gastric secretion and agents that improve blood circulation in the walls of the stomach. Apply Pentagastrin, Eufillin, Trental.
6. Ursodeoxycholic acid, which neutralizes toxic bile acids. In order to neutralize the effect of the contents of the duodenum on the walls of the stomach, Nexium, Omez are used.

Folk remedies

Used to treat GHD folk recipes. Ways alternative medicine are also recommended by doctors. However, before using infusions and decoctions, it is necessary to be examined by a specialist and consult with him.

Celery root juice is considered one of the simplest, but effective means for the treatment of GHD. Take 1 tbsp. l. before meals, three times a day.

Dandelion flower syrup

Requires 300 g of dandelion flowers and 0.5 kg of sugar (can be replaced with fructose). Plant flowers fill a jar (3 l), extracting juice. Sprinkle sugar in layers. Use daily (once a day) for prevention. If the patient has a confirmed diagnosis of GHD, the number of doses can be increased to 2 to 4 times a day. Similarly, you can prepare a medicinal syrup from fresh chamomile flowers.

Medical collection

1 part of chamomile flowers, 2 parts of wormwood and mint are mixed, pour 1 liter of boiling water. The composition is infused for 2 hours. Take 100 ml three times a day, before meals.

Flaxseed oil (seeds)

Flax seed oil has an enveloping property. It should be drunk before meals for 1 tsp. At home, you can cook from flax seeds healing composition. 1 st. l. flaxseeds pour 200 ml of boiling water, after the seeds begin to secrete mucus, the infusion is considered ready for use. Take on an empty stomach, before breakfast.

herbal collection

Requires 1 tbsp. l. dry herb St. John's wort, sage, chamomile flowers. The collection is poured into 250 ml of boiling water, insisted for 2 hours, taken three times a day.

Drink to normalize intestinal motility

Take 1 tbsp. l. dry herb plantain, buckthorn. The collection is poured with 250 ml of boiling water, insisted for an hour, taken 3 times a day.

• Rue leaves. The leaves of the plant are used fresh. After each meal, you need to chew a few leaves.
• Aloe. Before each meal, drink 1 tsp. freshly squeezed juice from the leaves of the plant.
• Infusion from the herb fumes. 2st. l. dried herbs pour 0.5 liters of boiling water. The resulting composition is insisted for an hour. Ready infusion is taken in 50 ml every 2 hours.

Prevention

In the treatment, as well as to prevent the development of GHD, it is important to follow a special diet. It is necessary to observe the diet, especially with a predisposition to the development of pathology. You need to eat 5 times a day, in small portions. Overeating and fasting should be avoided. The first causes excessive production of bile by the liver. Starvation can cause stagnation of the secret in the bladder.

You need to keep your weight under control. Excess body weight can cause an increase in pressure inside the stomach, followed by the release of acid into the esophagus. Fat starts to press and gallbladder, causing the reflux of liver secretions.

An active lifestyle helps to speed up the metabolic process and provide internal organs with oxygen, which positively affects the condition of the stomach and the alimentary tract as a whole.

It is necessary to give up bad habits. After eating, it is not allowed to take a horizontal position or go to bed for an hour.

In the presence of pathology of the digestive tract, it is important to maintain them in a state of remission, avoiding exacerbations. It is necessary to regularly be examined by a doctor, which will help to identify the disease at an early stage and avoid possible complications.

Possible Complications

DGR pretty — serious illness, the neglect of which can lead to certain complications:

• type C gastritis, as a result of which the gastric mucosa is affected under the influence of chemicals.
• stomach ulcer. The tissues of the digestive organ are affected.
• adenocarcinoma. Is malignant neoplasm esophagus.
• gastroesophageal reflux. It is characterized by the reflux of the contents of the stomach into the esophagus.

Diet

You need to cook dishes for a couple, after which the resulting mass must be crushed with a blender to obtain mashed potatoes.

It is necessary to take crushed food, in small portions, every 4 hours. Portions should be balanced, that is, each serving should contain proteins, fats, carbohydrates, which helps to reduce the load on the digestive tract. Rough food should be completely abandoned. In order to reduce the acidity of the stomach, it is necessary to abandon acidic foods and dishes (citrus fruits, cabbage, tomatoes, garlic, apples, plums).

Do not use beverages containing caffeine, chocolate, bakery products, especially warm bread.

Smoked, fried, salty products should be excluded from the diet, canned foods should be abandoned.

Duodenitis gastric reflux can be completely cured at an early stage. proper nutrition, active image life, regular examination by a specialist will help prevent the development of pathology, and in the presence of GHD, avoid its exacerbation.

Often the cause of gastritis is the development of various diseases in the digestive system. One of these pathologies is duodeno-gastric reflux (DGR). Some mistakenly call it duodeno-gastric gastritis, but this is not so. The syndrome is often an independent pathology and usually develops against the background of various diseases: ulcers, duodenitis, including gastritis.

DGR is the reflux of the contents of the duodenum into the stomach cavity. Even operations on the abdominal organs and long-term use antibiotics. But the most common cause is called a violation of the diet and frequent use fatty, spicy food, alcohol.

Chronic and atrophic gastritis as a complication of duodeno-gastric reflux

With a long absence necessary treatment duodeno-gastric reflux complications arise in the form of chronic gastritis. This is a relapsing disease characterized by the action of bile on the surface of the stomach, which leads to various pathologies up to the development of cancer. Outwardly, the disease is almost asymptomatic, in contrast to the acute condition.

A chronic disorder is classified according to the degree of damage into the following types:

1. Type A - atrophic.
2. Type B - antral.
3. Type C - reflux gastritis.

Atrophic gastritis occurs as a result of duodeno-gastric reflux and is the most insidious type of all listed. main reason- in that it causes a precancerous condition of the stomach in patients. It occurs most often in the elderly and is asymptomatic in the early stages.

As a result of reflux, the surface of the mucosa is damaged. The cells of the walls of the stomach atrophy and cannot function normally. As a result, they do not produce components of gastric juice. So, they reproduce ordinary mucus, and not the necessary components. The disorder proceeds against the background of a low level of acidity. However, gastritis in the presence of duodeno-gastric reflux is less asymptomatic: it can be frequent pain in the abdomen, belching sour taste and nausea.

In this case, you should immediately consult a doctor so that he necessary diagnostics and made the correct diagnosis. With this type of chronic gastritis, it is absolutely impossible to self-medicate.

The doctor will prescribe medications and a strict diet, which excludes "heavy" food: canned food, marinades, spices, "soda".

Duodeno-gastric reflux as a symptom of antral superficial and erosive gastritis

Duodeno-gastric reflux appears as a symptom antral gastritis, and the causative agent is a bacterium Helicobacter pylori. Develops with malnutrition, alcohol abuse and smoking.

Gastritis is localized in the outlet section of the stomach - antrum. Here are the glandular cells that secrete bicarbonate to process food. Inflammation causes blockage of these components and raises the pH level. As a result, acidic contents enter the duodenum and provoke the appearance of ulcers. Diagnose using EFGDS and pH-metry.

Classified according to features clinical course. Allocate superficial gastritis, the striking symptoms of which are duodeno-gastric reflux and heartburn. This is inflammation on the top layer of the mucosa without ulceration or scarring. In this type of disease, bacteria block the production of mucus, and gastric juices damage the stomach. upper layer antrum walls.

The hyperplastic type has no bright symptoms, but vomiting occurs in the advanced stage, and. With such a pathology, the mucous tissues grow and form polyps, the walls of the stomach thicken significantly. The disease can be diagnosed by gastroscopy and biopsy.

Another type of antral gastritis is erosive, and duodeno-gastric reflux is its specific feature which aggravates the course of the disease. Due to the fact that the contents of the intestine are thrown into the stomach, large areas of the epithelium are affected. Such inflammation affects the deep layers of the walls of the antrum, resulting in ulcers and erosion. Due to significant hemorrhage, the patient's feces are often black. Diagnosis is by gastroscopy and targeted biopsy. This disease is difficult to treat.

The third type of chronic disease is reflux gastritis. A feature of this type is that reflux is no longer a symptom, but the cause of the disease. Depending on the dominant pathologies, gastritis is distinguished:

1. Surface.
2. Billiary.
3. Erosive.

With superficial gastritis with duodeno-gastric reflux, the contents of the intestine return to the stomach with bile. Those create unfavourable conditions, which irritate the surface of the stomach and cause swelling. Degeneration of the surface epithelium and impaired tissue regeneration are characteristic. At the same time, there is no damage to the glands that are responsible for the production of bicarbonates.

Treatment of duodeno-gastric reflux gastritis of superficial and erosive type

Treatment of duodeno-gastric reflux gastritis of the superficial type is carried out in a complex. For this, drugs are prescribed that protect the mucous membrane from damage (for example, Almagel, Phosphalugel). They are added to those that convert the components of bile into water-soluble forms (Ursofalk, Ursosan, etc.) and, finally, they use drugs that prevent the backflow of intestinal contents into the stomach (Ondansetron, Motilium, etc.) .).

When biliary disorder is observed nervous system and endocrine glands. Vivid symptoms are heaviness in the stomach, nausea and constipation, "jamming" in the corners of the lips. With the biliary type, a person may lose weight due to a deterioration in the digestibility of food.

Duodeno-gastric reflux gastritis of erosive type in chronic form affects the mucous membrane very deeply and causes irreversible processes. The tissue structure is damaged so severely that there is constant bleeding. As a symptom - black feces. With this type, not only the antrum is affected, but most of the stomach. Treatment of the disease is extremely difficult. Except medications, you must adhere to a strict diet prescribed by your doctor.

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