What happens in the duodenum
The duodenum takes food from the stomach, mixes it with bile and pancreatic juice and moves it further. This requires coordinated cuts and free passage. If motility is impaired or there is an obstruction, the contents are retained, the pressure in the intestine increases, and some of the contents are pushed back through the pylorus. Bile acids dissolve the protective mucous barrier of the stomach, the mucous membrane becomes inflamed - reflux gastritis is formed. If the cast rises higher, the esophagus is also damaged.
- Retention of contents in the duodenum
- Pressure increase and backflow
- Destruction of the protective layer of the gastric mucosa
- Chemical reflux gastritis
- Damage to the esophagus due to high casting
Reasons
Functional disorders are more common: intestinal motility weakens in chronic diseases of the digestive organs, after infections, in diabetes mellitus and neurological diseases. Mechanical causes include adhesions after surgery, scar narrowing, tumors and congenital features of the location of the intestine. Separately, there is superior mesenteric artery syndrome, when the intestine is compressed between the aorta and the artery; it develops with sudden weight loss and thinning of the fat layer. Removal of the gallbladder and gastric surgery also contribute to reflux.
- Motility disorders in chronic digestive diseases
- Adhesions after abdominal surgery
- Scar narrowings and tumors
- Superior mesenteric artery syndrome with sudden weight loss
- Condition after gallbladder removal
- Surgeries on the stomach and pylorus
- Diabetes mellitus and neurological diseases
Symptoms
The most typical symptoms are bitterness in the mouth, especially in the morning, and belching with a bitter or yellowish taste. I am concerned about nausea, heaviness and distension in the upper abdomen after eating, and sometimes vomiting mixed with bile, which brings relief. A burning sensation behind the sternum with this type of reflux often does not decrease with drugs that reduce acidity - this is an important clue. A yellowish coating on the tongue, bad breath, bloating and unstable stool are possible.
- Bitterness in the mouth in the morning
- Belching with a bitter taste
- Nausea and vomiting with bile
- Heaviness and bloating after eating
- Burning sensation resistant to conventional heartburn medications
- Yellowish coating on the tongue, bad breath
Diagnostics
Endoscopy is a key method: the doctor sees bile in the stomach on an empty stomach, characteristic changes in the mucous membrane and takes a biopsy to confirm reflux gastritis and exclude other diseases. X-ray examination with contrast shows delayed advancement and backflow, and also helps to identify mechanical obstruction. Ultrasound evaluates the gallbladder, ducts and pancreas. Computed tomography is needed if there is a suspicion of compression of the intestine by blood vessels, adhesions or a tumor. Additionally, liver and H. pylori indicators are checked.
- Endoscopy with bile assessment and biopsy
- X-ray of the stomach and intestines with contrast
- Ultrasound of the abdominal organs
- Computed tomography for suspected compression
- Liver parameters and H. pylori test
- Motor assessment when techniques are available
Treatment
In the functional form, the main thing is diet and medications that improve motor skills. Eat 5-6 times a day in small portions, limit fatty foods, fried foods, coffee, chocolate and alcohol, do not lie down after meals and do not eat at night. The doctor may prescribe prokinetics, ursodeoxycholic acid drugs, which make bile less aggressive, bile acid binders, and enveloping drugs. Proton pump inhibitors help when combined with acid reflux. If there is a mechanical obstruction, adhesions or compression by blood vessels, surgery is discussed. The doctor selects the therapy.
- Small meals 5–6 times a day
- Limit fatty foods, fried foods, coffee, alcohol
- Do not eat 3 hours before bedtime, head of bed elevated
- Prokinetics as prescribed by a doctor
- Ursodeoxycholic acid preparations
- Bile acid binders
- Surgical treatment for mechanical causes