Inflammation of the duodenum, or duodenitis, is rare in isolation - in most cases, this disease is combined with other diseases of the gastrointestinal tract (gastritis, ...). This pathology is diagnosed in people of different age groups, and affects both men and women equally.
Classification
According to the generally accepted classification, duodenitis occurs:
- by etiology – acute and chronic; acute, in turn, is divided into catarrhal, ulcerative and phlegmonous, and chronic is divided into primary (an independent disease) and secondary (a disease accompanying another pathology of the digestive tract);
- by localization of foci - local, diffuse, bulbar, postbulbar;
- according to the level of structural changes - superficial (affects only the superficial layer of the mucous membrane), interstitial (the inflammatory process spreads to the deeper layers of the intestine) and atrophic (thinning of areas of the mucosa, absence of glands in the affected areas);
- according to the endoscopy picture - erythematous, erosive, hemorrhagic, atrophic, hypertrophic, nodular;
- special forms of duodenitis - fungal, immunodeficiency, tuberculosis, Crohn's disease...
Etiology of duodenitis
Alcohol abuse quite often leads to duodenitis.The most common causes of acute duodenitis are:
- food poisoning;
- excessive consumption of spicy foods and alcoholic beverages;
- mechanical damage to the intestinal mucosa by a foreign body.
Chronic duodenitis is often the result of irrational and irregular nutrition.
Factors provoking the onset of the disease are the presence of the Helicobacter pylori bacterium in the stomach cavity and duodenostasis (impaired movement of food through the duodenum). In addition to the above factors, the development of duodenitis is promoted by:
- ascariasis;
- giardiasis;
- foci of chronic infection in the oral cavity, in the genital area.
Pathogenesis
Acute and primary duodenitis occur as a result of damage to the mucous membrane of the duodenum by gastric contents of high acidity. If the number of protective factors in the duodenum is reduced, hyperacid juices have an irritating effect on the intestinal mucosa, causing inflammation in it.
Secondary duodenitis is a consequence of duodenostasis: the contents of the stomach, falling into the duodenum, remain in it for a longer period than necessary, which means it irritates the mucous membrane for a longer time, which leads to inflammation.
Symptoms of inflammation of the duodenum
Acute duodenitis is characterized by patient complaints of:
- severe pain in the epigastric region 1.5–2 hours after eating, night pain;
- nausea and vomiting;
- general weakness.
The symptoms of chronic duodenitis are more smoothed out and vary greatly in different forms of the disease. Patients are usually concerned about:
- constant aching, dull pain in the epigastric region;
- feeling of fullness, heaviness in the upper abdomen after eating;
- and belching;
- nausea, in some cases – vomiting;
- decreased appetite;
- general weakness, irritability, headaches and other so-called general symptoms.
With duodenostasis, pain in the epigastrium or in the right hypochondrium is pronounced, twisting, bursting, and paroxysmal in nature; Patients also complain of rumbling in the stomach, a feeling of bloating, bitterness in the mouth and vomiting bile.
If duodenitis is combined with duodenal ulcer, the symptoms of the above disease come to the fore, namely, intense pain in the epigastric region on an empty stomach.
In cases where duodenitis is combined with another intestinal disease, it is manifested primarily by intestinal symptoms (pain along the intestines, bloating, frequent loose stools).
If the disease lasts for a long time, the mucous membrane of the duodenum atrophies and the synthesis of enzymes that contribute to normal digestion is disrupted. As a result, profound disorders arise not only in the gastrointestinal tract, but also in many other systems of our body, including the central and autonomic nervous systems.
Diagnosis of duodenitis
The patient's complaints, medical history and objective examination will help the doctor suspect duodenitis. On palpation, you will notice varying degrees of pain in the epigastric area. To clarify the diagnosis of duodenitis and differentiate it from other gastrointestinal pathologies, the patient may be prescribed:
- EGDS (esophagogastroduodenoscopy) – examination of the upper part of the digestive organs through a probe; may be performed with or without biopsy;
- Ultrasound of the abdominal organs;
- study of gastric juice (determination of its acidity and composition);
- X-ray of the stomach and duodenum;
- coprogram;
- biochemical blood test (liver tests, amylase and other indicators).
Duodenitis: treatment
The food of a patient with duodenitis should be mechanically and thermally gentle, and it is recommended to prepare it by steaming, boiling or baking. The main point in the treatment of duodenitis is diet.
- Food should be as thermally, chemically and mechanically gentle as possible; therefore, sour, spicy, fried, cold and hot foods, as well as alcohol, canned food and smoked foods are completely excluded for 10–12 days.
- Grinded food prepared by boiling or steaming should form the basis of the diet, and it should be taken in small portions 5-6 times during the day.
- Recommended for consumption: day-old wheat bread, porridge cooked in water or milk (rice, buckwheat, semolina, rolled oats), small pasta, cereal puddings or casseroles, lean meats and fish, soft-boiled eggs or in the form of a steam omelet no more than 2 in day, fermented milk products, whole milk, dry biscuit, vegetables (potatoes, beets, broccoli, cauliflower, zucchini, carrots).
- Excluded from the diet: legumes, millet, barley, large pasta, fresh bread, muffins, pancakes, fried or hard-boiled eggs, fatty dairy products, salty or sharp cheeses, overcooked butter, fatty meat and fish, sweets, carbonated and strong drinks .
The diet must be followed throughout life, but during the acute period of the disease it should be as strict as possible, and as the signs of exacerbation fade, the patient should gradually expand the diet (of course, within the limits of what is permitted).
The phlegmonous form of acute duodenitis is an indication for surgical treatment followed by antibiotic therapy.
Diseases of the stomach and duodenum (DPC) are the most common pathologies of the digestive tract. Many people suffer from duodenitis. Its treatment is a rather pressing problem. Indeed, due to its anatomical location, it leads to disruption of the pancreas and gallbladder, as well as their ducts. The whole body suffers from this.
What is duodenitis
Duodenitis is an inflammation that occurs in the initial part of the mucous membrane of the small intestine. An isolated process of only the duodenal bulb is bulbitis. If the stomach is also affected - gastroduodenitis.
The ducts of the pancreas and gallbladder open in the duodenum. Enzymes, bile and juices of the small intestine contribute to the further breakdown of food. They ensure the absorption of nutrients and the movement of the food bolus through the gastrointestinal tract.
The duodenum functions constantly and very intensively. That is why any violations can negatively affect its work and lead to inflammation - duodenitis.
The pathological process in the duodenum leads to reactive inflammation:
- pancreas (pancreatitis);
- gallbladder (cholecystitis);
- bile ducts (cholecystocholangitis).
How to cure a disease - video
Classification of duodenitis
There are two forms of inflammation of the duodenum:
- Spicy. This pathology is manifested by pain in the upper abdomen (epigastric region), nausea, and weakness. The patient experiences acute discomfort when palpating (feeling) the abdomen. Vomiting may occur, and most often repeatedly. As the purulent process develops, signs of peritoneal irritation appear, weakness and nausea increase. An acute process can be:
- catarrhal (superficial lesion);
- erosive-ulcerative;
- phlegmonous (purulent).
- Chronic. Clinically, this form is manifested by dull, constant pain in the epigastrium, nausea, decreased appetite, and vomiting if the diet is not followed. Patients complain of a feeling of fullness in the upper abdomen, especially after eating.
Chronic duodenitis is divided into:
With an increase in the number and size of the duodenal glands, they speak of hyperplastic duodenitis.
Treatment
A gastroenterologist deals with the treatment of diseases of the gastrointestinal tract, including inflammation of the duodenum. If there are indications for surgical intervention, the pathology is treated by a surgeon.
Inpatient treatment is indicated in the following cases of duodenitis:
- severe pain syndrome;
- complications such as bleeding, perforation (perforation of the integrity of the intestinal wall), acute pancreatitis, peritonitis;
- difficulties in diagnosis;
- damage throughout the intestine;
- severe concomitant gastrointestinal diseases;
- neglect of the process;
- suspicion of malignancy.
In all other cases, outpatient therapy is permitted under the supervision of a physician, in compliance with all recommendations.
Treatment lasts from 1–2 months to six months. It depends on the form and severity of duodenitis.
When treating at home, the patient is given the following recommendations:
- compliance with the principles of dietary nutrition;
- normalization of sleep and rest patterns;
- giving up bad habits (smoking, alcohol);
- avoiding emotional and physical overload;
- refusal of junk food (chips, crackers, soda, candy bars);
- providing moderate physical activity (swimming, walking).
Diet therapy
Nutritional therapy is the basis for the treatment of diseases of the gastrointestinal tract.
The main principles of the diet for inflammation of the duodenum:
- During an exacerbation, food should be thermally and chemically gentle, pureed, pureed, steamed.
- Complete exclusion of fried, salty, spicy, smoked foods.
- Pickles, marinades, and sausages are limited in consumption.
- Products containing coarse fiber (cabbage, corn, carrots, apples, radishes) are limited.
- Prohibited: onions, radishes, mustard, garlic, horseradish, spices, fatty and stringy meat, lard, mushrooms, whole milk, sharp cheeses, baked goods, puff pastry products, rye bread, strong meat broths.
- The diet is fractional (5-6 times), in small portions. The patient should not experience severe hunger.
Prohibited products - gallery
Mustard must be avoided 
Onions cause irritation to the mucous membranes 
Mushrooms are a prohibited product for duodenitis 
Baking is contraindicated for patients suffering from inflammation of the duodenum. 
Cabbage contains coarse fiber, so intake of the product is limited
Drug therapy
The choice of medications depends on the nature of the inflammatory process.
For the treatment of duodenitis use:
With an ulcer-like course:
- Agents that neutralize hydrochloric acid (antacids): Rennie, Phosphalugel, Almagel, Gastal, Gaviscon.
- Gastroprotectors. These are drugs that have an antacid, anti-Helicobacter effect and protect mucosal cells from irritation. The drug De-nol is most often used.
- Proton pump inhibitors. They reduce the secretion of gastric juice. Recommended: Nolpaza, Omeprazole, Losek, Ultop.
For Helicobacter pylori infection:
- triple therapy: Ranitidine, Clarithromycin, Metronidazole;
- quadruple therapy: Omeprazole, De-nol, Metronidazole and Tetracycline.
With cholecyst-like course:
- Agents that stimulate bile production: Allohol, Ursosan, Nikodin, Flamin, Hofitol.
- Medicines that promote the secretion of bile: Motilium, Motilak, Cholecystokinin.
- Antispasmodics that relieve pain and spasms: Duspatalin, No-shpa, Dolce.
- Enzymes, for example, Creon.
For severe pain, analgesics and antispasmodics are used:
- Atropine;
- Platyfillin;
- Analgin;
- Tramal.
For duodenitis, which is accompanied by diarrhea, medications are recommended:
- Smecta;
- Enterosgel;
- Activated carbon.
Drugs that improve intestinal motility:
- Domperidone;
- Gastrosil;
- Cerucal.
Enzyme preparations:
- Mezim;
- Festal;
- Pancreatin.
Pre- and probiotics - to normalize intestinal microflora:
- Acipol;
- Baktisubtil;
- Hilak forte;
What medications to treat the disease - gallery
Rennie neutralizes hydrochloric acid 
De-Nol protects the mucous membrane from irritation 
Nolpaza reduces the secretion of gastric juice 
Ursosan stimulates bile production 
Motilium promotes bile secretion 
No-spa eliminates spasms 
Neosmectin is used for diarrhea 
Linex normalizes microflora
Physiotherapeutic methods
Physiotherapy is prescribed to treat inflammation of the duodenum. This therapy eliminates pain, improves motility and blood supply to the mucosa.
For this use:
- Electrosleep. The nervous system is affected by low-frequency current. This event promotes the restoration of affected tissues, relieves spasms and activates metabolism.
- Galvanic collar. Impact on tissues with direct current. The procedure accelerates regeneration, reduces pain, activates blood circulation and nutrition of the affected areas.
- Pearl baths. This is a procedure that involves hydromassage. The event is called pearl baths because the water contains many small bubbles that visually resemble small pearls. Baths promote relaxation, relieve pain and spasms. They reduce inflammation and activate microcirculation.
- Amplipulse therapy. The event is based on the impact of modular sinusoidal currents on the affected area. The procedure eliminates pain, activates blood circulation, and provides improved tissue nutrition.
- Magnetic and laser therapy. The abdomen is exposed to a laser or magnetic field. The measures effectively eliminate spasms and reduce inflammation.
- Electrophoresis of antispasmodics. Thanks to the electric current, deeper penetration of painkillers into the tissue is achieved.
- Paraffin and mud applications. These are effective measures that reduce inflammation and reduce pain.
- Balneotherapy. In the treatment of inflammatory diseases of the duodenum, treatment with mineral waters is used. The following are appointed: Borjomi, Rychal - Su, Essentuki No. 4, Narzan.
With the ulcerative form of duodenitis, you need to wait until the inflammation subsides. Only during remission is it possible to prescribe physiotherapy.
For patients suffering from chronic diseases of the digestive tract, annual sanatorium-resort treatment is indicated (Zheleznovodsk, Essentuki). It is resolved after 3 months after the exacerbation.
If malignant degeneration is suspected, physiotherapy should be completely abandoned.
Surgical intervention
This treatment is indicated for:
- a long-term process that does not respond to conservative therapy;
- non-healing ulcers and erosions on the mucous membrane;
- sudden bleeding;
- acute inflammation: phlegmon and/or peritonitis;
Folk remedies
Healing recipes have been used since ancient times to treat diseases of the stomach and intestines.
For this purpose use:
- Infusion of viburnum fruits. Pour a glass of boiling water over the raw materials (1–2 tbsp.). Leave for 4 hours in a warm place. Drink the strained infusion 3-4 times a day, one glass at a time.
- Propolis solution. Dry propolis (100 g) is poured with alcohol (70%). They insist for 10 days. In this case, the container is shaken daily. The product is filtered. Drink 15 drops diluted in milk (1 tablespoon) before meals, 3 times.
- Flax seed. Pour the raw materials (2 tbsp) into a thermos with boiling water (0.5 l). Infuse and filter. Drink half a glass before meals, 3 times a day.
- Decoction of marshmallow rhizome. Place chopped marshmallow (1 tbsp) in a glass of water. Cook for 1 minute. Leave for half an hour. Strain the mixture. Take 1 tbsp. l. 3 times before meals.
- White cabbage juice. After chopping the cabbage leaves, carefully squeeze out the juice. You need to take half a glass before meals, 3 times.
- Sea buckthorn oil. The product is used 1 tbsp. l. before meals, 4 times a day.
- Honey. It is recommended to stir the bee treat (1 tsp) in a glass of warm water. You need to drink a glass 3 times a day.
- Aloe juice. This remedy is taken 1 tbsp. l. before meals, three times during the day.
- Medicinal infusion. Centaury grass and fennel seeds (50 g each) are mixed and poured with a glass of boiling water. Leave for 30 minutes. It is recommended to drink half a glass 2 times a day.
Folk remedies do not exclude, but complement drug therapy. Their appointment must be agreed with the doctor. Especially if the patient is a child. Flax seed helps treat duodenitis 
Sea buckthorn oil has a positive effect on the mucous membrane of the digestive tract 
Aloe juice is an excellent cure for duodenitis
Homeopathic medicines
Homeopathic remedies can also be used to treat gastrointestinal diseases.
For this purpose, use:
- Natrium Sulfuricum;
- Phosphoricum;
- Gepar Sulfur;
- Antimonium Crudur.
It should be noted that there is no specific cure for duodenitis. Therefore, drugs are selected individually for each patient based on symptoms.
Features of treatment for children and adults
In the treatment of duodenitis, it is necessary to take into account the patient’s age and condition:
- Children need to calculate the dosage correctly. In addition, many medications are contraindicated for treating children. Therefore, self-treatment is strictly prohibited.
- If the duodenum is affected in a pregnant woman, it should be remembered that any medications must be prescribed by a doctor. For example, Atropine can cause miscarriage, and Tetracycline can cause congenital deformities of the fetus. Therefore, during the period of bearing a child, you should not self-medicate. Taking any drug or traditional medicine must be agreed with your doctor.
Duodenitis is a common intestinal disease that occurs in both adults and children. The causes of pathological processes in the duodenum can be very different. The treatment of the disease is based on adherence to the principles of diet therapy, medication and physiotherapeutic methods of influencing the pathological focus. Only timely diagnosis and adequate treatment of duodenitis will help avoid serious complications.
The inflammatory process of the mucous membrane of the duodenum leads to the development of a chronic disease - duodenitis. Treatment of duodenitis with folk remedies often helps eliminate the disease.
Not a single digestive process is complete without the participation of the duodenum, which is anatomically a vessel or cavity with a channel for draining digestive juices and enzymes. This organ serves to digest food absorbed by microvilli, then process and distribute nutrients throughout the body.
In addition, the duodenum produces up to 30 hormones necessary to maintain normal several important systems: endocrine, cardiovascular, digestive and nervous.
Infection by viruses and bacteria leads to the development of inflammation in the duodenum, decreased functionality, atrophic changes in the walls of the cavity, and the appearance of erosive areas. As the inflammatory process develops, it begins to extend beyond the walls, affecting the muscular layer and the entire intestine as a whole.
Reasons for the development of duodenitis
The main causes of duodenitis are directly related to diet. These include eating on the go, eating dry food, in large portions or irregularly with long periods of time between meals. Often duodenitis develops as a result of eating processed foods, fast food, canned food, coffee, salty, fried and spicy foods in large quantities.
Provoking factors may be:
- constant malnutrition;
- alcohol and smoking;
- eating hot food, carbonated drinks, spicy dishes.
These are the reasons for the development of initial duodenitis with an acute course.
If measures are not taken to revise diet and lifestyle in general, the disease becomes secondary and chronic.
Symptoms of duodenitis
The disease manifests itself in different ways. The main symptom of the development of an acute inflammatory process in the colon is acute pain in the stomach, attacks of nausea and vomiting. When the disease becomes chronic, the pain becomes dull, pressing in the pit of the stomach, bursting in the upper abdomen, usually together with heartburn, vomiting after eating.
Abdominal bloating and rumbling, bitter belching and constipation are observed. With inflammation of the upper intestines, the symptoms are similar to an ulcer, when the stomach begins to hurt about 0.5 hours after eating.
If pain occurs 2 hours after eating, then an intestinal ulcer can be suspected.
If your stomach hurts on an empty stomach or at night, weakness, headache, irritability and lack of appetite are observed, this indicates the development of a local form of duodenitis.
For chronic duodenitis:
- pain in the right hypochondrium;
- the skin turns yellow due to a violation of the outflow of bile;
- there are hunger pains in the epigastric part of the stomach;
- signs of dyspepsia and intestinal disorders appear;
- Digestion is disrupted.
Symptoms and treatment for the development of inflammation in the duodenum are very similar to ulcers, gastritis, cholecystitis or pancreatitis. This often leads to difficulties in making a definitive diagnosis. A number of diagnostic procedures are carried out: x-ray of the stomach, endoscopy of the esophagus and duodenum, duodenal intubation, examination of intestinal secretions and stomach if infection with Helicobacter pylori is suspected.
The disease is more common in men, and not many people rush to see a doctor when they experience stomach pain. However, most patients are interested in how to treat duodenitis using traditional methods. This is quite possible, but it is necessary to follow a diet, adjust the diet, chew food thoroughly, and eat small portions up to 5 times a day.
Treatment with folk remedies
Treatment of duodenitis is carried out with medicinal herbs, sold in pharmacies in the form of tea bags in a wide range. Before you start taking it, you first need to consult a doctor and undergo an examination.
The following herbs are used:
- eucalyptus - suitable for eliminating existing symptoms, stimulating digestion, eliminating stomach pain;
- cardamom (seeds) - to calm the nerves and stomach;
- chamomile flowers - to relieve stomach upsets and improve blood circulation;
- ground cinnamon - to eliminate stomach pain and increase appetite;
- fennel (seeds) - to reduce pain and nausea;
- ginger root - to relax the intestines;
- kava-kava root - to improve mood, relieve stomach pain;
- lemon balm - for the treatment of duodenitis;
- sage (leaves and flowers) - for pain relief, relaxing effect;
- valerian root - to improve digestion;
- licorice root - to increase appetite;
- yarrow - to improve digestion, stimulate the production of gastric juice.
Folk recipes
In the chronic stage of duodenitis, treatment with folk remedies can be carried out with the following formulations:
- infuse fennel fruits and centaury (50 g each), take 1 tbsp. portions up to 4 times a day;
- infuse peppermint (40 g), eyebright herb (20 g) and drink 1/3 tbsp. 3-4 times a day before meals;
- Brew a collection of sage, peppermint, lavender flowers (15 g each) with boiling water, leave and drink in portions before meals;
- infuse peppermint (15 g), chamomile flowers (50 g), fennel fruits (10 g), valerian root (10 g), drink 1 tbsp. for 1 dose, if colic and heaviness in the stomach appear;
- infuse peppermint (20 g), chamomile flowers (30 g), buckthorn (30 g), anise (10 g), take 1 tbsp.;
- Infuse vodka for 7 days in a dark place with juniper (10 g), chamomile and peppermint (25 g each), take 1/2 tbsp. 2 times during the day and at night.
Doctors advise constantly drinking tea from the above herbs at home to eliminate the unpleasant symptoms of chronic duodenitis, but together with a diet and an established diet. The treatment is long-term.
You need to drink herbal teas daily for at least 2 months.
As a result, it is possible to achieve healing of ulcers and erosion, reduce the inflammatory process in the gastric mucosa, reduce the influence of irritating factors on the duodenum, and relieve symptoms of inflammation in the epigastric region of the stomach.
To relieve inflammation and eliminate unpleasant symptoms, along with diet, the following preparations provide a therapeutic effect:
- Grind licorice, buckthorn root, marshmallow root, shepherd's purse, chamomile, lavender, lemon balm flowers, cinquefoil erecta (10 g each), pour boiling water (1 tbsp.), leave. Then strain and drink 3-4 times a day in portions.
- Prepare cinquefoil tea (1 tablespoon of dry raw material, brew 0.5 liters of boiling water), infuse and drink before meals 3-4 times a day.
- Sea buckthorn oil should be taken for a healing effect. Pour sunflower oil over sea buckthorn and leave in a dark place in a sealed container for 7 days. Next, strain, squeeze out the resulting cake, rub through a sieve. Take the resulting pulp on an empty stomach, 2 tbsp. before every meal.
- Brew plantain (dry leaves) with boiling water (0.5 l), leave for 30 minutes, strain and drink 0.5 tbsp. before meals 6-7 times a day.
- To relieve inflammation and improve the activity of the duodenum, pour oatmeal with cold water and insist on taking it as liquid porridge for breakfast.
- Grind the aloe, squeeze out the juice, mix with a decoction of oatmeal, take 0.5 cups as jelly 3-4 times a day (first dose in the morning on an empty stomach).
You can prepare aloe with May honey using natural grape wine. Squeeze the juice out of the aloe, add liquid honey heated to 60 °C, mix, leave for up to 7 days in a cool place, shaking occasionally, then strain. Take the course for 3 months. - Propolis tincture. Pour alcohol (100 g) into propolis (150 g), leave for 10 days in the dark, shaking occasionally, take 15-20 drops of propolis with added milk 3 times a day. Instead of propolis, you can use flax seeds.
- Pour boiling water (0.5 l) over calamus root, tansy, valerian root, leave for 2 hours, take 0.5 cup 3-4 times a day.
Any finished product can be stored in the refrigerator for several days. - You can cure duodenitis by taking 1 tbsp of sea buckthorn oil on an empty stomach. 2 times a day and for 2 weeks. Next, you need to take a break for 2 weeks and repeat the course of treatment.
Proper nutrition
With duodenitis, the symptoms can be completely different, and only a doctor can establish the correct diagnosis based on the examination, prescribe a comprehensive comprehensive treatment and develop a diet. The energy value of the menu must be at least 3000 kcal per day. It is important that the diet is balanced, with a complete refusal to eat spicy, sour, fried, smoked foods, alcohol and limiting salt (no more than 2 tsp per day). You need to drink at least 1.5 liters of water per day.
Food should be cooked exclusively by steaming.
To alleviate the condition, eliminate pain in the stomach and other symptoms of inflammation, the diet should be varied. It is recommended to eat dried bread, savory buns, dry biscuits or cookies with the exclusion of fresh yeast products, pancakes, pies, and baked goods from the diet.
To give strength, you can cook any porridge from semolina, rice, buckwheat, rolled oats in water. Make casseroles and puddings from cereals, excluding legumes and pasta from the diet.
With duodenitis, the body requires a sufficient amount of protein, so you must eat soft-boiled eggs, cook omelettes, and scrambled eggs. Lean varieties of meat, chicken, veal, rabbit, and turkey are recommended to be boiled and taken pureed.
Boiled or pureed beets, potatoes, carrots, cabbage, broccoli, and boiled zucchini are useful. Marinated and salty foods, chocolate, nuts, kvass, coffee, sour juices, alcohol and beer should be excluded from the diet.
Gradually the diet can be expanded.
The main rule is to prevent exacerbations and minimize any irritation of the gastric mucosa by products.
Inflamed intestines require restoration, so treatment is long-term and the diet must be followed constantly. You should not overeat, eat 2 hours before bedtime, you need to monitor your well-being, steam food, limit salt intake to 8 g per day, and drink more liquids.
Thanks to diet and constant intake of herbal teas, noticeable relief should occur within a couple of weeks.
Duodenitis is an inflammatory process that occurs on the mucous membranes of the intestines. Characteristic symptoms of the disease are general malaise, pain in the epigastric region, heartburn, belching, nausea, and vomiting. It occurs in 2 forms - acute and chronic. It is depending on the form of the pathology that it is determined how to treat duodenitis.
Treatment of acute duodenitis
Therapy for a disease occurring in the acute stage must be started as soon as possible. This can be explained by the fact that duodenitis is often accompanied by negative consequences and often becomes chronic, which will require other specific therapy. First of all, a patient with acute duodenitis needs to start following a strict diet. Treatment is supplemented with special medications.
Nutrition
The main goal of a diet for such a disease is to achieve normalization of the gastrointestinal tract, reduce the intensity of inflammation in the intestines and its further suppression.
It is important to exclude foods that irritate the organ mucosa from your daily diet. These include pickles, spicy foods, marinades, which contain large amounts of purines. It is also recommended to exclude foods rich in preservatives, stabilizers, taste enhancers - those chemical compounds that are involved in increasing gastric secretion.
In addition, limit the consumption of foods containing coarse fiber. The latter is retained in the gastric environment for a long time and negatively affects the development of the disease. Dietary food should not include foods that increase gas formation, refractory fats that interfere with the normal absorption of nutrients.
In case of acute duodenitis, the following products are prohibited:
- rye and fresh bread, yeast and puff pastry, products made from such;
- meat, fish, mushroom broth;
- rich vegetable soup (this includes borscht, okroshka, rassolnik, cabbage soup, etc.);
- fatty meat, including poultry;
- fatty fish;
- canned fish and meat;
- pickles and marinade;
- smoked meats;
- seasonings and spices;
- pasta;
- legumes, white cabbage, radishes, radishes, sorrel;
- cereals: millet, pearl barley, barley;
- sausages;
- fast food;
- soda, coffee and cocoa;
- fermented milk products and ice cream;
- alcoholic drinks;
- sweets, sugar, chocolate, cakes with butter cream;
- raw fruits.
Despite such a large list of prohibited foods, there are also useful ones for the gastrointestinal tract during the development of duodenitis. These help neutralize hydrochloric acid, which is produced by the stomach. Food is consumed only in grated form, rolled or boiled to a puree state.
For both acute and chronic duodenitis, it is important to exclude legumes from the diet
In case of acute duodenitis, the following products are allowed:
- slightly stale bread, dried cookies, dry biscuits;
- vegetable cereal soup, milk and puree soup;
- lean meat;
- potato, carrot, beet side dish, boiled cauliflower;
- rice, semolina, buckwheat porridge, pudding;
- vermicelli;
- steamed protein omelet, soft-boiled eggs;
- low-fat milk, condensed milk, cream, yogurt and low-fat kefir;
- boiled ground fruits and berries, jelly;
- weak tea with milk, fruit juice diluted with water, rosehip decoction;
- butter and vegetable oil;
- salad made from pre-boiled vegetables.
Be sure to include in the diet foods that contain ascorbic acid (helps accelerate the regeneration of the intestinal mucosa and strengthen the general immune system).
Medications
To relax the smooth muscles of the intestinal walls and reduce the intensity of pain, which in most cases accompanies the development of duodenitis, myotropic antispasmodics are prescribed. A representative of this group is the drug Platyfillin, which is effective not only for duodenitis, but also for other diseases of the gastrointestinal tract. Another medicine is No-shpa, aimed at eliminating spasms.
Also, myotropic antispasmodics include drugs such as Papaverine, Duspatalin, Drotaverine. Such drugs are taken before or after meals three times a day. Despite their effectiveness, there are some contraindications for use, the main of which are asthma and renal failure.
Symptoms of duodenitis are also treated with antacid medications. These have an enveloping and local anesthetic effect and help neutralize hydrochloric acid. Drugs are prescribed for pain caused by duodenitis, as well as for diet violations. These include Maalox and Almagel, which are taken after meals three times a day.
If the disease is caused by an infection, which, in turn, develops due to exposure to the bacterium Helicobacter pylori, the use of antibiotics is necessary. This could be Tetracycline (four times a day for a week), Clarithromycin (twice a day for a week), Amoxicillin (twice a day for a week), Metronidazole (twice a day for a week).
Prokinetic drugs are necessary for the treatment of duodenitis, which has a gastritis-like form. These help regulate the activity of the gastrointestinal tract and normalize the process of moving food masses through the intestines. The drugs have antiemetic and local antiedematous effects. Representatives of this group are Ganaton, Itomed, which are taken in a daily dosage of 3 tablets, divided into 3 doses.
You can reduce pain with No-shpa tablets
Multienzyme preparations include pancreatic enzymes, which are involved in the normalization of digestion, absorption of nutrients, and help eliminate unpleasant symptoms of the disease. For example, it could be Creon 1000, which is taken in a daily dosage equal to meals (the capsule is taken with food).
Treatment of chronic duodenitis
Chronic duodenitis requires complex therapy with therapeutic measures in relation to the organs of the digestive tract adjacent to the intestine. In combination with following a special diet and taking medications during an exacerbation, complete rest and bed rest are prescribed.
Nutrition
If a person has been diagnosed with chronic duodenitis, he must follow a therapeutic diet, as with a peptic ulcer. The principles of nutrition depend on the stage of the pathology: during exacerbation, this is table No. 1A and No. 1B, during remission - table No. 1.
Diet 1A helps limit any adverse effects on the intestinal mucosa. It is followed starting from the first day of therapy for duodenitis and continues to be followed for 5 to 14 days.
Basic principles of diet No. 1A:
- food should be liquid or mushy;
- exclude the consumption of broth, legumes, mushrooms, hard meat, cold and hot dishes;
- It is necessary to eat food fractionally, that is, in small portions and often (up to 6 times a day);
- It is allowed to eat slimy soups, twisted beef and chicken, milk, soft-boiled eggs, steam omelet, liquid porridge cooked in water, jelly, weak tea.
As soon as the inflammatory process has subsided, they move from table No. 1A to table No. 1B. This diet does not have the sharp restrictions that were provided for in diet No. 1A. Allowed products include crackers, pureed soups, milk porridges, canned fruits and vegetables. Meat and fish are consumed in the form of purees, soufflés, and cutlets.
First courses are served only as puree
Table No. 1 is prescribed during the remission stage of the disease. Just as during an exacerbation, exclude foods that irritate the gastrointestinal tract: legumes, grapes, currants, gooseberries, meat, wholemeal bread. The dishes are thicker, but still mushy. Sometimes it is allowed to eat baked fish and meat cooked in pieces.
Medications
Chronic duodenitis is treated in a hospital setting using the following drugs:
- antibacterial, with which you can get rid of the bacteria Helicobacter pylori (for example, Amoxicillin);
- enveloping (for example, Sulfactrate);
- enzymatic (for example, Creon);
- drugs that help reduce acidity (for example, Maalox);
- drugs that help reduce the secretion of hydrochloric acid (for example, Ranitidine);
- antispasmodics (for example, Papaverine, No-shpa).
An individual treatment regimen is established for each patient.
Physiotherapy
Intestinal duodenitis can be treated with physiotherapeutic procedures. This can be paraffin applications, ultra-high frequency therapy, hydrotherapy using mineral waters. Such physiotherapeutic techniques are considered the most effective for duodenitis.
If physical therapy in combination with taking medications does not bring the desired recovery, the person experiences intestinal obstruction, and surgery is prescribed to prevent further complications.
Folk remedies
In combination with the main therapeutic treatment, you can use folk remedies that will enhance its effect and speed up recovery. This can be an infusion of fennel and centaury (100 g of raw materials per 1 liter of water), of peppermint (40 g of raw materials per 500 ml of water), of mint, sage, lavender (60 g of raw material per 200 ml of water), of juniper and vodka (10 g of raw material per 200 ml of water). Any of the remedies is taken orally three times a day, 2 tsp. Such folk remedies help normalize the activity of the gastrointestinal tract and accelerate the healing of the intestinal mucosa.
Intestinal duodenitis is one of the most insidious diseases of the gastrointestinal tract, which can be accompanied by dangerous consequences. That is why you should not ignore the first symptoms of pathology, but you should immediately contact a specialist.
Duodenitis is inflammation of the mucous layer of the duodenum. The overall prevalence of the pathology among the population is 5-10%; the disease is found 2 times more often in men, which is associated with a greater commitment to addictions.
There are acute and chronic forms of the disease. Acute duodenitis most often occurs due to poisoning and consumption of spicy foods, and is manifested by inflammation of the mucous membrane, the development of erosions (a superficial defect of the epithelium that heals without scarring) and, less commonly, phlegmonous cavities filled with pus. The disease manifests itself as digestive disorders and pain. If you follow the diet and doctor's instructions, you can be cured in 1-2 weeks. If o occurs again. duodenitis, the risk of chronicity is 90%.
Chronic duodenitis develops against the background of chronic pathology of the digestive tract (gastritis, stomach ulcers, pancreatitis), with prolonged diet violations. Atrophy of the mucosa (atrophic duodenitis) or its erosion (erosive duodenitis) gradually develops. Under the influence of provoking factors, an exacerbation of the disease occurs. Treatment is longer than for the acute form.
Structure
After the pylorus of the stomach comes the duodenum. It, like a horseshoe, goes around the head of the pancreas (PG), continuing into the jejunum. Its length is 25-30 cm. Fixation to the walls of the abdominal cavity is carried out due to connective tissue fibers. The duodenum is located in the projection of the XII thoracic – III lumbar vertebrae.
Divisions: superior (bulb or ampulla), descending, horizontal, ascending. The mucous membrane of the bulb is equipped with longitudinal folds, the remaining sections - transverse. When they contract, a bolus of food moves into the jejunum.
The greater or Vater's nipple opens into the duodenum cavity. It is formed by the fusion of the main pancreatic duct and the common bile duct. The papilla of Vater has a sphincter, with the help of which the flow of bile and pancreatic juice into the intestines is regulated. The minor nipple is located in the area where the accessory duct of the pancreas exits.
Functions
The duodenum performs several functions:
- Neutralization of acidic gastric contents. The bolus of food mixed with acidic gastric juice is neutralized in an alkaline environment. Due to this, irritation of the intestinal epithelium does not occur.
- Regulation of the formation of digestive enzymes, bile, pancreatic juice. In the duodenum, the contents are analyzed and the appropriate command is transmitted to the digestive glands.
- Relationship with the stomach: the duodenum ensures the opening and closing of the pylorus of the stomach, the entry of a new portion of the bolus of food into the small intestine. This occurs as the next amount of gastric contents is neutralized in the cavity of the duodenum.
What causes acute duodenitis
The reasons leading to the development of o. duodenitis:
- Dry food, eating food that has an irritating effect on the epithelium of the digestive tract: coffee, smoked foods, fried, fatty, spicy. To process such food, an increased amount of hydrochloric acid is formed in the stomach, which reduces the protective properties of the duodenum epithelium.
- Foodborne toxic infections caused by the bacterium Helicobacter pylori (which causes ulcers), staphylococci, enterococci, clostridia, as well as giardiasis, helminthiases. Pathogenic bacteria lead to the development of inflammatory phenomena in the duodenal mucosa, damage to epithelial cells and their death. A large amount of fluid leaks into the intestinal lumen, which manifests itself as diarrhea.
- Diseases of the digestive system: colitis, hepatitis, cirrhosis, pancreatitis, ulcers, gastritis. Inflammation of nearby organs leads to the transition of the inflammatory process and the development of duodenitis (pancreatitis-duodenitis, gastritis-duodenitis). Another mechanism that causes inflammation of the duodenum is a disruption in the production of bile and pancreatic juice, without which the normal functioning of this organ is impossible.
- Reflux or backflow of the contents of underlying intestinal segments into the duodenum. This may occur due to spasm or obstruction (due to a tumor or other reasons) of the jejunum. Bacteria from the lower parts of the small intestine enter the duodenum, causing reflux duodenitis.
- Alcohol consumption.
- Ingestion of chemicals (acids, alkalis, chlorine-containing compounds) leading to burns of the intestinal epithelium.
- Mechanical damage to the duodenal mucosa due to ingestion of foreign bodies.
What causes chronic duodenitis
Reasons leading to the appearance of chronic duodenitis:
- Intestinal pathology leading to deterioration of peristalsis, stagnation of intestinal contents, stretching of the walls and atrophy of the duodenum mucosa: prolonged constipation, intestinal adhesions, impaired blood supply and nervous regulation of the intestine.
- Chronic gastritis with high acidity causes acid damage to the intestinal epithelium with the gradual development of its atrophy. Gastritis-duodenitis is formed.
- An abnormality of the liver, gallbladder and pancreas leads to disruption of the release of enzymes into the lumen of the duodenum, which impairs its functioning.
- Regular violation of diet and nutrition.
- Food allergies.
- Prolonged stress.
- Taking a lot of medications.
- The presence of bad habits (drinking alcohol, smoking, substance abuse).
Clinic
Manifestations of duodenitis depend on the cause of its occurrence and the presence of concomitant pathology. Often the disease is hidden under the guise of other ailments: stomach ulcers, gastritis, cholecystitis.
Symptoms of duodenitis in adults:
- Painful sensations in the epigastric region, aggravated by palpation (palpation) of the abdomen. Pain has its own characteristics in various forms of duodenitis:
- in the chronic form - constant, aching, worsening on an empty stomach and 1-2 hours after eating;
- with duodenitis caused by intestinal obstruction, the pain is bursting, paroxysmal, and occurs when the intestines are full;
- with gastritis-duodenitis with high acidity - develops 10-20 minutes after eating, which is explained by the entry of acidic gastric contents into the intestines;
- the ulcer-like form caused by Helicobacter pylori is characterized by fasting pain;
- with local inflammation around the nipple of Vater, the outflow of bile from the gallbladder is disrupted, resulting in a clinical picture similar to an attack of hepatic colic: pain in the right hypochondrium.
- Increased fatigue, weakness. This is due to the action of toxic substances formed during inflammation.
- A slight increase in body temperature is possible (up to 37-38 0).
- Digestive disorders (dyspepsia):
- nausea;
- decreased appetite;
- increased gas formation (flatulence);
- belching, vomiting with a bitter taste (due to bile) - throwing food back into the stomach;
- bowel disorder (diarrhea or constipation).
- Yellowing of the skin and mucous membranes. Swelling of the papilla of Vater leads to a decrease in the lumen of the bile duct, stagnation of bile and its release into the blood.
- Dumping is a syndrome. Occurs after a heavy meal. When the duodenum is overfilled, a redistribution of the bloodstream occurs (blood flow to the digestive organs, outflow from the head). Manifested by dizziness, drowsiness, a feeling of fullness in the stomach, heat in the upper body.
If the disease is asymptomatic, there may be no complaints; detection of pathology is an accidental finding during gastroduodenoscopy.
Diagnostics
The diagnosis of duodenitis is made if there is a combination of data:
- The presence of characteristic complaints described above.
- Inspection. When palpating (feeling) the abdomen, pain is noted in the projection of the duodenum.
- Instrumental examination data:
- FGDS (fibrogastroduodenoscopy) – scopic examination of the stomach cavity, duodenum. In the presence of duodenitis, characteristic signs are determined: (swelling of the mucous membrane, redness). Each form of duodenitis has its own characteristics of FGDS - pictures:
- a) with catarrhal (or superficial) duodenitis - uniform redness of the epithelium;
- b) the presence of erosions - with an erosive form;
- c) smoothness of the folds indicates a decrease in intestinal tone;
- d) nodules on the mucous membrane – about the nodular form;
- e) hemorrhages – hemorrhagic;
- f) atrophy of the epithelium - about atrophic.
- X-ray contrast study - performing fluoroscopy or graphy after the patient has consumed a contrast agent (barium sulfate). With such a study, it is possible to identify gross disturbances in the structure and functioning of the organ; restructuring of the mucous membrane cannot be detected in this way. In case of duodenum pathology, a number of signs are found:
- a) areas of narrowing indicate a tumor, adhesions, developmental anomalies;
- b) areas of expansion indicate a decrease in tone, blockage of the lower parts of the intestine, disruption of food passage, and nervous regulation;
- c) a niche symptom is observed with erosion, ulcer;
- d) with mechanical obstruction, an accumulation of gases is detected;
- e) smoothness of folds - with swelling, inflammation;
- f) reflux - the reflux of contents from the duodenum back into the stomach.
- Laboratory data:
- a general blood test can determine an increase in ESR, indicating inflammation and anemia, as a sign of internal bleeding;
- biochemical blood test: in the initial stages of duodenitis, an increase in enzymes (esterokinase and alkaline phosphatase) will be noted, later their activity decreases;
- stool test for occult blood (will be positive in the presence of bleeding, maybe in the erosive form).
Features in children
Small children cannot correctly localize pain; they most often simply point to their stomach and say that it hurts. Among the symptoms, the most common are malaise, weakness, abdominal pain, nausea, belching, heartburn, and constipation. Exacerbation of duodenitis occurs more often in autumn and spring. In older children (10 years or more), the clinical picture does not differ significantly from adults.
The treatment is complex. If the cause of duodenitis is helminthiasis, deworming is a mandatory component.
Treatment
The main tasks in the treatment of duodenitis:
- elimination of inflammation;
- prevention of process chronization;
- normalization of duodenum function;
- restoration of normal digestion.
Most often, treatment is carried out in a clinic. For recovery, a number of conditions must be met:
- stick to a diet;
- observe the work and rest schedule;
- avoid stress;
- give up bad habits (smoking, alcohol).
Indications for inpatient treatment:
- exacerbation of the disease;
- suspicion of tumor formation;
- danger of bleeding (with erosive form);
- severe general condition.
Treatment components:
- therapeutic nutrition;
- folk remedies;
- medicines;
- physiotherapy;
- use of mineral waters.
Nutrition
The menu for duodenitis plays a primary role in therapy. If you do not adjust your diet, relapses of the disease will occur again and again.
During exacerbation of the chronic form or o. duodenitis for the first 3-5 days, you should follow table 1a according to Pevzner. The same diet is used to treat exacerbation of stomach ulcers. It is allowed to eat slimy cereal decoctions (rice, oatmeal), pureed soups, liquid porridge with half-and-half milk (first the cereal is boiled in water, so it swells faster and becomes more slimy, then add milk, the ratio of water and milk is 1/1).
Basic principles of nutrition:
- food should be: pureed, not hot, steamed
- frequent meals - 6 times a day, in small portions
- Avoid overeating and long breaks in meals
For example, let's look at diet 1a, scheduled for one day.
| Eating | Recommended dishes |
| 1st breakfast | Buckwheat porridge cooked with half-and-half milk (buckwheat - 50, milk and water - ½ cup each, butter - 10), milk - 1 cup |
| 2nd breakfast | Milk – 1 glass |
| Dinner | Milk cereal soup (oat flakes - 40, milk - ¾ cup, eggs - ¼ piece, butter - 10, sugar 2, water - 1¾ cups), meat puree (boiled lean beef - 100, milk - 1/4 cup, butter - 10), dried apple compote (water – 200, dried apples – 20, sugar – 15) |
| Afternoon snack | Milk – 1 glass, soft-boiled egg |
| Dinner | Rice porridge cooked with half-and-half milk (rice – 50, milk and water – ½ cup each, butter – 10), egg “in a bag”, milk – 1 cup. |
| 2nd dinner | Milk – 1 glass |
Then the diet is gradually expanded.
- ulcer-like form – table No. 1;
- gastritis-like variant – table No. 2;
- Pancreatito- and cholecyst-like form – table No. 5.
- boiled lean meat, minced through a meat grinder or chopped with a blender;
- dairy and lactic acid products (milk, kefir, fermented baked milk, yogurt);
- boiled or baked vegetables, peeled, vegetable puree;
- eggs, boiled soft-boiled or prepared as an omelet;
- fats (butter, vegetable oil);
- juices;
- yesterday's bread and crackers (easier to digest than fresh baked goods);
- natural sweets (honey, mousse, jelly).
Products that stimulate gastric secretion and contain difficult-to-digest fibers are prohibited:
- raw fruits and vegetables;
- canned food, smoked meats;
- spicy dishes, seasonings, onions, garlic;
- rich fish, meat, mushroom broths;
- fatty meats and fish (duck, pork, carp, mackerel);
- ice cream;
- carbonated drinks;
- alcohol.
- You should eat in small portions, 4-6 times a day. You should not wait until you are hungry to eat, otherwise you may experience “hunger pains.”
- Food should be warm, but not hot or cold.
- A gentle preparation method is preferable to avoid irritation of the duodenum mucosa. These are soups, porridges, steam dishes.
- Avoid overeating and eating at night.
Traditional methods
Treatment with folk remedies is of auxiliary value. The main goal is to suppress the aggressive effects of hydrochloric acid and protect the duodenum epithelium.
Medicinal plants that are suitable for this purpose are: coltsfoot, sage, nettle, St. John's wort, peppermint, oregano, plantain, strawberry leaves, chamomile inflorescences, fennel seeds, eucalyptus leaves.
During the period of remission, the following herbs are used: lingonberry leaves, St. John's wort herb, licorice root, flax seed, oregano herb, nettle herb, chamomile root.
Recipes for preparing medicinal potions for duodenitis:
- 2 tbsp. spoons of St. John's wort raw material are poured into 200 ml of boiling water, heated in a water bath for 0.5 hours, left for 15 minutes, filtered, drunk 1/3 cup 3 times a day 0.5 hours before meals;
- 3 tbsp. spoons of plantain juice are mixed with 1 teaspoon of honey, take 1 tbsp. spoon 3 times a day before meals;
- 50g of propolis is poured with 2 glasses of alcohol, the resulting mixture is placed in a dark place to infuse for 3 weeks, taken outside of exacerbation, before meals, 1 tbsp. spoon, pre-mixing with 1 tbsp. a spoonful of milk;
- 2 tbsp. spoons of Hercules are boiled in 2 liters of water, filtered, and ¼ cup of aloe juice is added to the broth. Drink ½ glass 3 times a day;
- 1 teaspoon of flax seeds is poured into 1 glass of boiling water, left for 15 minutes, consumed on an empty stomach for a month.
- 0.5 kg of sea buckthorn is ground, poured with unrefined sunflower oil and infused for a week in a glass jar, take 1 tbsp. spoon on an empty stomach.
Drug therapy
How to treat duodenitis? Depending on the form of the disease, various combinations of drug groups are used:
| Drug group | Mechanism of action | Representatives | How to use |
| PPIs – proton pump inhibitors | Blocks the production of hydrochloric acid (HCl), thereby reducing irritation of the duodenum mucosa. |
|
20 mg 1-2 times a day, for 7-10 days. |
| Antibiotics, antibacterial agents | In case of infection, Helicobacter pylori is detected. |
|
2 times a day, 7-10 days. |
|
2 times a day, 7-14 days. | ||
| H2 - histamine blockers | Suppress the release of HCl. |
|
0.15 - 2 times a day, course 1 - 1.5 months. |
|
0.02 g – 2 times | ||
| Antacids | Neutralize with HCl. Envelop the mucous membrane and have a local analgesic effect. |
|
For heartburn, up to 3 times a day. |
| Prokinetics | Regulate peristalsis, help promote bolus movement |
|
1 tablet 3 times a day. |
| Enzyme agents | Contain pancreatic enzymes, help better digestion of food |
|
After every meal. |
| Antispasmodics | Remove spasms, relieve pain |
|
1 tablet – 3 times. |
| Sedatives | Calming effect | Valerian and motherwort tablets | Course 10-14 days. |
Separately, it is worth mentioning the drug De-nol. It combines antacid, antibacterial (directed against Helicobacter pylori), anti-inflammatory, astringent action, protects the duodenum mucosa, and promotes its restoration. Adults take 1 tablet 4 times a day (3 times after meals, the 4th at night). Take the drug with water (you can’t take it with milk due to the formation of insoluble compounds). Children under 12 years of age are prescribed 1 tablet 2 times a day. The course of admission is up to 8 weeks.
In each case, the combination of drugs is selected individually. If Helicobacter pylori is present, antibiotics are mandatory. If the disease is triggered by stress, sedatives are used. When acidity increases, you cannot do without antacids, PPIs, and histamine blockers.
Physiotherapy
Magnetic therapy, ultrasound, and phonophoresis are used.
Application of mineral waters
Low-mineralized alkaline reaction waters that do not contain carbon dioxide are used: “Borjomi”, “Essentuki No. 4”, “Smirnovskaya No. 1”, “Slavyanovskaya”, “Luzhanskaya”, “Berezovskaya”. Before drinking, mineral water is slightly heated and gases are released. Take 1-1.5 hours after meals.
All these treatment methods together help relieve inflammation and achieve stable remission of duodenitis.