Bile in excess

Abstract

The article presents consideration for the pathogenetic mechanisms of the occurrence of duodenogastric reflux (DGR), duodenogastroesophageal reflux (DGER), their role in the occurrence of biliary reflux gastritis and reflux esophagitis. The fundamental bases for the formation of bile reflux are the failure of the sphincter apparatus, antroduodenal dysmotility, elimination of the natural antireflux barrier. Gallbladder dysfunction and duodenal dysmotility are considered the risk factors for primary DGR. The leading mechanism for the development of DGR, DGER after cholecystectomy is a violation of gastroduodenal motility and gastroduodenal hypertension. These syndromes are formed also at gallstone disease and other organic and functional pathological conditions, including pancreatic insufficiency. The syndrome of chronic duodenal hypertension or «duodenal demon» is manifested by heaviness in the epigastrium, belching, heartburn, nausea, vomiting, flatulence, and stool disorders. It is supplemented by the phenomena of psychosomatic asthenization, decreased mental and physical performance, apathy, and a negative assessment of life prospects. The clinical features of hologenous diarrhea are considered, differential diagnostic signs of diarrhea in chronic duodenal hypertension and irritable bowel syndrome are demonstrated.The clinical and pathogenetic substantiation of the treatment of chronic duodenal hypertension accompanied by hologenous diarrhea with colloidal bismuth preparations is presented. The summary of the comparative analysis has been presented of the physicochemical and structural properties of tablet formulations, containing bismuth tripotassium subcitrate, the original drug De‑Nol (Astellas) and the generic Ulcavis (KRKA). It has been concluded that it is advisable to include Ulcavis in the treatment regimen for patients with hologenous diarrhea.