Duodenal hypertension in practice of gastroenterologist

Abstract

The article provides a literature review of a highly prevalent syndrome — chronic duodenal hypertension (CDH), a complex of symptom of organic (mechanical) or functional nature, characterized by difficulty in promoting (passage) of the food chyme along the duodenum, delaying its evacuation to the lower parts of the small intestine. The authors provided CDH classification and paid much attention to the functional and organic genesis of this pathology (the latter is called chronic duodenal obstruction, CDN). Presented are modern views on the etiology and pathogenesis of CDH. The features of the formation of CDN in postcholecystectomy syndrome are considered. The role of biliary and pancreatic insufficiency, which reduce the bactericidal activity of duodenal contents and contribute to microbial contamination of the small intestine, is emphasized. The mechanisms of reflex excitation of the vomiting center are listed, the emphasis is on the extension of the walls of the main pancreatic duct (typical for obstructive pancreatitis) and the common bile duct (for cholecystitis and biliary chronic pancreatitis). The mechanisms of the formation of intoxication, headache, and nausea are explained. The analysis has been conducted for the mechanisms of development of various symptoms of duodenal hypertension with phenomena of psychosomatic asthenization, a decrease in mental productivity and physical performance. The nuances of pharmacotherapeutic and surgical correction of CDH are considered. Own clinical observation illustrating the CDH case against the background of gallstone disease and postcholecystectomy syndrome has been presented. The facts have been elucidated that justify administration of pancreatic enzymes, proton pump inhibitors, bismuth preparations and bile acids to correct the symptoms of CDH.