Duodenal bulb inflammation

　　Traditional Chinese medicine etiology

　　1. Irregular diet, imbalance of cold and heat. This is mostly due to overeating, irregular eating and drinking, overeating of cold foods, and a preference for spicy foods; or long-term alcohol consumption, or prolonged illness without recovery, leading to internal injury of the spleen and stomach, with cold and heat mutually binding in the middle, causing a mixture of cold and heat and the imbalance of the rising and descending of the spleen and stomach.

　　2. Liver Qi depression and stagnation, the liver attacks the stomach. This is mostly due to worry, frustration, and anger, emotional discomfort, leading to liver Qi stagnation, loss of function in the excretion, and the liver attacking the stomach; or irregular diet injures the stomach, leading to the stomach losing its descent, affecting the liver's excretion.

　　3. Liver Qi depression transforming into heat, heat attacks the stomach. This is mostly due to inherent depression, emotional discomfort, leading to liver Qi depression, which transforms into heat over time, and the heat attacks the kidney or the inherent excess of internal heat in the stomach, further attacked by the heat caused by liver Qi depression, resulting in the disharmony of liver and stomach heat, and the stomach losing its descent.

　　4. Stagnation of blood in the interior, blocking the meridians and collaterals. Emotional discomfort, Qi depression for a long time, leads to Qi stagnation and poor blood circulation. Or Qi deficiency leads to insufficient power to move blood, resulting in blood stasis; or cold blood makes the blood vessels coagulate; or long-term illness affects the collaterals; or injury leading to blood stasis inside.

　　5. Deficiency of the middle-jiao, the stomach loses warmth. This is due to inherent weakness of the spleen and stomach, or internal injury due to overwork and fatigue, or prolonged illness extending to the spleen and stomach; or irregular eating and drinking, overeating of cold foods; or improper medication, which can damage the spleen and stomach, leading to deficiency of the middle-jiao, poor digestion and absorption, and the stomach losing warmth, thus causing the disease.

　　6. Deficiency of Yin fluid, the stomach loses its nourishment. This is mostly due to injury to the stomach Yin after warm diseases, or due to vomiting and diarrhea, injury to the body fluid and consumption of body fluid; or due to the constant consumption of fried and dry foods; or due to excessive use of warm and dry substances, which gradually consume the stomach Yin over time, leading to insufficient stomach Yin and the malnourishment of the meridians and collaterals.

　　Western medicine etiology

　　The etiology of primary duodenitis is not yet fully clear. Stimulative foods, drugs such as aspirin, alcohol, and radiation exposure can all cause this disease. Patients with chronic superficial gastritis and atrophic gastritis often have duodenitis, suggesting that this disease may have the same etiology as some chronic gastritis.

　　Secondary duodenitis or specific duodenitis is a group of duodenitis caused by various specific etiologies, including infections (parasites, tuberculosis, fungi, molds, etc.), hemorrhagic duodenitis caused by cerebrovascular diseases and myocardial infarction, portal hypertension, heart failure, and other conditions such as hepatitis, pancreatic and biliary diseases. Due to local compression or spread, duodenal blood supply disorders may occur. It can be seen that this disease is a multi-causal disease, and the pathogenesis is not very similar due to different etiologies.

　　(1) Ulcer bleeding: The gastric wall is distributed with a large number of blood vessels. After eating, a large amount of blood will gather in the gastrointestinal tract to assist digestion. If bleeding is excessive and rapid, it can even threaten life, and the mortality rate of ulcer bleeding is about 25%.

　　(2) Ulcer perforation: Ulcer perforation accounts for about 15% of ulcer diseases and is one of the main causes of death from ulcer disease. One of the main reasons for ulcer perforation is overeating. Experts point out that overeating in ulcer patients can make the gastric wall thin, enlarge and deepen the ulcer wound, and trigger perforation.

　　(3) Ulceration cancer: The incidence of gastric ulceration cancer is more common in older patients with a history of chronic ulcers, accounting for about 2% to 5% of ulcer diseases, and canceration is occasionally seen in young people.

　　1. Dyspeptic symptoms may include upper abdominal fullness, acid regurgitation, belching, nausea, and vomiting, but some patients may have no symptoms or signs in the early stage of the disease. Duodenitis has similar symptoms to many other diseases, so it is necessary to differentiate it well, such as duodenal inflammatory polyps, duodenal Brunner's gland hyperplasia, and duodenal frost-like ulcers, etc.

　　2. Upper abdominal pain, similar to duodenal ampulla ulcer, is usually hunger pain or night pain, which is relieved after eating. If the upper abdominal pain is caused by duodenitis and is not treated in time, it is easy to deteriorate into duodenal ulcer, gastric ulcer, atrophic gastritis, or superficial gastritis, etc.

　　3. Upper gastrointestinal bleeding is a complication of erosive duodenitis, which may cause black stools or vomiting of blood.

　　4. Common signs include mild upper abdominal tenderness, some patients may have glossitis, anemia, and weight loss, etc. Duodenitis belongs to gastrointestinal diseases, and when it occurs, it is generally accompanied by chronic gastritis, liver cirrhosis, chronic hepatitis, chronic pancreatitis, and other diseases.

　　How to prevent duodenal bulbitis in daily life? Pay attention to the following aspects:
　　1. Live a regular life, maintain an optimistic mood, quit smoking and drinking, and do not overeat or under-eat.
　　2. Eat small and frequent meals, avoid indigestible and strongly刺激性 (spicy) foods, such as coffee and spicy foods.
　　3. For those with stomach stuffiness, acid regurgitation, and belching, metoclopramide or胃复安 (antinausea medication) should be taken half an hour before meals.
　　4. For those with abdominal distension and pain, analgesics or other stomach drugs with pain-relieving effects can be used.

　　1. In mild cases, X-ray examination may show no positive changes.

　　2. Irritation phenomenon: frequent irritation of the bulb, enhanced peristalsis, rough outline of the bulb when filled with barium, and frequent changes in shape.

　　3. There is no spheric deformation and indentation shadow.

　　4. The mucosal folds change: the mucosal folds become thickened and disordered, and can appear in a grid-like pattern.

　　5. The diagnosis of duodenal bulbitis relies on endoscopy and biopsy.

　　The differential diagnosis between duodenal bulbitis, duodenal Brugia adenoma, and duodenal bulb ulcer is difficult, and it should be based on endoscopy and biopsy.

　　1. Duodenal bulbitis patients should not eat spicy and刺激性 foods such as chili, seafood, tobacco, and alcohol in their daily life, as these foods can cause strong stimulation to the gastrointestinal mucosa, further expand the inflammation, and be不利于 the recovery of the disease.

　　2. Avoid eating cold and hard foods, and you can eat easily digestible noodles, eat more vegetables and fruits, and it is best to boil them with boiling water before eating, so as to reduce the stimulation to the gastric and duodenal mucosa.

　　3. Try to eat less sugary and acidic foods, and you can eat lean porridge and eggs, but in moderation, not too much, to avoid indigestion.

　　4. Have regular meals, avoid overeating and fasting, quit smoking and drinking, and do not drink strong tea or coffee.

　　5. Be cautious with medication, especially non-steroidal anti-inflammatory drugs, which can stimulate the gastric mucosa and cause recurrent episodes of the disease.

　　6. Avoid eating vinegar products, as these foods are easy to produce acid in the stomach, causing stomachache and heartburn.

　　Generally, the so-called 'triple therapy' is adopted, that is, two antibiotics + one acid-neutralizing drug, such as metronidazole + amoxicillin + omeprazole.
　　(1) Acid suppressants and acid neutralizers, omeprazole, ranitidine, etc.
　　(2) Antihelicobacter pylori drugs. Such as colloidal bismuth subcitrate, amoxicillin, metronidazole, etc.
　　(3) Mucosal protective agents, such as sucralfate, gastric therapy, and Letdewei, etc.
　　On the other hand, it is necessary to eliminate pathogenic factors related to lifestyle, diet, and medication. For example, life should be regular, and food should mainly include milk, congee, soft food, meat, vegetables, fruits, and other easily digestible foods with little stimulation. Increase activity and appropriate exercise. Those who are overweight should lose weight appropriately. If symptoms such as upper abdominal pain, bloating, and acid regurgitation are obvious, one can take antacid or gastric mucosal protective drugs, such as domperidone + famotidine, or domperidone + Rolaids, for a period of time; or choose traditional Chinese medicine treatment. There are many traditional Chinese medicine formulas, such as the Four Gentlemen Decoction, Hericium Erinaceus Extract, etc. The duration of medication should not be too long, and medication can be stopped after the symptoms disappear.