Focal bulbitis: superficial, catarrhal, erosive, atrophic, hyperplastic, hemorrhagic

Many of our readers know what gastritis is. This very common pathology is nothing more than an inflammatory disease that affects the gastric mucosa and, if unfavorable, ends in the formation of an ulcer. But the disease called bulbitis is something unusual and unknown to most people. In fact, by analogy, focal bulbitis is the same inflammation of the mucosa, but in the duodenum (DU), often occurring in a severe form.

Epidemiology

Duodenitis is considered the most common disease of the duodenum, one of the varieties of which is bulbitis. It is called focal bulbitis due to the fact that the mucosal lesion has a limited localization, i.e. the inflammation does not cover the entire duodenum, but only its bulbous section.

This pathology has no clear age restrictions for patients. Adults, children and old people suffer from it equally. Very often the disease begins to develop in childhood, which is where the idea of the influence of a hereditary factor came from.

As for the dependence of the frequency of bulbitis diagnosis on the gender of patients, here the statistics are more favorable to men. Most often, this pathology is detected in young girls and middle-aged women.

Causes focal bulbitis

To be more specific, the inflammation does not occur in the entire duodenum, which connects the stomach and intestines and is 12 finger widths long, as in duodenitis, but only in its initial section - the bulb, which is adjacent to the pylorus of the stomach. Such closeness of the organs is the reason that bulbitis is often confused with gastritis. Hence the alternative name - gastric bulbitis.

But this is all anatomy, and what are the reasons for the development of this pathology with an unusual name? The thing is that inflammation occurs where food is retained, abundantly flavored with gastric juice, causing irritation of the mucous membrane. Long-term presence of food in the bulb of the duodenum leads to the growth of bacteria in it. Food retention in turn occurs due to impaired motility of the organ. But this is only one of the reasons why inflammation develops in the duodenum.

The disruption of the "health" of the duodenum in its bulbar section and the development of the same focal bulbitis are facilitated by both some pathologies and causes far from medicine. Among the pathological processes in the body that lead to bulbitis, it is worth highlighting some diseases of the gastrointestinal tract. We are talking about the well-known gastritis, colitis, pancreatitis, gastric ulcer and duodenal ulcer, especially in the chronic course of diseases, the presence of a bacterial infection in any of the organs of the gastrointestinal tract (for example, the same Helicobacter pylori).

The development of bulbitis can be caused by disorders in other organs, such as the pancreas, gall bladder, kidneys, and liver. The cause of bulbitis can be both anomalies in their structure, affecting the location and functioning of the stomach, as well as the upper intestines, and disorders of their functioning. Pathologies of the respiratory and cardiovascular systems, leading to oxygen starvation of tissues and disruption of metabolic processes in them, can also cause inflammatory processes in the gastrointestinal tract.

Risk factors

The following factors may be risk factors for the development of inflammation of the mucous membrane in the duodenum, which is similar in structure to the gastric mucosa:

• Abuse of drugs that have a negative impact on the health and functioning of the gastrointestinal tract, and the duodenum in particular.
• Traumas in the peritoneum.
• Endocrine diseases, metabolic disorders.
• Damage to the mucous membrane of the bulbar part of the duodenum due to the passage of a foreign body through it.
• Cavity operations (their consequences).
• Bad habits: addiction to alcohol, smoking abuse, overeating. Smoking and alcohol contribute to increased production of pepsin and hydrochloric acid while slowing down the motility of the gastrointestinal tract.
• Intoxication of the body due to poisoning with food products and chemicals.
• An unhealthy diet with a predominance of heavy, fatty foods, generously seasoned with spices and hot sauces.
• Irregular meals, eating dry food, overindulgence in caffeine-containing products and fried foods.
• The spread of bacterial infection in the body.
• Frequent stressful situations, prolonged depression.
• Weakened immunity.

There are certain prerequisites to believe that the development of the disease may be influenced by heredity or a genetic factor that causes pathologies in the structure of the duodenum itself, which makes it difficult for food to move through it, causing stagnation and inflammation.

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Pathogenesis

It so happens that the most common cause of various inflammatory diseases of the gastrointestinal tract, including focal bulbitis, is a bacterium called Helicobacter pylori. It is to it that we owe the restructuring of the epithelial layer of the gastric mucosa and the duodenal bulb, leading to metaplasia and the development of inflammation.

The modified mucosal tissue is most susceptible to irritation by aggressive substances, such as hydrochloric acid and pepsin, produced by special stomach cells. Hence, there is a high probability of small wounds (erosions) appearing on the mucosa, which aggravate the inflammatory process.

In principle, increased acidity of gastric juice can sooner or later cause an inflammatory process even in the absence of a bacterial infection. And there are a great many reasons for the increased level of hydrochloric acid in the stomach.

Some factors, such as the presence of parasites in the body (lamblia, worms, etc.), can not only cause the development of pathology, but also transfer it to a chronic form. While the use of certain drugs in large doses or alcoholic beverages becomes a frequent cause of exacerbations of focal and other types of bulbitis.

By and large, pure bulbitis is quite rare. It usually accompanies other gastrointestinal pathologies, especially inflammatory ones. And the presence of the Helicobacter pylori bacteria in the stomach can very likely transfer the inflammatory process to the area of the duodenal bulb, located in close proximity to the pylorus.

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Symptoms focal bulbitis

The symptoms of bulbitis are not specific, because the bulk of symptoms are to one degree or another characteristic of most pathologies of the gastrointestinal tract. And yet, there are some points that allow a gastroenterologist to suspect focal bulbitis in a patient, and not the same gastritis or duodenal ulcer.

So, the first signs of bulbitis development are considered to be pains under the "pit of the stomach". The pains arising in the epigastric region can be different: strong or not expressed, sharp, cramping, pulling-aching. The pain can appear at any time of the day, but most often it happens an hour or two after eating or at night.

The localization of pain may vary slightly. Sometimes it radiates to the right hypochondrium or is concentrated near the navel.

Pain can be relieved by eating small meals at regular intervals or taking medications that reduce the acidity of gastric juice (antacids).

In addition to pain, constant and pronounced symptoms of focal bulbitis include various dyspeptic symptoms, such as nausea, a burning sensation in the esophagus (heartburn), belching with a bitter taste, sometimes accompanied by vomiting, a feeling of bitterness in the mouth regardless of food intake, and an unpleasant odor from the mouth (according to complaints from many patients). A whitish coating with some yellowness is observed on the tongue.

The feeling of heaviness and distension in the epigastric region gradually becomes permanent, although at the beginning of the development of the pathology they were episodic.

A change in the quality of stool is noted. Most often, patients complain of constipation lasting for several days.

Focal bulbitis is also characterized by some neurological symptoms resembling "dumping syndrome". The appearance of such symptoms as severe sweating, causeless weakness with attacks of dizziness, rapid fatigue, hand tremors, loose stools to the point of diarrhea in young patients is associated with the excitation of the vegetative part of the central nervous system, which in turn is caused by disturbances in the functioning of the gastrointestinal endocrine system, which regulates the functioning of the gastrointestinal tract and some other organs. These symptoms are most often observed 2-3 hours after eating.

Sometimes, against the background of bulbitis, patients note frequent headaches, incomprehensible periodically recurring tremors in the body and an almost insatiable feeling of hunger.

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Forms

We have considered the general symptoms of bulbitis, without going into some of the nuances. But focal bulbitis is, in a sense, a collective name, which unites several varieties of this pathology.

So, in gastrology, the following types of bulbitis are distinguished:

• Focal superficial bulbitis

This diagnosis indicates that the foci of inflammation may be located in one or several places of the mucous membrane of the bulbar region of the duodenum, but only the upper layers of the epithelium remain damaged.

This is probably the mildest and most common form of bulbitis. It is characterized by spasmodic pain in the epigastrium, radiating to the right hypochondrium and the navel area. They can appear either an hour or an hour and a half after eating, or independently of it. In addition, patients may suffer from nausea, constant gas, headaches, weakness. A whitish coating appears on the tongue.

• Erythematous bulbitis

Depending on the cause, it can be called either toxic-allergic (due to taking medications) or infectious-allergic (due to the influence of a bacterial infection).

If oval lesions of a bright red color form on the mucous membrane, this type of pathology is called focal erythematous bulbitis.

It is characterized by decreased appetite, heartburn attacks, “hunger pains” and pain immediately after eating, which radiate to the right hypochondrium, mild nausea, digestive and stool disorders.

• Erosive focal bulbitis

The second most common type of pathology. It is characterized by the appearance of inflammation foci on the mucous membrane, on which there are small wounds or cracks, surrounded by inflamed, edematous folds. This type of bulbitis is considered a borderline condition between its superficial form and an ulcer of the duodenal bulb.

In this case, pain may appear 1-2 hours after eating, at night, and also in the morning on an empty stomach. It may radiate to the navel and back area. After eating, the intensity of pain noticeably decreases. After eating, belching of the food eaten is observed, a bitter taste appears in the mouth, attacks of heartburn and nausea become more frequent, sometimes leading to vomiting, dizziness, weakness.

• Follicular bulbitis

This type of bulbitis is spoken of when an endoscopic examination shows the presence of small bubbles with liquid contents on the surface of the mucous bulb of the duodenum, which are called follicles. If separate clusters of such bubbles are visible, we are talking about a focal form of follicular bulbitis, characterized by a severe course.

This type of inflammatory pathology of the duodenum is characterized by night and morning pain on an “empty” stomach, radiating to the back and navel, as well as belching of undigested food, nausea and vomiting, heartburn, bitterness and an unpleasant odor in the mouth.

• Focal catarrhal bulbitis

Here we are talking about the stage of exacerbation of the chronic form of focal bulbitis, characterized by symptoms similar to peptic ulcer disease. These are attacks of morning sickness, intestinal disorders, sour belching after eating, dyspeptic symptoms (bloating and heaviness in the stomach), pain under the "spoon", in the navel area or right hypochondrium. These symptoms are accompanied by frequent headaches and general malaise.

• Atrophic form of bulbitis

It is characterized by atrophy of the mucous bulb of the duodenum. This manifests itself in its thinning and disruption of the organ's functions.

It is accompanied by heaviness in the stomach, belching of undigested food, aching pain in the epigastrium, digestive and stool disorders, and general malaise.

Acute bulbitis is spoken of when the symptoms of the pathology are expressed most clearly, and the patient's well-being leaves much to be desired. In the chronic form, the course of the disease consists of a constant change of periods of exacerbation and remission. And all therapeutic measures are reduced to the earliest possible onset of the latter.

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Complications and consequences

The fact is that focal bulbitis is a rather insidious pathology, because the inflammatory process even in a small area of the duodenum can negatively affect the functioning of the organ itself and the work of other organs and systems of the body. And we are not only talking about the digestive system.

It is worth noting that any type of focal bulbitis, except erosive, in the absence of appropriate treatment threatens to turn into an erosive form, which in turn is a kind of bridge to a duodenal ulcer. Perforation of the ulcer threatens the contents of the duodenum to enter the abdominal cavity and the development of peritonitis. And here time is running out.

An exacerbation of the chronic inflammatory process in the duodenum with insufficient treatment and non-compliance with the diet can ultimately lead to bleeding on the mucous membrane of the organ, which is also dangerous not only for the health, but also for the life of the patient.

But these are all complications, and the consequences of inflammation of the mucous membrane of the duodenal bulb will eventually affect the health of the entire body. Violation of the mucous membrane structure leads to deterioration of the organ's functioning, as a result of which the body does not receive the necessary nutrients from food (vitamins, microelements, amino acids, etc.), immunity decreases. Other organs and systems begin to suffer, which is fraught with the development of other pathologies affecting the endocrine, cardiovascular, nervous and other systems.

Diagnostics focal bulbitis

With all the variety of symptoms of focal bulbitis, it is often not so easy to diagnose it. The disease can proceed in a latent form, which is typical for a chronic course, and be discovered completely by chance during a gastrologic or X-ray examination for a completely different reason.

The situation is complicated by the fact that the pain syndrome can vary in intensity, occur at different times of the day, and the nature of the pain is inconsistent. For example, nagging, unexpressed pains radiating to different areas of the abdominal cavity and back can confuse even an experienced doctor. Several organs are suspected at once.

Stabbing pains in the area of the navel on the right with acute superficial bulbitis are more likely to raise suspicion of appendicitis than of inflammation of the bulb of the duodenum. However, in this case, inflammation of the appendix is easily excluded by palpation.

And the rest of the symptoms, especially neurological ones, are characteristic of many pathological processes, sometimes not even associated with the digestive system.

The fact that the symptoms of the disease are not unique does not mean that they should be ignored. When diagnosing focal bulbitis, the gastroenterologist is interested in any details that can clarify the situation: full symptoms, including the localization and time of pain, their connection with the intake of spicy and fatty foods, etc.

On palpation, the doctor detects pain in the area of the duodenal bulb, accompanied by noticeable muscle tension. Examination of the tongue will show a thick coating on it, accompanying problems with digestion.

Laboratory research

Blood tests (general and biochemical) will help determine the presence of an inflammatory process without special studies. However, during remission of the disease, a general blood test may not show anything. But during an exacerbation, an increase in the level of leukocytes and ESR is observed. A biochemical analysis will show an increase in CRP (C-reactive protein produced in the liver), a change in the level of pancreatic enzymes.

The erosive form of bulbitis may be accompanied by internal bleeding of varying intensity. Both a blood test (change in the number of red blood cells and hemoglobin level) and a stool test for the presence of blood will help to identify them.

But laboratory tests do not end there, because they can only show the presence of inflammation, but not its location or cause. But a common cause of focal bulbitis is a bacterial infection. Laboratory tests will help to identify the causative agent of the infection, but specific ones, the material for which is obtained during instrumental examination.

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Instrumental diagnostics

Since the inflammatory process in focal bulbitis develops deep inside the body, it is impossible to determine it during an external examination without additional laboratory and instrumental studies. Instrumental diagnostics plays a major role in establishing the correct diagnosis.

The main methods for diagnosing diseases of the stomach and duodenum are:

• X-ray examination of the corresponding organs with a contrast agent (barium passage radiography, antroduodenal manometry). X-ray examination of bulbitis will show spastic contractions of the muscles of the duodenal bulb, chaotic peristalsis, stagnation of food in the bulbous region (bulbostasis), accompanied by an increase in the organ's volume.
• An ultrasound examination will help determine the chronic course of the disease and the localization of inflammation, the condition of the duodenum, pancreas and liver.
• Fibrogastroduodenoscopy (FGDS) allows you to see damage to the organ from the inside and take material (a sample of gastric juice) for testing for the presence of an infectious agent. As a result of the study, it is possible to examine foci of inflammation, the presence of microdamage and wounds on the mucous membrane of the duodenal bulb, and determine the acidity of the gastric juice.

Research is required to detect a bacterial infection and determine its type. The following may be performed:

• breath test,
• enzyme immunoassay (ELISA) for the presence of antibodies in the blood or antigens,
• analysis based on the polymerase chain reaction (PCR) method, which allows the detection of the DNA of the pathogen in the test material,
• morphological studies of biopsy.

Differential diagnosis

Differential diagnostics is carried out based on the results of the above studies, as a result of which focal bulbitis can be distinguished from similar diseases of the digestive system and other health pathologies. In particular, from the same gastritis (or pathologies coexist together, which will also be shown by differential diagnostics), Crohn's disease, affecting the entire digestive tract, gastric ulcers and duodenal ulcers, pancreatitis, colitis, etc.

Treatment focal bulbitis

Focal bulbitis, like any other disease of the gastrointestinal tract, requires complex treatment, including medication, herbal decoctions, vitamin complexes in combination with physiotherapy and adherence to a special therapeutic diet.

Treatment should begin immediately with a change in the patient's lifestyle. He will have to reconsider his taste preferences, limiting himself in both the methods of cooking and the amount of food at one time, giving preference to fractional meals. An important condition for the effective treatment of gastrointestinal diseases is considered to be quitting smoking and drinking alcohol, which have an irritating effect on the mucous membrane of the stomach and duodenum. It may be necessary to reconsider the medicine arsenal in the home medicine cabinet.

Drug therapy is also multicomponent, since it simultaneously pursues several goals:

• Reduction of dyspeptic symptoms and improvement of the patient's well-being. For this purpose, anti-inflammatory drugs and antacids (in particular bismuth preparations) are used: Wobenzym, Almagel, Gastal, etc.
• Normalization of gastric and duodenal motility by relieving spasms of the smooth muscles of the gastrointestinal tract. Reduction of neurological symptoms. For this purpose, antispasmodics (No-shpa, Spazmil, etc.) and dopamine receptor antagonists (Motilium, Cerucal, etc.) are used.
• Improvement of metabolic processes in the mucous membrane of the duodenal bulb, which accelerates the healing process, increases tissue resistance to the negative impact of aggressive factors (biogenic stimulants and drugs that improve tissue metabolism - Solcoseryl, Actovegin, sea buckthorn oil, as well as protective agents with anti-inflammatory and enveloping action - Liquiriton, licorice root infusion).
• Fighting the bacterial infection that caused the development of the inflammatory process with the help of antibiotics (Amoxicillin, Clariromycin and Metronidazole according to special 2-component and 3-component treatment regimens), proton pump inhibitors Omez, Omeprazole, Pantoprazole, which are used according to the regimen together with antibiotics, bismuth preparations (De-nol, Novobismol, etc.), histamine H2-receptor blockers ₍ Ranitidine, Famotidine, etc.).

The antibacterial treatment regimens used are the same as those used in the treatment of gastritis with high acidity caused by Helicobacter pylori.

Phytotherapy has also proven itself in this regard. Patients are prescribed special herbal infusions that normalize the functioning of the gastrointestinal tract. Such infusions are sold in almost all pharmacies.

In addition to medications and herbal infusions, patients are prescribed vitamins and vitamin-mineral complexes to help replenish the body's lack of essential nutrients that arise as a result of improper functioning of the digestive system. Including vitamins in the treatment plan allows you to:

• effectively combat the manifestations of anemia,
• significantly reduce the manifestations of the disease associated with the autonomic system,
• improve the general condition of patients with chronic diseases and lead to faster recovery in acute cases of the disease.

Physiotherapeutic treatment for focal bulbitis can also be multifaceted. Its main goals are to reduce inflammation and relieve pain. Magnetic therapy, UHF procedures, UV radiation, electrophoresis with drugs with antispasmodic and analgesic effects (Papaverine, Novocaine) have proven themselves well.

Patients with focal bulbitis are recommended to undergo sanatorium and resort treatment twice a year, with mandatory intake of medicinal mineral waters. Mineral waters can be included in the diet and during home treatment. Borjomi, Essentuki No. 4, Essentuki No. 17, Truskavets, etc. will prove effective.

Doctors resort to surgical treatment if other methods do not produce results, and then mainly in the case of erosive focal bulbitis, accompanied by bleeding. According to indications, operations of trunk or proximal vagotomy are performed with the interruption of nerves responsible for the production of hydrochloric acid.

In case of bleeding, emergency surgery is performed to ligate the bleeding vessels or apply a special clip during gastroduodenoscopy. If there is a suspicion of a duodenal ulcer, duodenoscopy is performed with subsequent suturing of the ulcer.

Drug therapy for focal bulbitis

We will not dwell in detail on anti-Helicobacter therapy, the methods of which can be found in the article on the treatment of gastritis with high acidity. Let's consider some drugs that help improve the condition of patients with focal bulbitis caused by both Helicobacter pylori and other causes.

So, to relieve inflammation in the duodenal bulb and increase the body's defenses, allowing it to effectively resist the disease, the drug "Wobenzym" will be useful. Quite often, this drug is prescribed for erosive gastritis (without a tendency to bleeding) to prevent its transition to peptic ulcer disease.

This drug will also be useful during antibiotic therapy, as it is able to normalize the intestinal microflora, preventing the development of dysbacteriosis.

Method of administration and dosage. The drug is available in the form of tablets for oral administration, which must be taken whole, without crushing. It is advisable to do this at least half an hour before meals, washing down the medicine with a glass of water.

The dosage is determined by the doctor individually depending on the patient's age, diagnosis and form of the disease. For adults, the recommended dose is 3 to 10 tablets three times a day; for children aged 5 to 12, the effective dose is determined based on the patient's weight (1 tablet for every 6 kg of body weight).

The therapeutic course can last from 2 weeks to 3 months, and in chronic cases it is repeated in courses up to six months.

During antibiotic therapy for 2 weeks, it is recommended to take the drug 5 tablets 3 times a day.

There are not so many contraindications to the use of the drug. These are age up to 5 years, with an increased likelihood of bleeding, during hemodialysis. And of course, the medicinal "Wobenzym" is not prescribed in case of hypersensitivity to the drug.

Side effects of the drug are limited to changes in the appearance and smell of feces, the appearance of an allergic reaction (urticaria). The latter requires dose adjustment.

The widely known drug "Motilium" will help reduce the intensity of dyspeptic symptoms (nausea, vomiting, belching, heartburn, bloating, etc.).

It is best to take the drug in the form of tablets or suspension (option for children) before meals. In this case, a single dose for tablets is 1-2 pieces 3 or 4 times a day, for suspension 10-20 mg also 3 or 4 times a day. For children under 12 years of age with a body weight below 35 kg, the dosage is calculated based on the patient's weight.

The drug is not prescribed for proctilanoma, gastrointestinal bleeding, ulcer perforation, intestinal obstruction, serious liver dysfunction, hypersensitivity to the components of the drug.

When prescribing the drug during antibiotic treatment, it should be taken into account that it is incompatible with some of them, for example, with Clarithromycin, used to combat Helicobacter pylori, as well as other drug interactions.

Side effects that may occur in patients taking Motilium are limited to increased anxiety, decreased sexual desire, drowsiness, dry mouth, bowel disorders, amenorrhea, menstrual irregularities, urticaria. Some patients note discomfort in the mammary glands (pain, swelling, etc.).

To speed up the process of tissue regeneration and improve metabolism in focal bulbitis, the drug "Actovegin" is the best choice. It is available in the form of an injection solution, tablets and ointments.

The drug in the form of a solution is used for intramuscular injections and intravenous infusions. Tablets are intended for oral administration.

The injection of the drug is carried out according to two schemes: 1) daily, 2) 3 or 4 times a week. In this case, a single dose is 5 (i/m) or 10 (i/v) ml of solution.

Tablets are taken before meals in the amount of 1-2 pieces. Frequency of administration is 3 times a day. The therapeutic course is quite long - from 1 to 1.5 months.

The drug is not used in the treatment of patients with hypersensitivity to its components. Taking the drug may be accompanied by the development of various allergic reactions against the background of increased sensitivity.

"Liquiriton" is a preparation based on licorice root, which has many useful properties. It envelops the mucous membrane of the stomach and duodenum, forming a protective film that protects tissues from the effects of aggressive factors, gives a good anti-inflammatory, antispasmodic and mild acid-reducing effect.

The drug is available in the form of tablets for oral administration, which should be taken 1-2 pieces 3 to 4 times a day every day. This should be done half an hour before meals for 4-5 weeks.

The drug is not prescribed in case of hypersensitivity to its components. Side effects in the form of allergic reactions occur precisely against this background.

Folk treatment of focal bulbitis

I think many people understand that it is unlikely that you will be able to get rid of a bacterial infection in the gastrointestinal tract using folk remedies, but alternative medicine methods are quite capable of alleviating the condition of such patients. And if focal bulbitis is not caused by a bacterial cause, then in some cases folk treatment plus diet are the main methods of combating the disease.

To relieve pain and inflammation, as well as to speed up the healing of erosions on the mucous membrane, use propolis tincture, purchased at a pharmacy or prepared independently from 50 g of propolis and a glass of 70% alcohol (insist for a week!). We use the tincture by diluting 20 drops in ½ glass of milk and drinking an hour and a half before meals. Frequency of administration is 3 times a day. The course of treatment is 3-4 weeks.

Rosehip syrup, prepared from 0.5 kg of crushed plant fruits, 0.5 kg of sugar and 3 glasses of water, is also effective for focal bulbitis. The syrup should be taken 1 tablespoon 3 times a day.

To reduce the aggressive effect of hydrochloric acid on the duodenal mucosa, use fresh potato juice (half a glass 2-3 times a day on an empty stomach).

Also useful are enveloping decoctions (rice and oatmeal), prepared without salt, as well as tea from licorice root.

Herbs provide invaluable help in the treatment of bulbitis. Herbal treatment is considered more gentle when it comes to damaged mucous membranes of the gastrointestinal tract. Useful in this regard are licorice, calamus, plantain (leaves and seeds), chamomile, St. John's wort, Icelandic moss and medicinal infusions based on these plants.

Homeopathy

Homeopathy will also have a gentle but effective effect on the diseased stomach and duodenum in case of focal bulbitis.

The same Bismuth, preparations of which help to normalize the acid function of the stomach and fight bacterial infections, should be taken for pain in the epigastric region, heartburn, and loose stools.

Acidum aceticum will also help reduce the level of hydrochloric acid in the stomach, stop vomiting, and stop bleeding in erosive bulbitis.

Agaricus helps relieve neurological symptoms associated with gastrointestinal diseases.

Aloe preparations will help with abdominal pain and bloating, bitterness in the mouth and heaviness in the liver area.

Gentiana is useful for belching, flatulence and nausea. It can also stimulate the appetite.

There are a great many homeopathic remedies used to treat the gastrointestinal tract. But the name, method of application and dosage of the prescribed drugs depend on the doctor's prescription. Homeopathic remedies are diluted in different potencies. In the chronic course of the disease, higher potencies are indicated (12, 30), and in acute bulbitis, the homeopath will prescribe the same drugs, but in lower potencies (3 and 6).

Diet for focal bulbitis

A diet for digestive system diseases, including focal bulbitis, is not a way to combat excess weight, but a treatment procedure no less significant than other doctor's prescriptions. And here it is important that the diet is complete, but gentle on the stomach and duodenum.

Dishes that can irritate the duodenal mucosa or provoke increased production of gastric juice (too salty or sweet, spicy, sour, fried foods, hot sauces, seasonings, etc.) are excluded from the patient’s diet.

For some time you will have to give up canned food, various pickles, foods with coarse fiber, coffee and drinks containing it, and strong tea.

Dry food is excluded. Dishes should be liquid or pureed with limited addition of oil. Food should not be hot or cold.

Patients are ideally suited to steamed meat, fish and vegetables, but you can also include boiled, stewed and baked dishes without oil, vegetable broths, fruits (not sour) and vegetables (not fresh), compotes and herbal teas in the diet.

Fractional nutrition is recommended. In this case, the frequency of food intake increases, and portions are cut.

Prevention

Since focal bulbitis most often develops against the background of existing gastritis, the main preventive measure in this case will be timely treatment of the pathology that caused inflammation of the duodenum. If Helicobacter infection also joins in, then effective treatment is necessary according to the indications and schemes prescribed by a gastroenterologist.

To avoid Helicobacter pylori getting into the body, it is necessary to wash your hands with soap before eating. Many products, especially those that are not subsequently heat treated, should also be thoroughly cleaned under running water.

Proper nutrition and quitting bad habits will help prevent many gastrointestinal diseases. You should try to avoid stress, strengthen your body with physical exercise in the fresh air and vitamins. Immune stimulant drugs will also be useful.

Forecast

The prognosis of bulbitis depends on the timeliness of seeking help from a medical institution and following all the doctor's instructions. The least favorable prognosis is observed with the erosive form of focal bulbitis, which tends to develop into an ulcer of the duodenal bulb.