The evaluation of the digestive and suction function of the duodenum in chronic duodenal insufficiency

Objective: a comprehensive study of neurohormonal regulatory factors and the determination of their involvement in the violation of digestive and suction functions in chronic duodenal insufficiency. Materials and methods: 60 patients with CDN were under observation. The average age of patients was 36.1±12.4 years, women were 27 (45.0%), men - 33 (55%). The control group included 30 healthy individuals. CDN was verified using anamnesis, objective data and the results of X-ray and endoscopic examinations. Protein, lipid, vitamin and trace element metabolism and hormonal background were studied using enzyme immunoassay. The enteral microbiota was studied using gas chromatography combined with mass spectrometry. Loading absorption tests with glucose, starch and sucrose were used to assess intestinal digestion, absorption and barrier function of the DPC. All the results of the study were subjected to statistical processing. Results: All patients with CDN noted dyspeptic symptoms presented in 34 (56.7%) patients with belching (χ2=51.8, p=0.001), in 46 (76.6%) - a feeling of bitterness in the mouth (χ2=66.53, p<0.001), in 32 (53.3%) - heartburn (χ2=20.2, p<0.001), flatulence - in 34 (56.6%) (χ2=50.4, p<0.001) and mushy stools - 43 (71.6%) patients (χ2=60.2, p<0.001).In patients with CDN, there was a decrease in total protein (62.24±0.17 g/l), triglyceride levels (0.42±0.13 mmol/l) and transferrin saturation coefficient (13.2%) compared to healthy individuals, respectively (72.3±0.21 g/l, 1.5±0.04 mmol/l, 37.4%, p<0.05). When studying the digestive function of the duodenum in CDN, a violation of abdominal digestion was revealed in 57 (95%) patients, parietal digestion-in 50 (83.3%), absorption- in 44 (74.1%) patients. The resident microflora is represented (p=0.015) by a decrease in Lactobacillus spp 1245.3±0.21 cl/g x 103 and Bifidobacterium spp 1453.2±0.18cl/g x 103 (p=0.021) and a significant increase in bacteria of the genus Clostridium, Eggerthella lenta, Propionibacterium acnes, Propionibacterium freudenreichii, Propionibacterium jenseni, Staphylococcus spp, Streptococcus mutans (anaerobic), Streptomyces spp. Conclusion. In chronic duodenal insufficiency, according to stress tests with mono-,di- and polysaccharides, a violation was noted at all stages of hydrolysis and resorption in the duodenum. In addition, a decrease in blood transferrin, vitamins B12 and D also reflect to a certain extent a violation of resorption processes in the duodenum. The data obtained indicate the involvement of hormonal factors and parietal dysbiosis in the violation of the digestive and absorption function of the duodenum.

chronic duodenal insufficiency, abdominal, parietal digestion, absorption, duodenum

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