Жовч в шлунку: причини, симптоми і лікування

Жовч в шлунку: причини, симптоми і лікування

Жовч в шлунку

Жовч в шлунку є характерним симптомом гастродуоденального рефлюксу. У нормі жовч потрапляє з печінки в дванадцятипалу кишку і далі просувається в нижні відділи кишечника. При деяких захворюваннях, що супроводжуються порушенням функції воротаря і підвищенням тиску в дванадцятипалій кишці, відбувається закид дуоденального вмісту в шлунок.

Причини жовчі в шлунку

Їжа, яку вживає людина, хатися лише в одному напрямку. З ротової порожнини вона потрапляє в стравохід, просувається в шлунок, проникає в дванадцятипалу кишку, а з неї – в інші відділи тонкого і товстого кишечника. Зворотному проходженню харчової грудки перешкоджають сфінктери – клапани, що складаються з кругових м’язів. Винятком єблювота – захисний рефлекс, що дозволяє вивести токсичні речовини з шлунка.

Найбільш поширені причини закидання жовчі в шлунок:

Травми, грижі, пухлинні захворювання органів черевної порожнини. Вони призводять до механічного здавлення дванадцятипалої кишки. Жовч, перебуваючи під тиском, долає опір сфінктера воротаря і потрапляє в шлунок. Вагітність. Механізм розвитку гастродуоденальної рефлюксу ідентичний тому, який описаний вище. Плід здавлює дванадцятипалу кишку, підвищуючи тиск у ній. У результаті відбувається закид жовчі в шлунок. Медичні препарати. Застосування спазмолітиків або міорелаксантів знижує тонус м’язів сфінктера воротаря. Між дванадцятипалої кишкою і шлунком утворюється просвіт, через який може проникати жовч. Оперативні втручання. Якщо під час хірургічної операції відбулося розсічення частини м’язових волокон сфінктера воротаря, то жовч буде потрапляти в шлунок постійно. Хронічний дуоденіт. Слизова оболонка дванадцятипалої кишки запалюється і набрякає. Це призводить до підвищення тиску і ввезенню дуоденального вмісту, в тому числі жовчі, в шлунок. до змісту # 8593;

Симптоми жовчі в шлунку

Час від часу закид жовчі в шлунок буває навіть у здорових людей. Якщо це відбувається нечасто, симптоми не з’являються. Але при тривалому перебігу гастродуоденальної рефлюксу розвивається клінічна картина захворювання.

Біль у животі. Цей симптом є постійним супутником будь-яких захворювань травної системи. При закиданні жовчі в шлунок відсутня чітка локалізація болю. Пацієнт не може точно вказати місце, яке болить. Печія. Іноді жовч може зі шлунка потрапляти в стравохід, дратуючи його слизову оболонку і викликаючи відчуття печіння за грудиною. Відрижка. У шлунку утворюються гази, які мають неприємний запах. Іноді відбувається відрижка гірким, коли в ротову порожнину потрапляє вміст шлунка разом з жовчю. Почуття розпирання в животі. Жовтий наліт на язиці. Блювота жовчю. до змісту # 8593;

Ускладнення

Заброс жовчі в шлунок небезпечний не тільки сам по собі. При тривалому перебігу захворювання можуть розвиватися деякі ускладнення гастродуоденального рефлюксу.

Рефлюкс-гастрит. Захворювання, при якому слизова оболонка шлунка запалюється внаслідок постійного впливу на неї жовчних кислот. Якщо кислотність в шлунку підвищена, ймовірність розвитку рефлюкс-гастриту збільшується. Гастроезофагеальна рефлюксна хвороба. При цьому захворюванні вміст шлунка періодично потрапляє в стравохід, пошкоджуючи його стінки. Якщо хвороба прогресує, хворому показане оперативне втручання. Стравохід Барретта. Регулярне пошкодження жовчними кислотами нижніх відділів стравоходу призводить до заміни плоского багатошарового епітелію циліндричним. Стравохід Барретта є передракових станом. до змісту # 8593;

Лікування жовчі в шлунку

При лікуванні жовчного рефлюксу варто пам’ятати, що він є лише синдромом, а не самостійним захворюванням. Якщо не усунути причину закидання жовчі в шлунок, то хвороба буде супроводжувати людину протягом усього життя. Тим не менш, симптоматичне лікування необхідно. Воно дозволяє поліпшити якість життя хворого і попередити можливі ускладнення гастродуоденального рефлюксу.

Селективні прокинетики. Ці препарати прискорюють спорожнення шлунка і підвищують тонус сфінктерів. Чим швидше жовч буде залишати шлунок, тим менше вона буде дратувати його слизову оболонку. Мотіліум і цизаприд є представниками цієї групи препаратів. Інгібітори протонної помпи. Чим вища кислотність в шлунку, тим більш агресивно жовч впливає на його слизову оболонку. Знижуючи кислотність за допомогою інгібіторів протонної помпи, можна захистити шлунок від шкідливого впливу жовчних кислот. Найбільш ефективними представниками цієї групи препаратів є рабепразол (парієт) і езомепразол (нексіум). Антациди. Ці препарати теж знижують кислотність в шлунку. Їх не потрібно використовувати разом з інгібіторами протонної помпи. Ці групи препаратів мають різний механізм дії, але їх застосування призводить до єдиного результату. Слід вибрати лише один з них. Інгібітори протонної помпи діють довше, але вони дорогі. Антациди дешевше, але приймати їх доведеться частіше. До них відносяться маалокс, альмагель і безліч інших препаратів. Урсодезоксихолева кислота (урсофальк). При рефлюксі урсофальк приймається два рази на день по 250 мг. Цей препарат змінює форму жовчних кислот на водорастворимую. Вона є менш токсичною для шлунка. Урсофальк усуває такі симптоми, як блювота жовчю і відрижка гірким.

Більшість захворювань, які призводять до закидання жовчі в шлунок, лікуються хірургічним шляхом. Винятком єхронічний дуоденіт. Він лікується консервативно.

Лапароскопічна корекція гастродуоденального рефлюксу. Це малоінвазивний спосіб лікування, при якому хірургічне втручання проходить без розтину черевної порожнини. Є ідеальним рішенням при недостатності сфінктера воротаря. Хірургічне втручання з використанням лапаротомії. Залежно від причини, що викликала розвиток гастродуоденального рефлюксу, застосовуються різні види операцій. Хірургічним методом видаляють пухлину або грижу, здавлюючу дванадцятипалу кишку. Різними способами усувають недостатність сфінктера воротаря.

Жовч в шлунку – це всього лише симптом, а не самостійне захворювання. Але поява цього симптому вимагає ретельної діагностики. Потрібно виявити і вилікувати основне захворювання, що стало причиною занедбаності жовчі в шлунок. При неможливості повного лікування, використовується симптоматична терапія, яка покликана знизити клінічні прояви хвороби і поліпшити якість життя хворого.

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