Biliary dyskinesia: symptoms, treatment, diet

Biliary dyskinesia - a disease of the gastrointestinal tract that is characterized by impaired motor function of the gall bladder and its sphincters in particular, the sphincter of Oddi. As a result of these violations are detected problems with the delivery of bile into the duodenum: its amount may be too little, not enough to digest food, or more than is necessary, which adversely affects the entire gastrointestinal tract.

According to statistics, biliary dyskinesia suffer most women. Some statistics indicate that women are 10 times more susceptible to this disease than men. Moreover, ill dyskinesia can be at any age. Also, there are statistics, DZHVP young people is characterized by excessive secretion of bile, and in later years there it is not enough for digestion. Treatment of this disease has a positive outlook, if a patient goes to a doctor when the first symptoms.

What it is?

Biliary dyskinesia - functional disorders of tone and motility of the gallbladder, bile ducts, and their sphincters, manifest violation of the outflow of bile into the duodenum, accompanied by the appearance of pain in the right hypochondria. In this organic changes of these bodies are absent.

Classification

It is from the manner in which there is a reduction of the gall bladder, and depends on the definition of forms of psoriasis:

gipomotornaya	reduction takes place slowly, the activity of the function of the gallbladder is significantly reduced. According to statistics gipomotornaya biliary dyskinesia often diagnosed in patients older than 40 years and in patients with persistent neurosis / psychosis.
gipermotornaya	in this case the body of the reduction is very frequent and fast. This form of the disease in question is inherent in young people.

Depending on the cause of this pathology doctors can divide it into two types:

primary	usually associated with congenital anomalies of the biliary tract structure.
secondary	the disease is acquired during life and is the result of abnormalities in other organs of the gastrointestinal tract (E.g., secondary biliary dyskinesia often "accompanies" pancreatitis - inflammation of the pancreas iron).

Causes of

Talking about psoriasis causes, we must remember that the disease is primary or secondary. Depending on this will change and the reasons which provoked dyskinesia.

The primary form of dyskinesia may be caused by the following reasons:

• inconsistency in the parasympathetic and sympathetic nervous system, so that the bubble itself and the sphincter of Oddi lose their tone;
• stress (acute, chronic), development psychosomatic pathologies;
• failures in the liver, resulting in bile produced with altered chemical composition;
• improper nutrition (overeating, eating too much fatty food, late breakfast, lunch and dinner);
• intestinal disturbances produce hormones responsible for the contractility of the gallbladder;
• not a meal, eating too much fatty foods, overeating, lack of refinement, eating in a hurry, etc .;
• allergy causing neuromuscular apparatus gall bladder is irritated condition and does not provide the normal reduction body;
• insufficient body weight, a sedentary lifestyle, muscular dystrophy.

Causes of secondary dyskinesia may be as follows:

• a history of chronic diseases of the abdominal cavity - ovarian cyst, pyelonephritis, adnexitis, etc .;
• previous myocardial duodenitis, peptic ulcer disease, gastritis, atrophy of the mucosa of the gastrointestinal tract;
• worm infestation;
• cholelithiasis, hepatitis, cholangitis, cholecystitis;
• congenital anomalies of the biliary tract and gall bladder;
• endocrine disorders, hormonal surges;
• inflammatory diseases of the gastrointestinal tract caused by pathogenic bacteria, such as salmonella.

There are documented cases of diagnosing biliary dyskinesia on the background of a sedentary lifestyle, excess weight (Obesity stage 2-3), excessive exercise (especially if you are constantly lifting weights) and after the psycho-emotional disruptions.

Symptoms of biliary dyskinesia

The clinical picture described by the pathology expressed enough, so the diagnosis is not difficult art. The main symptoms of biliary tract dyskinesia in adults are:

1. Dyspeptic syndrome is characterized by nausea, bitterness and dry mouth, belching bitter aftertaste, bloating, unstable stool constipation-predominant or diarrhea, fatty stool. These symptoms are caused by disorders of the digestive processes associated with insufficient or excess flow of bile into the lumen.
2. Pain syndrome. The occurrence of pain caused by errors in diet or stress situations. When the hyperkinetic form of dysfunction of the patient concerned, spastic nature of pain in the right half abdomen under the ribs, extending to the left side of the chest, shoulder blades or in taking shingles character. At hypokinetic form of pain are bursting with character, pulling, radiating or without intensifying or endangered when changing body position. Pain may disappear on their own and appear again with varying frequency - from a few attacks per day to rare episodes during the month.
3. Asthenic-vegetative syndrome is characterized by weakness, fatigue, a feeling of constant weakness, drowsiness or insomnia, increased anxiety and other symptoms.
4. Cholestatic syndrome is rare variant with hypokinetic dyskinesia when continuing normally produces bile does not enter the proper screen into the intestine, and stored in the gall bladder, leading to the appearance of jaundice of the skin and sclera, pruritus, dark urine, pale feces, increase liver.
5. Symptoms neurosis - panic attacks, phobias (fears), obsessive thoughts, compulsions, aggression, anger, tearfulness, susceptibility, and others.

If the patient is suffering from manifestations of hypotonic dyskinesia, then this state is characterized by a dull and aching, in which also manifests a feeling of fullness in the right hypochondrium. The pain of the patient constantly worries, with his appetite is markedly reduced, the person is often sick, manifested regurgitation. body temperature rise is not observed, the clinical blood test also indicates the presence of abnormalities.

If it's a hypertensive dyskinesia, the pain is distinguished paroxysmal in nature. In this case, the pain is sharp enough, but continues a short period of time. Pain can be given to the right shoulder, or the shoulder blade. Very often such attacks occur after consuming fatty foods, high stress, both physical and emotional. Very often patients are hypertensive dyskinesia celebrate the manifestation of bitterness in the mouth, which often happens in the morning.

possible complications

As a rule, biliary dyskinesia patients seek help from doctors almost immediately after the first attack of pain. But many of them by removing the unpleasant symptoms, stop treatment prescribed, thus provoking the development of complications:

• duodenitis - inflammation in the membrane of the duodenum;
• the formation of stones in the gall bladder and ducts - cholelithiasis;
• chronic cholecystitis - inflammation of the gallbladder that lasts more than 6 months in a row;
• atopic dermatitis - a skin disease, which is a consequence of the reduced level of immunity;
• pancreatitis chronic nature - inflammation of the pancreas within 6 months.

Biliary dyskinesia is quite favorable prognosis and does not shorten the life of the patient. But in the absence of effective treatment, and failure to comply with the recommendations of a nutritionist development of the above complications is inevitable. And even these diseases are not dangerous to human life, but the patient's condition will deteriorate considerably, will lead to disability over time.

Diagnostics

A significant role in the diagnosis of playing instrumental examination of the patient. The most effective results give duodenal intubation, ultrasound, gastroduodenoscopy, cholecystography.

1. Ultrasound examination during biliary dyskinesia conducted in two phases. First, an empty stomach and then again after 30-40 minutes after the "test meal". As a result of such procedures, analyzed the functionality of the biliary tract.
2. Duodenal intubation carried out with a special probe which is placed in the duodenum. The study bile taking samples for laboratory analysis. During manipulation tracked work biliary tract, the opening of their sphincters, analyzed the amount of bile secreted.
3. Oral cholecystography. During the study the patient drinks contrast agent. When it gets into the bladder, conducted a study of its functioning on the basis of which it can be concluded that some form of dyskinesia is manifested in the patient.
4. Gastroduodenoscopy carried out using a probe. During this procedure, examines the state of the mucous membranes of the esophagus, stomach and duodenum. If the mucosa of these organs in a state of inflammation and irritation, it is possible to conclude that the excess excretion of bile acids.
5. Laboratory methods: using biochemical blood tests to assess the condition of the biliary system. Analysis of blood lipid, or "lipidogram" indicates a high content of lipoproteins, low and very low-density lipoproteins (HDL, LDL, VLDL), as well as cholesterol.

It is also necessary to carry out a differential diagnosis of disease with other pathologies of the gastrointestinal tract, which is noted similar symptoms.

How to treat biliary dyskinesia?

In adults, treatment should be comprehensive, aimed at the normalization of the outflow of bile and preventing its stagnation in the gallbladder.

To do this, the following methods are used in the treatment of biliary tract dyskinesia:

1. Dieting (table № 5);
2. Normalization and maintenance of work and rest;
3. Acceptance of mineral water;
4. Physiotherapy (electrophoresis, diadynamic currents, paraffin baths);
5. Application closed tyubazh and duodenal intubation;
6. Acupuncture;
7. Massage;
8. Spa treatment (Truskavets, Myrhorod, resorts Transcarpathian Ukraine);
9. Medication normalizing the flow of bile, relieves pain syndrome, sphincter spasm removing and eliminating the painful symptomatology (enzyme, choleretic, antispasmodic);
10. Medication normalizing nervous system (tranquilizers, sedatives, tonics, etc.).

Binding methods of treatment of dyskinesia are normalization of work and rest, diet, medication and the use of tyubazh. All other methods are complementary and can be used on request and subject to availability. The duration of dyskinesias mandatory methods of treatment is 3 - 4 weeks. Helper methods can be used for much longer, cycling courses for the prevention of recurrence of the disease.

medicines

Since dyskinesia refers to diseases caused by the violation of the nervous regulation depends on mental state, before beginning the treatment of movement disorders in the biliary tract using choleretic medication, is necessary to restore the mental background patient. If pathology has appeared on the background of the doldrums, it is necessary to appoint a course of antidepressants lungs. If the violation was caused by the secretion process of expressed anxiety neurosis, it is advisable to start with neuroleptics and tranquilizers.

Such drugs may appoint a psychiatrist or psychotherapist. In addition, we treat the causes of psoriasis: the correction of dysbiosis, the elimination of vitamin deficiencies, allergy treatment, antihelminthic therapy.

The choice of drugs for functional recovery zhelcheoobrazovaniya biliary excretion and depends on the type of dyskinesia.

• When hypotonic type biliary dyskinesia prescribed flamen, cholecystokinin, magnesium sulfate, pancreozymin; Mineral waters of high salinity (Essentuki 17 ARZNI et al., room temperature or gently warmed for 30-60 minutes before meals, depending on the secretion of stomach). Phytotherapy: corn silk, flowers, Helichrysum, chamomile, nettle leaves, rose hips, St. John's wort, marjoram.
• When hypertonic type biliary dyskinesia used oksafenamid, Nicodin, mineral water weak mineralization (Slavyanovskaya, Smirnovskaya Essentuki 4, 20, Narzan in hot or heated state 5-6 times day). For herbal use chamomile flowers, peppermint, licorice root, valerian root, grass motherwort, fennel fruit.
• When intrahepatic cholestasis carried tyubazh (tubeless biliary drainage system, or "blind" sensing) 1-2 times a week. Prescribe tonics, choleretic and holekinetki. At elevated liver enzymes ALT choleretic not administered.
• When hypokinetic type biliary tract dyskinesia recommend sorbitol, xylitol, cholecystokinin, pancreozymin, magnesium sulfate, mineral water of high salinity room temperature or gently warmed for 30-60 minutes prior to food. Phytotherapy both in hypotonic type.
• When hyperkinetic type biliary dyskinesia used spasmolytics short course, preparations of potassium and magnesium, mineral water weak mineralization in preheated form 5-6 times per day. Herbal Medicine: chamomile flowers, peppermint, licorice root, valerian root, grass motherwort, fennel fruit.

Therapy in each case is individually, and for this you need to contact a specialist. comprehensive examination will be scheduled, and the time of diagnosis the doctor will choose the appropriate drugs. Self-medication is dangerous: incorrect recognition of symptoms can only lead to the deterioration of health.

Diet and proper nutrition

The mainstay of treatment of dyskinesia is the food. Only through a clear compliance with the rules can avoid attacks and carry out prevention of surgical complications such as cholelithiasis and acute cholecystitis. Diet for dyskinesia assumes that the total power of the rules, but there are points that differ greatly depending on the type of disease (hypokinetic and hyperkinetic).

From the diet for any form of dyskinesia should be completely excluded the following products:

• spicy, fried, fatty, smoked, sour, salty, and all canned;
• fatty meats and fish;
• confectionery, including chocolate, cocoa;
• baking of pastry;
• sodas, coffee, alcohol;
• seasonings;
• vegetables, irritating the digestive tract - garlic, onions, radishes, sorrel;
• products reinforcing flatulence (beans, rye bread, etc.);
• milk;
• marinades.

Features food at gipomotornoy dyskinesia. The diet should consist of products that stimulate the motility of the biliary tract:

• cream;
• eggs;
• black bread;
• sour cream;
• vegetable oil and butter;
• vegetables (boiled, steamed, baked);
• fruits.

Features food at hypermotor dyskinesia:

In the presence of this form of disease it is mandatory to exclude products from the daily diet, which stimulate bile secretion and bile formation: soda, broth, fresh vegetables, fat sour milk and dairy products, brown bread, animals fats.

In any form of dyskinesia must eat 5 - 6 times a day in small portions (content portions should fit into two handful). Do not allow breaks between meals than 2 hours. All meals and beverages have to be warm or room temperature and not cold or hot, as too high or low temperature can provoke attack dyskinesia. Salt is necessary to limit, consuming no more than 3 grams per day to eliminate the stagnation of fluid in the tissues. Cook different dishes to be cooking methods, grilling or steaming.

Mineral water

Mineral water should be drunk regularly, 1/2 - 1 glass for 20 - 30 minutes before meals in the form of heat, selecting the desired species depending on the form of dyskinesia. Thus, when gipomotornoy dyskinesia recommended drinking water of high salinity (e.g., Essentuki 17 Batalinskaya, Borjomi Mashuk, etc.), and at hypermotor -. Low salinity (e.g. Darasun, Karachinskaya, Lipetsk, Narzan Smirnovskaya and etc.).

Mineral water can be and should be drunk as a diet a long period of time, ie a minimum of 3 - 4 months. However, if the mineral water can not be included in a comprehensive treatment of the disease, then their use is quite possible to give up.

Lifestyle with dyskinesia

For patients with biliary dyskinesia is very important to lead a healthy life, the concept of which includes:

• rejection of bad habits,
• moderate physical activity without physical overload,
• rational mode of work and rest,
• a good night's sleep,

The main component of lifestyle - healthy eating - the exception of fatty, fried, spicy, salty, spicy food, restriction of animal products, the increase in consumption of vegetable products origin. During the treatment of dyskinesia should follow a strict diet, or medical table №5.

Folk remedies

At home, the treatment of dyskinesia is best done in conjunction with the use of traditional techniques. But before preparing or eating them should consult with their physician

Used infusions, decoctions, extracts of herbs and syrups, can activate bile formation, to adjust the motor function of the sphincter and bile ducts.

1. When hypertonic and hyperkinetic type used mint, chamomile flowers, grass motherwort, licorice root, fennel fruit, valerian root.
2. Pi hypotonic and hypokinetic form, are used for herbal hips, helichrysum flowers, St. John's wort, corn stigmas, marjoram, nettle leaves, camomile.

Choleretic action has thistle, immortelle, tansy, leaves and dandelion root, corn silk, chicory, rosehips, fumitory, parsley, turmeric root, thyme, yarrow.

Decoction of herbs used for 20-30 minutes before meals.

Surgery

In the absence of adequate relief after awaited and complex conservative therapy doctors use surgical techniques. They may be:

• minimally invasive (often using endoscopic apparatus);
• radical.

In the case of the sphincter of Oddi dysfunction detected spend:

• injection directly into the sphincter of botulinum toxin (it significantly reduces the spasm and pressure, but the effect is temporary);
• balloon dilatation of the sphincter;
• setting special Katerere stent in the bile duct;
• endoscopic sphincterotomy (its excision with duodenal papilla) followed by (if necessary) surgical sphincteroplasty.

At measure to combat severe hypotonic-hypokinetic embodiment biliary dysfunction is cholecystectomy (atonic complete removal of the gallbladder). It is carried out laparoscopically (instead incision on the abdominal wall to make several puncture apparatus and instruments) or laparotomy (incision with traditional) route. But the effectiveness of this major surgery is not always felt by patients. Often, after the resumption of complaints associated with established postcholecystectomic syndrome. Are rare.

Biliary dyskinesia in children

For the treatment of children preferred herbal preparations. They are selected according to the type of pathology.

So, when appointed gipomotornoy dyskinesia:

• Medicaments which increase the tone of the biliary tract: magnesium sulfate, sorbitol or xylitol;
• drugs that stimulate bile formation: Holagol, holosas, allohol, liobil;
• "Blind sensing" the reception sorbitol or xylitol;
• Herbal Therapy: infusions of dandelion, wild rose, corn stigmas, mint;
• Mineral water "Essentuki 17".

When hypermotor psoriasis treatment is carried out:

• Herbal Therapy: St. John's Wort herbal teas, chamomile, nettle nettle;
• drugs, antispasmodics: aminophylline, Riabal;
• electrophoresis with novocaine in the area of ​​the gall bladder;
• Low-mineralized water "Slavyanovskaya", "Smirnoff".

After cupping of an attack carried out rehabilitation in a sanatorium, where mineral waters are appointed, other physiotherapy:

• sodium chloride bath;
• Microwave therapy;
• galvanic collar on Shcherbak;
• with sedative purpose: pine baths, bromelektroson;
• to increase locomotor activity biliary tract: CMT-therapy, electrophoresis magnesium sulfate.
• to eliminate the spasm of the biliary tract: magnitotrapiya, electrophoresis antispasmodic (No-Spa, papaverine) in the area of ​​the biliary tract /

Children with dyskinesia are registered at the children's gastroenerologa, neurologist and pediatrician. Them twice a year, assigned routine holding ultrasound. Also, every 6 months courses conducted choleretic therapy. Once or twice a year, the child is given directions on carrying out sanatorium treatment.

prevention

To prevent the emergence and development of the disease should be:

1. Establish good sleep and rest (sleep at least 8 hours a day);
2. Provide daily outdoor exercise;
3. Organize a proper and balanced diet;
4. Exclude the presence of stress and psycho-emotional stress.

For secondary prevention (ie after revealing dyskinesia) may prevent disease, adhering to physician recommendations and regular checkups