Treatment of Duodenal Obstruction in Israel

Professor Zamir Galperin

leading gastroenterologist

The gastroenterologists at the Top Ihilov Medical Center provide qualified and prompt assistance to patients suffering from duodenal obstruction syndrome and any other disorders of the duodenum. The clinic employs the most modern diagnostic and treatment methods available only to major medical institutions in the USA, Europe, and Israel.

30%

of diagnoses made in the CIS countries are refuted at the Top Ihilov clinic

82%

successful cases of treatment with conservative methods

1230

procedures using the modern "da Vinci" system

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Treatment of Chronic Duodenal Obstruction in Israel

Functional forms of the disease are treated conservatively. The following are used:

• Diet therapy, including frequent small meals, excluding spicy, fried, fatty, and heavy foods, alcohol, rich broths, and spicy seasonings;
• Physiotherapy: amplipulse therapy on the epigastric area, intestinal stimulation, microwave therapy, ultrasound;
• If necessary, medication therapy (enzymes, antiemetics, probiotics, etc.);
• Therapeutic exercise;
• Psychotherapy.

Mechanical forms are treated surgically – removing obstacles to the normal passage of intestinal contents through the duodenum.

Diagnosis of Chronic Duodenal Obstruction at the Top Ihilov Clinic

The syndrome can manifest in two functional forms: primary and secondary. The primary form is caused by a disturbance in the motility of the duodenum, which can be provoked by a failure in the controlling function of the nervous and endocrine systems, as well as a breakdown of the myogenic regulation mechanism directly in the muscle wall of the intestine, resulting in myocytes failing to respond to stretching with contraction, as occurs normally.

The secondary form is a complication of chronically occurring diseases in the area that includes the duodenum, the biliary system, and the pancreas. These diseases include:

• Peptic ulcer disease;
• Cholecystitis;
• Pancreatitis.

Chronic duodenal obstruction (CDO) is a complex of the following clinical symptoms:

• Increased pressure in the duodenum;
• Decreased speed of food bolus progression;
• Delay in the transportation of chyme from the duodenum to the small intestine.

The diagnosis of CDO is made based on the patient's complaints, medical history, physical examination, clinical tests, and instrumental examination methods.
The patient may present the following complaints:

• Feeling of heaviness in the stomach, worsening after eating;
• Constant dull pain in the epigastrium;
• Belching of ingested food, foul-smelling;
• Vomiting;
• Heartburn;
• Constipation.

During the physical examination, tenderness along the intestine and abdominal distension may be noted.

Instrumental examination methods used include:

• FGDS (fibrogastroduodenoscopy);
• Ultrasound of the abdominal organs and the retroperitoneal space;
• Duodenography, both relaxation probe with double contrast and non-probe;
• Duodenokinesiography – recording the frequency and strength of muscle contractions of the duodenum using the balloon manometric method;
• Measurement of pressure within the duodenal cavity (sequential stepwise manometry).