In the field of medicine, papilla stenosis is a narrowing of the major duodenal papilla, also known as the papilla duodeni of Vater. The papilla is a fold of mucous membrane within the duodenum into which the two ducts of the pancreas and the gallbladder jointly open. Narrowing of the papilla can have a variety of causes and impedes the flow of digestive enzymes that are provided by the gallbladder and pancreas.
What is papillary stenosis?
Approximately in the middle of the approximately 25 centimeters long duodenum, which is directly connected to the stomach, there is a characteristic mucosal fold. The large bile duct (ductus choledochus) and the pancreatic duct (ductus pancreaticus) both flow into the mucosal fold. See gradinmath for What are Crush Wounds.
The digestive enzymes secreted by the liver and pancreas trickle out of the duodenal papilla of Vater into the passing chyme. If the common junction is partially obstructed or narrowed, there is papillary stenosis.
In the event of a serious constriction or total blockage, the enzymes in the gallbladder and pancreas are backed up and the chyme in the intestine is not or insufficiently supplied with the necessary enzymes, which, among other things, are used to break down fat and protein and to break down carbohydrates.
The causes that lead to papilla stenosis can be pathological processes in or on the papilla itself, the two supply ducts or, for example, solid concretions that move the papilla of Vater. Inflammation of the bile ducts or the pancreatic duct with consequent narrowing can be caused by a bacterial infection.
The pathogenic bacteria either come from the bloodstream or they are transported from the intestine into one of the two supply ducts, for example during an ERCP (endoscopic retrograde cholangiopancreatography). The ERCP offers the possibility of endoscopically inspecting the papilla and the two supply ducts and making changes or even removing gallstones.
Inflammation can also be promoted by gallstones and a backlog of enzymes. In rare cases, bacterial inflammation appears as the cause, which is usually socialized with an autoimmune disease. In very rare cases, after surgery or after an ERCP, scarring adhesions can form that lead to papillary stenosis. Other possibilities of an outflow disturbance can arise from tumors developing in the area of the papilla or the two supply ducts.
Symptoms, Ailments & Signs
Depending on its severity, papillary stenosis is announced with pain in the upper abdomen. The initially relatively unspecific abdominal pain becomes more specific and severe if the papillary stenosis persists and cholestasis or pancreatitis or both develop due to the backlog of enzymes and digestive juices.
The cholestasis caused by papillary stenosis is extrahepatic cholestasis accompanied by nausea and vomiting and showing signs of jaundice (icterus) due to the onset of hyperbilirubinemia. The first thing you notice is the yellowing of the eyes and a brownish discoloration of the urine.
Pancreatitis also makes itself felt with pain in the upper abdomen, which often radiates to the lower thoracic spine and is somewhat comparable to lumbago. In severe cases, symptoms of jaundice can also appear and serious problems can develop.
If the papillary stenosis is due to “mechanical” causes such as painless adhesions or painless benign tumors, the same symptoms appear with increasing severity of the stenosis.
Diagnosis & course of disease
If papillary stenosis is suspected, a detailed medical history can be used to clarify whether gallstones were ever present or whether there were problems with the pancreas or gallbladder. In many cases, high-resolution sonography allows conclusions to be drawn about the condition of the papilla and any stenosis that may be present.
If there is still uncertainty, an endoscopic retrograde cholangiopancreatography (ERCP) can provide clarity. The ERCP provides a direct endoscopic view of the papilla and the two ducts supplying it, the ductus choledochus and the ductus pancreaticus. For purely diagnostic purposes, ERCP is gradually being superseded by MRCP, magnetic resonance cholangiopancreatography, because it is a non-invasive procedure that poses no risk of injury or infection.
However, it is naturally a purely imaging, diagnostic procedure that is not suitable for any necessary interventions. The course of the disease symptoms caused by the papillary stenosis depends on the course of the stenosis. If the stenosis persists, the development of pancreatitis and cholestasis with all the associated problems is provoked.
Papillary stenosis has a very negative effect on the patient’s overall quality of life and can significantly reduce it. As a rule, those affected suffer from severe abdominal pain, which, however, occurs without a specific and visible reason. There is also vomiting and permanent nausea. As the disease progresses, jaundice develops, leading to damage to the kidneys.
The affected person’s eyes also turn yellow. The pain in the stomach can also spread to the other regions of the person concerned and thus lead to sleeping problems, especially at night. The patients appear irritable due to the papillary stenosis and often suffer from depression. The persistent abdominal pain often leads to a loss of appetite, so that those affected also lose weight.
The treatment of papillary stenosis is carried out with the help of drugs. In some cases, however, self-healing can occur. There are no particular complications. As a rule, the life expectancy of the patient is not affected.
When should you go to the doctor?
Persistent or recurring pain in the stomach area should be presented to a doctor. If there is inner weakness, a decrease in physical performance and a lower resilience of the person concerned, a doctor is needed. Nausea, vomiting or yellowing of the skin and eyes are signs of a health problem and must be investigated. If the existing pain leads to problems with locomotion or coping with everyday life, a doctor is needed.
Until you have consulted the doctor, you should refrain from taking pain medication due to possible complications. A continuous experience of stress, a reduced zest for life and a reduced quality of life should be discussed with a doctor. If there are disorders of the digestive tract, noise in the gastrointestinal tract, a loss of appetite and a decrease in body weight, a doctor should be consulted.
If irregularities in the upper body spread further or if back problems arise, these are warning signals from the organism. You may have a medical condition that requires treatment. Difficulty urinating, discoloration or an unusual odor in the urine are other indications that should be discussed with a doctor. If you are depressed or withdrawn, you need a doctor. Many papillary stenosis patients complain of feeling sick, unwell, or generally dissatisfied with their lives.
Treatment & Therapy
The treatment of papillary stenosis depends on the cause. The first goal of therapy is to identify and correct the cause of the stenosis. In many cases, this can be to combat an inflammation in order to reduce swelling in the area of the papilla or the ducts that supply it, so that the stenosis dissolves more or less by itself.
In most cases, an ERCP can be performed, in the course of which not only the exact diagnosis is made, but also immediate interventions such as the removal of gallstones or the widening of the papilla or the bile or pancreatic duct. In addition, stents or drains can be placed and the necessary incisions can also be made using a papillotome and a cutting wire.
Outlook & Forecast
The prognosis of a papillary stenosis can generally be documented as favorable. As soon as medical care is sought, medicines are administered that bring about relief from the symptoms within a short time. Recovery can be achieved after a few days or weeks. Without cooperation with medical professionals, an increase in complaints is to be expected. The pathogens can spread further in the organism and lead to pain or functional disorders in other places. In addition, the risk of secondary diseases is increased.
Depending on the intensity of the existing health irregularities, surgical intervention can be considered. Thanks to medical advances, the complications of this procedure are few. Normally, even with this treatment method, the patient can be discharged free of symptoms after a few weeks. In the further course, check-ups should take place at regular intervals in order to be able to react immediately to possible changes or abnormalities. Long-term impairments or permanent health problems can be avoided with good medical care and a healthy lifestyle.
If papillary stenosis develops again in the course of life, the prognosis remains unchanged. The best results are achieved when therapy is started early. In the case of high-risk patients such as children or elderly people in particular, however, a reaction should be taken as quickly as possible if the irregularities develop again.
Direct preventive measures that could prevent papillary stenosis do not exist. A lifestyle that provides for relaxation phases in addition to stressful situations can be considered generally preventive. A diet that consists partly of natural foods is also beneficial. People with a family history of multiple cases of papillary stenosis are at slightly higher risk. Any diffuse pain in the upper abdomen should then be clarified a little carefully.
In the case of papillary stenosis, the aftercare measures are in most cases significantly limited or are not available to the person concerned at all. Therefore, at the first signs of the disease, the patient should consult a doctor in order to prevent the occurrence of further complications. In this case, self-healing cannot occur.
If left untreated, however, the affected person can die of papillary stenosis. In most cases, those affected are dependent on a surgical procedure, which can permanently relieve the symptoms. Ideally, this should happen immediately after the diagnosis. After such a procedure, the person concerned should rest and take care of his body.
Stressful activities or exertion should be avoided in order not to unnecessarily burden the body. In most cases, the diet must also be greatly adjusted, so that greasy meals should be avoided. The life expectancy of those affected by this disease depends very much on the time of diagnosis and also on the severity of the papillary stenosis, so that a general prediction cannot be made. However, it may also be reduced.
You can do that yourself
In the case of papillary stenosis, medical treatment is necessary in any case. In addition, a number of measures can be taken to alleviate the typical gastrointestinal symptoms.
First of all, those affected should change their diet. A light diet is just as useful as a diet individually adapted to the symptoms. Patients should discuss this with a nutritionist. In addition, the gastrointestinal tract must be protected. Coffee and alcohol should be avoided. Because papillary stenosis also affects the gallbladder, it can cause serious gallstone disease, which is best treated with regular hydration. Patients should primarily follow the doctor’s instructions.
Papillary stenosis always requires medical therapy, but this can be supported by some self-help measures. Since the narrowing can take different forms, the measures must first be discussed with the doctor. The doctor can often give further tips for therapy and also support the patient in the search for a suitable self-help group. As a result, papillary stenosis can be treated reliably without expecting further symptoms, complications or long-term consequences.