Gastritis

Gastritis is an inflammation of the mucous membrane (in some cases even deeper layers) of the stomach wall.

Gastritis acute-acute inflammation of the gastric mucosa.

Etiology, pathogenesis. Acute gastritis is a polyethological disease caused by chemical, mechanical, thermal and bacterial causes. Pathogenesis is reduced to a dystrophic-necrobiotic damage to the superficial epithelium and glandular apparatus of the gastric mucosa and the development of inflammatory changes in it. The inflammatory process can be limited to the superficial epithelium of the mucosa or spread to the entire thickness of the mucosa, interstitial tissue and even the muscular layer of the stomach wall. Acute gastritis often occurs as acute gastroenteritis or acute gastroenterocolitis. Distinguish simple (banal, catarrhal), corrosive and phlegmonous gastritis.

Gastritis is most common. The cause of exogenous gastritis are errors in nutrition, food poisoning, the irritating effect of certain drugs (salicylates, butadione, bromides, digitalis, antibiotics, sulfonamides), food allergies (strawberries, mushrooms, etc.), etc. Endogenous acute gastritis occurs when Acute infections, metabolic disorders and massive decay of proteins (with burns, etc.). Acute gastric irritation can develop with severe radiation damage.

With catarrhal gastritis, leukocytes infiltrate the superficial, sometimes dystrophic, necrobiotic altered epithelium, as well as signs of inflammatory hyperemia.

Symptoms, course. Symptoms of acute gastritis usually appear 4-8 hours after exposure to the etiological factor. Characterized by a feeling of heaviness and fullness in the epigastric region, nausea, weakness, dizziness, vomiting, diarrhea. Skin covers and visible mucous membranes are pale, the tongue is covered with a greyish-white coating, drooling or, conversely, severe dryness in the mouth. When palpation, soreness in the elastogastric region is revealed.

Differential diagnosis: it is necessary to exclude first of all salmonellosis and other intestinal infections. Of decisive importance in this case are bacteriological and serological studies.

The prognosis with the timely begun treatment is favorable. If the effect of harmful factors repeats, then acute gastritis usually turns into chronic.

Treatment of acute gastritis begins with the purification of the stomach and intestines, and for infectious etiology of gastritis - the appointment of antibacterial drugs (enteroseptol 0.25-0.5 g 3 times a day, levomycetin 2 g / day, etc.) and absorbents (activated Coal, kaolin, etc.). In case of acute allergic gastritis antigys-tamines are indicated. At the expressed painful syndrome - holinolitichesky preparations (atropinum -0,5-1 ml of 0,1% solution p / k, platifillina gidrotartrat-1 ml of 0,2% solution p / k), spazmopitiki (papaverine hydrochloride 1 ml of 2% solution n /to). With dehydration, parenteral administration of isotonic sodium chloride solution and 5% glucose solution. With chlorpenic syndrome, intravenously injected hypertonic sodium chloride solution. In acute vascular insufficiency are shown cordiamin, caffeine, mezaton, noradrenapine.

Health food: the first 1-2 days it is recommended to refrain from eating, but it is allowed to drink a small portion of strong tea, Borjomi; On the 2nd-3rd day, low-fat broth, slimy soup, semolina and rice mashed rice, jelly are allowed. Then the patient is transferred to the diet number 1, and after 6-8 days - on the usual diet.

Prevention of simple gastritis is reduced to rational nutrition, strict sanitary and hygienic supervision at public catering establishments, and sanitary and educational work with the public.

Gastritis is corrosive due to ingestion of strong acids, alkalis, heavy metal salts, concentrated ethyl alcohol in the stomach.

Symptoms, course. Pain in the mouth, behind the breastbone and in the epigastric region, often unbearable, repeated excruciating vomiting; In vomit masses - blood, mucus, sometimes fragments of tissues. On lips, mucous mouth, throat and larynx - traces of chemical burn - edema, hyperemia, ulceration (from sulfuric and hydrochloric acid appear gray-white spots, from nitric-yellow and greenish-yellow scabs, from chrome - brownish-red, from carbolic - bright white, reminiscent of the plaque of lime, from acetic - surface whitish-gray burns). When the larynx is affected, hoarseness and breath of breath appear. In severe cases, collapse is developing. The abdomen is usually swollen, painful on palpation in the epigastric region; Sometimes there are signs of irritation of the peritoneum. Acute perforation occurs in 10-15% of patients in the first hours after poisoning (less often - later).

The prognosis depends on the severity of inflammatory-destructive changes and therapeutic tactics in the first hours and days of the disease. The life-threatening period of the disease lasts 2-3 days, death can come from shock or peritonitis. The outcome of a corrosive gastritis can be cicatricial changes, especially in the pyloric and cardiapaedema of the stomach.

Treatment begins with washing the stomach with a large amount of cold water through a probe lubricated with vegetable oil (contraindications to the introduction of the probe are collapse and destruction of the esophagus). Before washing, especially with pain syndrome, narcotic analgesics (morphine hydrochloride, promedol), fentanyl with droperidol are shown. In case of collapse, in addition, caffeine, cordiamine, mezaton, norepinephrine (n / k or IV with blood substitutes, glucose, isotonic sodium chloride solution), as well as strophanthin. During the first days - fasting, parenteral administration of isotonic sodium chloride solution, 5% glucose solution. If it is impossible in the next few days to supply through mouth-parenteral injection of plasma, protein hydrolysates. With perforation of the stomach, edema of the larynx - urgent surgical treatment. To prevent narrowing of the esophagus, bougie is produced during the healing period; When the latter is ineffective, surgical treatment of stenosis.

Gastritis phlegmonous (phlegmon of the stomach) is extremely rare, characterized by phlegmonous inflammation of the stomach wall with diffuse or limited pus spread, mainly in the submucosa; It is usually recognized during surgical intervention. Usually accompanied by the development of perigastritis and often peritonitis. Arises more often primarily; Is caused by streptococci, often in combination with E. coli, less often staphylococcus, pneumococcus, proteus, etc. Sometimes it develops as a complication of an ulcer or decomposing stomach cancer, damage to the stomach mucosa in case of a stomach injury. The secondary form develops with common infections (sepsis, typhoid fever, etc.).

Symptoms, course. Characteristically acute development with chills, fever, sharp adynamia, pain in the upper abdomen, nausea and vomiting. The tongue is dry, the abdomen is blown. The general condition deteriorates sharply. Patients refuse to eat and drink, quickly exhausted, face features change (face of Hippocrates). In the epigastric region with palpation - soreness. In the blood there is a high neutrophilic leukocytosis with toxic granularity, increased ESR, changes in protein fractions and other signs of inflammation. Forecast in many cases is unfavorable. Possible complications (purulent mediastinitis, pleurisy, subdiaphragmatic abscess, thrombophlebitis of large vessels of the abdominal cavity, abscess of the liver, etc.).

Treatment is carried out mainly in surgical hospitals. Parenterally, broad-spectrum antibiotics are administered in large doses. If the conservative therapy is ineffective, surgical treatment.

Gastritis chronic is manifested by chronic inflammation of the mucous membrane (in some cases even deeper layers) of the stomach wall. A very common disease, which in the structure of diseases of the digestive system is about 35%, and among diseases of the stomach - 80-85%.

Etiology. Chronic gastritis is sometimes the result of the further development of acute gastritis, but more often it develops under the influence of various exogenous factors (repeated and prolonged eating disorders, acute and rough food intake, addiction to hot food, poor chewing, dry food, strong alcoholic drinks - alcohol gastritis) . The cause of chronic gastritis can be qualitatively inadequate nutrition (especially deficiency of protein, iron and vitamins), long uncontrolled intake of medications that have irritating effect on the gastric mucosa (salicylates, butadione, prednisolone, some antibiotics, sulfonamides, etc.), production hazards Lead, coal, metal dust, etc.), diseases that cause tissue hypoxia (chronic circulatory failure, pneumosclerosis, anemia), endogenous intoxications in kidney diseases, gout (in which the urogenital mucosa, urea, indole, skatole and others .), The effect of toxins in infectious diseases and local chronic foci of infection (the so-called elimination chronic gastritis), hereditary predisposition. In 75% of cases, chronic gastritis is combined with chronic cholecystitis, appendicitis, colitis and other diseases of the digestive system.

Pathogenesis. Under the influence of prolonged exposure to endogenous and exogenous etiological factors, functional secretory and motor disturbances of the stomach activity first develop, and in the future, dystrophic and inflammatory changes and disturbances in the regeneration processes. These structural changes develop primarily in the epithelium of the superficial layers of the mucosa, and subsequently the gastric glands are involved in the pathological process, which gradually atrophy or rearrange in the crypt type. In the progression of the disease, autoimmune processes are important.

Distinguish chronic gastritis as the main and as a concomitant disease (secondary gastritis). On the etiologic sign distinguish exogenous and endogenous chronic gastritis. According to the degree of secretory disorders, chronic gastritis with secretory insufficiency is isolated. Based on the biopsy data, surface gastritis, gastritis with gland lesions (without atrophy), atrophic gastritis (moderately pronounced), gastritis with the phenomena of restructuring of the gastric mucosa are isolated. Localization of morphological changes is distinguished: chronic gastritis is common, antral and isolated gastritis of the body (bottom) of the stomach. Special forms of chronic gastritis include hemorrhagic, rigorous, giant hypertrophic and polyposis gastritis.

Symptoms, course. The most common symptoms are a feeling of pressure and raspiraniya in the epigastric area after eating, heartburn, nausea, sometimes dull pain, decreased appetite, unpleasant taste in the mouth, with palpation - often mild tenderness in the epigastrium. Initially, the disease can occur with a different secretory background, although most often there is a tendency to decrease secretion and acidity of gastric juice.

Chronic gastritis with normal and increased secretory function of the stomach - usually superficial or with lesion of the gastric glands without atrophy; Occurs more often at a young age, mainly in men. Characterized by pain, often ulcerative, heartburn, belching sour, a feeling of heaviness in the epigastric region after eating, sometimes - constipation. Gastric secretion: basal to 10 mmol / h, stimulated (after maximum histamine stimulation) - up to 35 mmol / h. Often there is abundant gastric secretion at night.

Hemorrhagic gastritis (erosive gastritis, chronic gastric erosion) is characterized by a tendency to gastric bleeding, mainly inflammatory and erosive changes in the gastric mucosa retained or high gastric secretion. In some cases, bleeding is associated with increased permeability of the stomach vessels and easy traumatization of its mucosa. Other clinical manifestations are as with the previous form of gastritis.

Chronic gastritis with secretory insufficiency is characterized by atrophic changes in the gastric mucosa and its secretory insufficiency, expressed in varying degrees; Develops mainly in persons of mature and advanced age. There are gastric and intestinal dyspepsia (unpleasant taste in the mouth, decreased appetite, nausea, especially in the morning, belching, rumbling and transfusion in the abdomen, constipation or diarrhea); With prolonged course - weight loss, hypoproteinemia, symptoms of polyhypovitaminosis, poorly expressed hypokorticism, insufficiency of other endocrine glands (general weakness, impotence, etc.), normochromic or iron deficiency anemia. Often there is concomitant enteritis; Intestinal dysbacteriosis, pancreatitis, cholecystitis impose their imprint on the clinical picture of the disease.

A stiff (antral) gastritis is characterized by pronounced deep inflammatory-cicatricial changes mainly of the antral part of the stomach, its deformation and constriction. Symptoms: pain in the epigastric region, dyspepsia, increased secretion of gastric juice, rarely achlorhydria. Radiographic examination reveals tubular narrowing of the pylorus, which presents differential diagnostic difficulties with the tumor. The diagnosis is confirmed by gastrofibroscope with targeted biopsy and dynamic observation of the patient.

Polyposis gastritis is characterized by atrophy and disregenerative hyperplasia of the gastric mucosa, achlorhydria. A typical clinical picture is not.

Giant hypertrophic gastritis (gastritis of the tumor, Menetrye's disease, polyadenoma creeping, etc.) is characterized by the presence of multiple or single adenomas and cysts in the mucous membrane of the stomach, resulting in its folds becoming sharply thickened rough form, increased protein loss with gastric juice, hypoproteinemia Cases). Differential diagnosis with a stomach tumor is based on radiographic and gastrofibroscopic examination with targeted biopsy (due to deep lying adenomatous tissue does not always get into the biopsy); Dosed bloating of the stomach during these studies facilitates diagnosis, causing smoothing of the gastric folds (unlike tumor infiltration).

The course is chronic with periods of exacerbation under the influence of unfavorable factors (violation of diet and diet, reception of strong alcoholic beverages and their surrogates, etc.). Possible complications: profuse bleeding (with hemorrhagic gastritis).

Chronic gastritis (especially "perestroika" and its atrophic-hyperplastic form) are considered as a precancerous disease.

The prognosis for life is favorable: under the influence of treatment, in most cases, the patients feel well relatively quickly, but the main morphological changes in chronic gastritis and violations of the secretory function of the stomach usually remain.

Differential diagnosis of the main forms of gastritis is performed with functional disorders of the secretory function of the stomach ("irritated stomach", gastric ailia, functional - see); While chronic gastritis is characterized by more persistent and pronounced symptoms, a picture of inflammatory changes in the mucous membrane given by gastrofibroscopy and biopsy.

Gastritis with preserved and increased gastric secretion, antral gastritis, often manifested by pain, should be differentiated from peptic ulcer; With gastritis there is no seasonal exacerbation, at the height of the exacerbation there is no ulceration of the gastric mucosa. Polyposis gastritis is differentiated from stomach polyposis; Data from the targeted biopsy are crucial.

To differentiate the antral and giant hypertrophic gastritis with a stomach tumor, gastrofibroscopy with targeted biopsy is critical.

Treatment is usually carried out on an outpatient basis, with hospitalizations being appropriate for exacerbations. The most important is the therapeutic diet. During the exacerbation of the disease, food should be divided, 5-6 times a day (diet number 1a). As the exacerbation of exacerbation, diet therapy is built taking into account the nature of secretory disorders. In case of chronic gastritis with secretory insufficiency, diet No. 2 is prescribed. In chronic gastritis with normal and elevated secretion during the exacerbation, diet no. 1a is prescribed, after 7-10 days they pass to table No. 16, in the next 7-10 days to diet No. 1. During the exacerbation of the exacerbation, the diet should be complete, only salt, carbohydrates and extractives are limited, especially with increased acidity of the gastric juice.

With increased secretory and motor-evacuation functions of the stomach, cholinolytic, spasmolytic and ganglion-blocking agents (atropine, platyphylline, spasmolitin, benzohexonium) in combination with antacids (vikalin, almagel, etc.) and drugs stimulating regenerative processes (methyluracide, pentoxyl, licorice preparations and etc.)

In chronic gastritis with secretory insufficiency for pain appoint ganglioblokiruyuschie drugs (kvateron, gangleron that, causing a pronounced antispasmodic effect, relatively little effect on the secretory function of the stomach), and the juice of plantain, plantaglyutsid, causing a slight increase in secretion, enhancing gastric motility and having Anti-inflammatory and antispasmodic effect. Binders and enveloping agents are shown. In order to influence on the secretory function of the stomach are appointed PP vitamins C, B6. Outside of acute gastritis with symptoms of decompensation (flatulence, diarrhea ahilicheskie) used replacement therapy -zheludochny juice abomin, betatsid, pancreatin and others. For the treatment of chronic gastritis with secretory insufficiency, in which the development of the significant role played by autoimmune processes, in some cases justified the appointment of glucocorticosteroid Hormones. Physical methods of treatment: hot-water bottles, mud therapy, diathermy, electro and hydrotherapy, etc...

Sanatorium treatment for chronic gastritis is carried out outside the exacerbation of the disease. Resorts with mineral water for drinking: Arzni, Arshan, Berezovsky Mineralnye Vody, Borjomi, Izhevsk, Jalal-Abad, Jermuk, Druskininkai, Essentuki, Zheleznovodsk, Pyatigorsk, Sairme, Theodosius, Shira, and others, as well as local motels gastroenterological profile.. Mineral water can also be used in vnekurortnyh conditions: at low pH, preferably use alkaline salt-water sources for 15-20 minutes before a meal, and when to conserve and enhance the secretory function - bicarbonate for 1 hour before meals and during heartburn.

Prevention. The main importance is rational nutrition, refusal to drink strong alcoholic beverages, smoking. It is necessary to monitor the condition of the oral cavity, to treat diseases of other abdominal organs in time, to remove occupational hazards. Patients with chronic gastritis, especially those with atrophic-disregeneratory changes, should be on dispensary records and should be examined at least twice a year.