Biliarny reflux gastritis
Biliarny reflux gastritis – an inflammation of a mucous membrane of a stomach as a result of its damage by the bile retrogradno arriving from intestines. The disease is shown by dull ache, feeling of weight in the top quadrant of a stomach which amplify after acceptance of food. There is an eructation, nausea and vomiting, a meteorizm, frustration of a chair. Diagnostic actions include survey of the gastroenterologist, carrying out FGDS, a X-ray contrast research of a stomach, a daily rn-metriya. Treatment assumes complex purpose of derivatives of ursodezoksikholevy acid, antatsidny, protivosekretorny medicines, prokinetik together with dietary food and maintaining a healthy lifestyle.
Biliarny reflux gastritis
The Biliarny (bilious) reflux gastritis is a chronic gastrointestinal disease at which the bile coming to a 12-perstny gut is thrown in a stomach, causing inflammatory changes of his mucous membrane. Normal the stomach has acidic environment, and a small intestine - alkaline. Bilious acids together with alkaline duodenal contents, getting into a stomach cavity, not only injure a mucous membrane, but also influence its acidity, breaking process of digestion of food. Pathology mainly affects middle-aged persons, practically does not occur at children. In the general structure of inflammatory gastrointestinal diseases prevalence the reflux gastritis makes 5%.
Reasons biliarny reflux gastritis
Development of pathology in many respects is defined by a way of life. Abuse of alcohol, obesity, smoking, frequent stresses act as the major contributing factors. During pregnancy, at the expense of the shift of abdominal organs up, the risk of a biliarny reflux increases. Distinguish from the causes of a disease:
- Digestive tract diseases. The Biliarny reflux arises against the background of a chronic duodenit, chronic gastritis, oncological diseases of a stomach and a 12-perstny gut. Elevated pressure in intestines as a result of a constant raising of weights or a natuzhivaniye promotes weakening of a pilorichesky sphincter and hit of bile in a cavity of body. At a gastroptoza the stomach is below or at the level of a 12-perstny gut that also promotes a biliarny reflux.
- Stomach and biliary tract operations. The patients who transferred a stomach resection according to Billroth of I and Billroth II, plastic surgeries on the gatekeeper, a holetsistektomiya and reconstructive interventions on bilious channels are more subject to emergence of a biliarny reflux.
- Diseases of biliary tract. Dyskinesia of biliary tract, violation of a tone of a sphincter of Oddi, chronic cholecystitis can promote excess emission of bile in a 12-perstny gut and a biliarny reflux in a stomach.
- Reception of some medicines. Prolonged use of medicines (NPVS, nitrates, beta-blockers, tranquilizers, etc.) can weaken a sphincter tone, creating conditions for retrograde throwing of bile.
During digestion moves ahead in the descending direction: from a stomach in 12-PK, then from a small intestine in thick. Due to motility of intestines, harmonious work of sphincters normal digestion of food is provided. Normal at receipt of food in a small intestine the pilorichesky sphincter is closed, and in 12-PK through Oddi's sphincter on the general bilious channel bile arrives. At biliarny throwing aggressive contents 12-PK get into a stomach, cause irritation and an inflammation of its mucous layer. The bile consisting of bilious acids, pigments and enzymes, the semi-digested food soaked with the alkaline environment of a gut and pancreas enzymes is a part of a reflyuksat. Bilious acids promote dissolution of membranes of an epithelium that causes irreversible metabolic changes in cages - develops . In response to an inflammation puffiness of own plate mucous body appears. Morphological transformation is characterized by proliferation of mucous cages with the subsequent growth of an epithelium. On the place of nekrotizirovanny sites erosion are formed.
Proceeding from sharpness of process, allocate a sharp and chronic course of disease. On the volume of defeat distinguish a focal and diffusion form of a disease. In the latter case inflammatory process evenly covers all mucous body. The focal form meets more often and is characterized by defeat of certain sites of a stomach. As damage to gastroenterology allocate the following types biliarny a reflux gastritis:
- Superficial. There is a gradual defeat of an epithelium of a mucous layer of a stomach. The damaged cages are replaced with an intestinal epithelium, there is an intestinal metaplaziya. The long chronic current with possible malignant regeneration is characteristic of this form.
- Erosive. There are superficial defects which are not going beyond a mucous membrane. Erosion can increase in sizes and strike submucous and muscular layers of body, forming ulcers.
- Atrophic. Is the most dangerous form a reflux gastritis creating a basis for a further malignization. The mucous membrane becomes thinner, and atrophied walls of body become hyper sensitive to any hostile environment, including to gastric juice.
Symptoms biliarny reflux gastritis
The clinical picture of a disease is variable and depends on scale and depth of defeat of a wall of a stomach. The main symptom of a disease is the pain localized in the right podreberye or an epigastriya irradiirushchy in a backbone. Pain develops in time or after plentiful meal and has the stupid, aching character. After food the feeling of weight and overflow of a stomach is noted. The Dispepsichesky syndrome is shown by nausea, a meteorizm, an eructation "sour", vomiting with a large amount of gastric juice. Patients have an instability of a chair: the lock is replaced by diarrhea. In view of the fact that at a disease process of digestion of substances of food is broken, at patients decrease in body weight is noted, "zayeda" in mouth corners, anemia, dryness and pallor of integuments appear. At a long course of disease constant weakness, a sleep disorder, irritability develops.
The long course of gastritis against the background of a biliarny reflux can lead to periodic throwing of contents of a stomach in a gullet with development of an ezofagit. At hit of gastric juice on vocal chords or in a trachea there is a reflex laryngospasm which in the absence of emergency measures causes asphyxia. Progressing a reflux gastritis promotes development of stomach ulcer of a stomach which can be complicated by gastrointestinal bleeding, perforation of a wall of body, peritonitis. The ulcerations which are formed as a result of a biliarny reflux tend to malignant regeneration.
The correct diagnosis requires performing complex diagnostics of a GIT. Survey of the gastroenterologist includes fizikalny inspection, collecting the anamnesis of life and a disease. At survey the expert pays attention to features of developing of pains and their intensity, existence of the accompanying chronic pathology (cholecystitis, pancreatitis, etc.) and a way of life of the patient. Confirmation of the diagnosis requires carrying out additional researches:
- Fibrogastroduodenoskopiya (FGDS). At a disease it is possible to reveal an inflammation, puffiness, hyperaemia mucous a stomach, localized in the field of the gatekeeper. By means of gastroscopy ulcerations and atrophic changes of body are visualized. For specification of the diagnosis the endoscopist carries out a stomach cover biopsy for the subsequent histologic research of material.
- Stomach X-ray analysis with contrasting. Allows to define violation of integrity of a wall of body. When carrying out a research in horizontal position it is possible to observe retrograde throwing of X-ray contrast substance in a stomach.
- Daily rn-metriya. The intragastric rn-metriya allows to reveal fluctuations of acidity of gastric juice, especially after food and at night when the patient does not eat food.
- Laboratory researches. Play a supporting role and are used for diagnostics of inflammatory changes (OAK, biochemical blood test) and complications (kcal on the hidden blood). At a chronic course of disease carry out tests for identification of bacteria of Helicobacter pylori (IFA, PTsR, a research of histologic material, etc.).
Differential diagnosis of pathology is carried out with other diseases having similar symptomatology: stomach ulcer of a stomach and duodenum, chronic gastritis, cholecystitis, cholelithiasis, pancreatitis. Tool methods of a research allow to carry out differential diagnostics with the duodeno-gastralny reflux which is characterized by throwing of contents 12-PK in a stomach.
Treatment biliarny reflux gastritis
Treatment of a disease is directed to normalization of digestive function, restoration of a normal tone of sphincters and a gall bladder, reduction of an inflammation and prevention of complications. An important role in therapy is played by dietary food. To patients the sparing diet which assumes the use of small portions of easy, semi-fluid food of 5-6 times a day is appointed. The last meal has to occur in 2-3 hours prior to a dream. Preference is given to fresh, boiled or stewed dishes: to vegetable broths, steam cutlets, the baked vegetables, low-fat cottage cheese, the porridges cooked on water. It is recommended to exclude fried, spicy, rough food, the aerated and alcoholic beverages, white and rye bread. It is necessary to pay attention to behavioural recommendations: not to accept horizontal position directly after food, to avoid an overeating, a raising of weights, strong emotional shocks and stresses. During sleep it is better for patients to be in situation with the raised head end.
Medicamentous therapy includes purpose of medicines of ursodezoksikholevy acid which, contacting bilious acids, form safe complexes, thereby preventing damage of membranes of epiteliotsit. On a stomach and a small intestine apply to restoration of a normal passage of a himus pro-kinetics. For reduction of irritation mucous the body caused by biliarny throwing appoint inhibitors of a proton pomp. At the increased acidity use antatsidny medicines. Symptomatic appoint the spazmolitichesky, anesthetizing, protivosekretorny means. At the initial stages of a disease the physical therapy has good effect (an amplipulsterapiya, magnetotherapy, UVCh, etc.).
Forecast and prevention
At timely differentiation of the diagnosis and competent treatment forecast favorable. Observance of all medical recommendations, application of medicamentous therapy together with a diet improves quality of life of patients and reduces quantity of episodes of a biliarny reflux. Lack of treatment and development of complications can cause life-threatening consequences (peritonitis, LCD bleeding, sepsis). Prevention of a disease consists in maintaining the correct way of life assuming refusal of addictions, the use of qualitative, fresh and dietary food, observance of the mode of a dream and rest, reduction of stresses, foot walks in the fresh air, gymnastic activity and the Scandinavian walking under the leadership of experts.