Chronic gastritis – the inflammation of a mucous membrane of a stomach arising under the influence of bacterial, chemical, thermal and mechanical factors. Digestion process violation (a loss of appetite, heartburn, an eructation, nausea, feeling of weight and dull ache in a stomach after meal), deterioration in the general state, bystry fatigue, feeling of fatigue is a consequence of gastritis. Cases of further development and transition of a disease from sharp in a chronic stage, developing of stomach ulcer are frequent.
Chronic gastritis – the inflammation having long, recidivous character. The degeneration mucous, pathological changes of its structure, an atrophy of cellular elements becomes result of a long course of inflammatory process. Glands in submucous cease to function and are replaced with interstitsialny fabric. If at the beginning of a disease decrease in secretion and peristaltic activity of a stomach is a little expressed, then at late stages of chronic gastritis these symptoms amplify.
Chronic gastritises are classified from the point of view of:
- anatomic arrangement of a zone of an inflammation (antralny or fundalny gastritis);
- origins (bacterial, autoimmune, endogenous, yatrogenny, reflux gastritis);
- histologic picture (superficial, atrophic, hyper plastic);
- conditions of sekretorny function (gipatsidny – the lowered secretion, giperatsidny – the increased privacy, with normal sekretorny function).
- chronic gastritis of type A – primary autoimmune gastritis of a bottom of a stomach (fundalny);
- gastritis of type B - antralny gastritis of a bacterial origin;
- type C – a reflux gastritis.
There are also specific chronic gastritises, such as radiation, allergic, lymphocytic, granulematozny. On a stage of chronic process gastritis can be in a phase of remission or an inflammation.
Etiology and pathogenesis
The modern theory of development of the most widespread chronic gastritis of type B (antralny bacterial gastritis) specifies Helicobacter pylori bacterium inhabiting a stomach and a duodenum of the person as the reason of its emergence. Helikobakteriyami struck more than eighty percent of adults in the world. Contamination in developing countries is slightly higher, than in developed. Most often this form of gastritis occurs at inhabitants of Latin America and Asia. Incidence of chronic gastritis of this type does not depend on a floor, the risk of development increases with age.
In clinical practice mark out risk factors of development of chronic gastritis: external and internal.
- violation of character of food (irregular meals, substandard food, insufficient chewing, having a snack on the run), harmful eating habits (use of a large number of spicy, fried, sour, smoked food), use of very hot or very cold products;
- insufficiency of chewing function (dental diseases, shortage of teeth, decrease in mobility of a temporal and mandibular joint);
- the regular use of alcoholic beverages (alcohol promotes the strengthened secretion of gastric juice, and high concentration of ethanol directly influences a stomach wall, causing irritation of mucous);
- the long experience of smoking, especially regular smoking on a hungry stomach, promotes at first hyper acidosis, and later to decrease in secretion of glands mucous and to deterioration in its protective properties (in addition, nicotine raises a tone of vessels, small capillaries that worsens blood circulation in fabrics including in a stomach wall);
- yatrogenny chronic gastritis is caused by the long use of medicines, the gastritis caused by medicines of group of nonsteroid resolvents is most widespread;
- professional factor (harmful production): most often gastritis develops during the work in the conditions of high dust content, presence at air of a suspension of harmful substances.
- chronic inflammations of an oral cavity, top airways, lungs;
- endocrine violations (hyper - and a hypothyroidism, diabetes, disorder of synthesis of corticosteroids);
- metabolic disorders (gout, insulinrezistentnost, enzymatic any insufficiency);
- the violations of breath and blood circulation leading to a fabric hypoxia (pulmonary and cardiovascular insufficiency);
- the insufficiency of secretory system conducting to high content in blood of nitrogenous connections - catabolism products (at decrease in removal of these substances kidneys, they begin to be allocated through digestive tract walls, injuring a mucous membrane);
- chronic pancreatitis, hepatitises, cirrhosis and other diseases of digestive bodies promote pathological changes in work of gastric glands, the changed environment damages mucous and conducts to a chronic inflammation, and violations of a vermicular movement of intestines can cause a reflux gastritis (an inflammation mucous around the gatekeeper, caused by the return throwing of bile from a duodenum);
- autoimmune states: the immunity violations which are characterized by development of antibodies to own body tissues (targets for autoantitet there are parietal cages mucous which are responsible for synthesis of hydrochloric acid, gastric mukoprotein, and also a gastroprotektivny component of gastric slime – Kasl's factor).
The most common symptoms of gastritis are a feeling of weight, pressure in an epigastriya after meal, nausea, heartburn, can be the dull aching ache. Are quite often noted unpleasant smack in a mouth, disorder of appetite. At a research - moderate morbidity of a forward belly wall in the field of a stomach projection.
At the first stages sekretorny function of a stomach can remain as in normal limits, and to amplify or be weakened. With the course of a disease secretion of glands, as a rule, decreases, acidity of gastric juice decreases.
Giperatsidny chronic gastritis is, usually, superficial inflammation mucous, without affection of glands and their atrophy. It is characteristic of persons of young age, meets at men more often. At such gastritis pain, quite often, expressed, similar to an attack of stomach ulcer, often patients complain of weight in a stomach after food, heartburn and a sour eructation. Also the increased production of gastric juice is noted at night.
At gastritis of an autoimmune etiology originally note symptomatology of the makrotsitarny anemia connected with insufficiency of B12 vitamin. Further manifestations from digestive tract join hematologic symptomatology (weakness, tachycardia, noise in ears, dizziness) (appetite loss, weight reduction, violations in work of intestines, can be noted morbidity of language) and neurologic violations (weakness, darkening in eyes, a sleep in extremities, lability of mentality).
As a rule, chronic gastritis is aggravated with stomach ulcer over time (mucous izjyazvlyatsya, there is a risk of bleeding, a stomach wall penetration).
Also the center of a chronic inflammation can , and stomach cancer, or a tumor of lymphoid fabric can be result.
Diagnosis of chronic gastritis includes the following stages: collecting anamnesis and external survey, fizikalny research, endoscopic diagnostics (gastroscopy), laboratory blood tests and gastric juice.
At poll pay attention to a way of life of the patient, eating habits, alcohol intake and smoking. The gastroenterologist reveals complaints, defines the nature of dynamics of symptoms. At fizikalny survey pallor of integuments (it is especially characteristic of autoimmune gastritis with anemia), a raid in language, an unpleasant smell from a mouth can be noted, at a palpation - morbidity of a belly wall in an epigastriya. The endoscopic picture gives an idea of localization of an inflammation, its expressiveness and depth. For specification of the diagnosis and an exception of a malignization take a biopsy mucous of various departments of a stomach.
At blood test it is possible to note symptoms of anemia that can be a sign of autoimmune gastritis. In that case blood is investigated on existence autoantitet. In diagnosis of chronic gastritis the level of a gastrin, pepsinogen (a ratio of a pepsinogen of I and a pepsinogen of II) in blood, content of B12 vitamin in serum is also significant. Determine the level of acidity of gastric juice (rn-metriya). Make a bacteriological research, the respiratory test, PTsR-diagnostics for establishment of infection of H.Pylori.
Treatment of chronic gastritis includes action in several directions: correction of a way of life (disposal of addictions, food on the mode according to a diet), pharmacological therapy, physical therapy, phytotherapy, and also courses of sanatorium treatment for remission fixing.
The diet No. 1 is recommended to the patients having chronic gastritis at the increased acidity, and at gipoatsidny gastritis – a diet No. 2. It is recommended to eat food often, gradually, to avoid in a diet of the products irritating mucous.
Medicines for treatment of gastritis.
- The medicines reducing secretion of hydrochloric acid (blockers of H2-histamine receptors, inhibitors of a proton pomp). Medicines of group of a famotidin belong to blockers of histamine receptors. Most effectively inhibitors of a proton pomp ( and medicines of its group) which are also surely applied at eradikatsionny measures in relation to H.Pylori block secretion of gastric glands.
- Antatsidny medicines connect hydrochloric acid and reduce activity of pepsin. Treat such medicines: aluminum phosphate, the combined medicine which part are aluminum hydroxide, magnesium hydroxide, .
- Preparaty-gastroprotektory. The bismuth medicines possessing enveloping and knitting properties, and also - hydroxide medicine a combination to sucrose octasulphite, used in therapy of erosive gastritis and possessing besides the main gastroprotektivny property, ability to adsorption, antatsidny effect and antiulcer action concern to them.
- For regulation of digestion in therapy of chronic gastritis fermental medicines, for removal of spasms and normalization of a vermicular movement – spazmolitichesky means are used.
- At infection of H.Pylori antibacterial medicines for an eradikation are used: antibiotics of a wide range, metronidazole, nitrofurans.
Physiotherapeutic techniques are pertinent after a stukhaniye of sharp symptoms and during remission. KVCh, a balneoterapiya belong to the methods applied at chronic gastritis an electrophoresis, .
Independently there is a therapy of autoimmune gastritis. As at treatment of this type of chronic gastritis most often there is a task to stimulate, but not to lower sekretorny activity of mucous, the substances increasing acidity of gastric juice are applied: amber and lemon acid, vitamin C and RR, plantain juice. The diet joins products, with the rich content of acids (a cranberry, a citrus, kefir, sauerkraut). These medicines and products stimulating synthesis of hydrochloric acid are appointed to the use on an empty stomach at the lowered secretion, but not at a full akhlorgidriya.
For stimulation of processes of regeneration in mucous a stomach appoint means for regulation of fabric exchange (inosine, oil of a dogrose and a sea-buckthorn, steroids and anabolic steroids). As well as at chronic gastritises of other types, in therapy appoint fermental medicines, gastroprotektor, apply a probiotics (the medicines and products containing cultures lakto-and bifidobacteria) to improvement of digestion. At autoimmune gastritis surely include in therapy B12 vitamin, for treatment of the accompanying megablastichesky anemia.
Medical examination and forecast
Patients with chronic gastritis have to undergo twice a year preventive inspection, for timely carrying out measures to treatment and improvement of quality of life. The patients having high risk of an ozlokachestvleniye (autoimmune, atrophic gastritises, metaplaziya and a dysplasia mucous), have to pass an endoscopic research regularly.
Chronic gastritis at due dispensary observation and treatment does not lead to considerable deterioration of life and reduction of its term. Less favorable forecast if the atrophy mucous is noted. Complications of chronic gastritis can pose possible hazard to life.
The prospect of a course of autoimmune gastritis is defined by degree of pernitsiozny anemia. At the expressed anemia the forecast is adverse, and there is a risk for life. Also at this form of gastritis the dysplasia of mucous often develops and kartsinoida are formed.
Primary prevention of chronic gastritis is the way of life promoting the general health. Healthy regular nutrition, refusal of smoking and abuse of alcohol, accurate use of medicines of the NPVP group.
Measures of secondary prevention are an eradikation of helikobakteriya and timely therapy for prevention of development of complications.