Chronic gastroduodenit – the combined damage of a mucous membrane of pilorichesky department of a stomach and duodenum of inflammatory character. Carry the dispepsichesky phenomena, an unpleasant smell from a mouth to symptoms of this disease, pain in epigastriya, an unstable chair. Usually include EGDS, an endoscopic biopsy with a morphological research of bioptat, EGG in the program of diagnostics, an antroduodenalny manometriya, an intragastric rn-metriya, tests on a helikobakter. Long-term treatment, consists in observance of a day regimen and food, special diet, correction of acidity of gastric juice, performing antikhelikobakterny and symptomatic therapy.
Chronic gastroduodenit is the widespread disease affecting both children's, and adult population. Feature of this disease - the combined defeat mucous a stomach and initial departments of a small intestine (DPK) therefore chronic gastroduodenit proceeds much heavier than the isolated gastritis or a duodenit and will much worse respond to treatment. On a clinical picture gastritis also gastroduodenit practically do not differ that creates certain diagnostic difficulties for gastroenterologists. Characteristic feature of pathology is that damage of a mucous membrane of a duodenum leads to disorder of activity of a pancreas and a gepatobiliarny zone, and also to vegetative violations. Therapeutic tactics at a gastroduodenita means obligatory inclusion in the scheme of treatment of vitamins of group B.
Reasons of a chronic gastroduodenit
All reasons of a chronic gastroduodenit are subdivided into internal (endogenous) and external (exogenous). Carry GIT pathology to the internal reasons (the raised stomach kislotoobrazovaniye, reduction of production of slime, violation of reparative processes and hormonal regulation of digestion), and also damage of a liver, pancreas and endocrine frustration. Secondary chronic gastroduodenit develops against the background of chronic gastritis, stomach ulcer of a stomach and DPK, pancreatitis, hepatitis, parasitic and allergic diseases, pathology of cardiovascular system and a chronic renal failure.
Rank the use of too hot, cold and hot dishes, a large number of the food containing dyes, preservatives and pesticides, hobby for alcohol, coffee and tea as the external reasons of a chronic gastroduodenit. Besides, H.pylori infection also belongs to factors of development of this disease.
In pathogenesis of a chronic gastroduodenit the leading value has distribution of the inflammatory process induced by a helikobakterny infection with mucous a stomach on a duodenum. The combination of the listed etiologichesky factors leads to increase in secretion of hydrochloric acid in a stomach, to violation of motive and evakuatorny functions of a digestive tube, decrease in rates of formation of bicarbonates in a pancreas. At chronic gastritis there is a metaplaziya mucous a stomach in DPK epithelium. Further these metaplazirovanny islands are damaged by sour gastric juice, as leads to development of the expressed inflammatory process.
Development of a chronic gastroduodenit at diseases of cardiovascular system is caused by hypoxemic damage of a wall of DPK. At a chronic renal failure through a mucous membrane of intestines a large amount of the nitrogenous slags injuring it is allocated.
Classification of chronic gastroduodenit means division on an etiologichesky factor (exogenous and endogenous), prevalence (localized and diffusion), a form (with the normal, reduced and increased acidity).
Symptoms of a chronic gastroduodenit
The clinical picture of a chronic gastroduodenit of a polimorfn, usually includes discomfort in epigastralny area, feeling of weight and a raspiraniye in a stomach. Often the spasmodic, holding apart pains in epigastralny area arising in 1-1,5 hours after acceptance of food disturb.
Quite often the dispepsichesky phenomena disturb: nausea, vomiting, heartburn, eructation acid. The chair becomes unstable: ponosa can alternate with locks. The Patognomonichny sign of a chronic gastroduodenit is the language oblozhennost a yellowish-brown raid, prints of teeth on its side surfaces; an unpleasant smell from a mouth. Vegetative frustration are typical: pallor, perspiration, bystry fatigue, irritability, sleep disorders. When pressing on area an epigastriya patients note moderate morbidity.
Alternation of episodes of an aggravation (during the autumn and spring periods) and remissions is characteristic of a chronic gastroduodenit. Weight of a condition of the patient in the period of an aggravation is usually caused by expressiveness and duration of a pain syndrome, dispepsichesky manifestations and other symptoms of a disease. The period of an aggravation can last up to two months, at the same time complaints to pains remain within about ten days, and morbidity at a palpation – up to three weeks. Lack of complaints in the presence of an endoscopic and morphological picture of a chronic gastroduodenit is characteristic of incomplete remission.
Diagnostics of a chronic gastroduodenit
For statement of the correct diagnosis to all patients with suspicion on chronic gastroduodenit consultation of the gastroenterologist and endoscopist is held. Hospitalization in office of gastroenterology is usually demanded only by patients with the heavy course of a disease. Short-term hospitalization can be necessary for inspection.
During an ezofagogastroduodenoskopiya its atrophy, thinning and pallor - can be visualized as hyperaemia and a hypertrophy mucous (focal or diffusion), and upon transition of process to an atrophic stage. Authentically to estimate a condition of a mucous membrane of a stomach and DPK, expressiveness of inflammatory process, the endoscopic biopsy, a morphological research of bioptat is conducted.
The intragastric rn-metriya is required for acidity assessment in antralny department of a stomach, and also for forecasting of acidity in DPK. The difference between bodies of a stomach and its antralny department has to make not less than 2. If the specified indicator decreases, it can speak about oppression of neutralizing function of an antrum and hit of too sour gastric contents in a duodenum with damage of its mucous. Criterion of the lowered acidity is decrease in all indicators as main secretion, and at its stimulation. Points out increase the increased acidity at least in one indicator.
For assessment motor functions of a stomach and a duodenum the elektrogastrografiya, an antroduodenalny manometriya is carried out. An auxiliary method of diagnostics is ultrasound examination of the stomach filled with liquid. With the same purpose, and also for a differentiation with other diseases, the stomach X-ray analysis with barium is used.
For the purpose of specification of an etiology of a chronic gastroduodenit definition a helikobakter is carried out to Calais by the IFA and PTsR method, antibodies to H.pylori in blood, the respiratory test. The most reliable method of diagnosis of a helikobakterny infection is histologic.
To differentiate chronic gastroduodenit follows with functional diseases (stomach dyskinesia, intestines dyskinesia, dyspepsia, a duodeno-gastralny reflux, functional diarrheas), the isolated inflammatory process in a stomach or a duodenum (stomach ulcer, stomach ulcer of 12 items of a gut, bulbit, chronic gastritis, chronic duodenit) or on the contrary, more widespread (the gastroenteritis, enterokolit).
Treatment of a chronic gastroduodenit
Treatment of a chronic gastroduodenit usually long, includes several stages, consistently following one after another. Treatment begins with purpose of a special diet. Include the wiped porridges on meat, vegetable or mushroom broth in food; low-fat grades of meat and fish; vegetables and fruit, fermented milk products; bakery products (excepting fancy bread). Preparation of products can be various (on couple, boiling, suppression, roasting); the use of svezheotzhaty juice is allowed. Even milk if it does not render laxative effect is allowed. Food has to surely include products, vitamin-rich B1, B2, PP, C. Meals there have to be not less than five in days. The food should be used warm, to chew carefully, small portions.
In the sharp period observance of a bed rest within not less than seven-eight days is required. If to adhere to a diet, it allows to reduce intensity of inflammatory process, a pain syndrome.
Considering the high frequency of detection of a helikobakterny infection at a chronic gastroduodenit, the activator eradikation according to a certain scheme which is chosen proceeding from disease severity is carried out:
- bismuth medicine, metronidazole and antibiotic of a tetracycline row within one-two weeks
- Metronidazole, , within a week
- Ranitidine, amoxicillin, metronidazole within 10-14 days
For appointment or correction of the most effective scheme of treatment repeated consultation of the gastroenterologist can be required. At the increased acidity blockers of H2-histamine receptors (, ranitidine, ), inhibitors of a proton pomp (, , , , ), antatsida (aluminum hydroxide, hydroxide of magnesium, aluminum phosphate, magnesium a carbonate), gastroprotektor are applied (bismuth, ). Surely include in complex treatment pro-kinetics and enzymes.
In therapy of a chronic gastroduodenit sanatorium and balneological treatment, physiotherapeutic actions, moderate physical activities and physiotherapy exercises is of great importance. Also phytotherapy (broths of a camomile, a train, plantain, mint, a yarrow, St. John's Wort, a valerian) is widely used.
Forecast and prevention of a chronic gastroduodenit
Prevention of a chronic gastroduodenit includes observance of a healthy lifestyle and food, physical activities. It is necessary to avoid stresses, to find enough time for rest and a dream. It is necessary to remember that timely treatment of a chronic gastroduodenit is excellent prevention of stomach ulcer of a stomach and duodenum. Secondary prevention of a chronic gastroduodenit is directed to the prevention of a recidivous course of a disease. Anti-recurrent treatment is carried out by two-month courses to the periods of probable aggravations (in the fall and in the spring). The diet No. 5 is appointed. Treatment by mineral waters, physical therapy, physiotherapy exercises is desirable.
If to carry out treatment of a chronic gastroduodenit irregularly and not in full, the disease gets a heavy current, considerably worsening quality of life and negatively influencing working ability of the patient.