Gastritis — group of diseases of different genesis with an acute or chronic inflammation mucous a stomach. It is shown by epigastralny pain, dyspepsia, intoxication, an adynamy. It is diagnosed by means of EFGDS, a X-ray analysis of a stomach, the ureazny test, an intragastric rn-metriya, a research of gastric juice, other laboratory and tool methods. Apply antibacterial, antisekretorny, gastroprotektorny medicines, components of gastric juice in combination with the medicines influencing separate links of pathogenesis to treatment. At some forms of a disease surgical treatment is shown.
Gastritis — one of the most widespread diseases of digestive bodies making up to 80% of stomach diseases. Frequency of emergence of frustration increases with age. According to observations in the sphere of gastroenterology, about 70-90% of elderly patients suffer from various options of pathology. In recent years cases of diagnosis of gastritis at children became frequent, the role of a bacterial factor increased in development of an inflammation — to 90% of cases it is connected with a helikobakterny infection. The tendency to mainly chronic course of process remains, prevalence of sharp options of a disease does not exceed 20%.
Gastritis — the polietiologichesky disease arising at impact on a stomach of various damaging factors. Its development is promoted by pathological processes at which local resistance of a mucous layer, the general reactivity of an organism, regulation of sekretorny and motor function of body is broken. The main reasons and prerequisites of gastritis are:
- Infectious agents. At 90% of patients with a chronic inflammation the helikobakter is sown. Sharp gastritis can be caused by colibacillus, stafilokokka, streptococci, other opportunistic microflora. Less often the disease has a virus origin or develops against the background of syphilis, tuberculosis, candidiasis, helminthic invasions.
- Chemical influences. The majority of sharp processes arise because of hit in a stomach of aggressive substances. At poisoning with corrosive sublimate, acids the fibrinozny inflammation, by alkalis, salts of heavy metals — necrotic is observed. At reception of NPVS, glucocorticoids, a number of antibiotics, warm glycosides, cocaine, abuse of alcohol erosive gastritis is possible.
- The changed reactivity. The inflammation caused by formation of antibodies to obkladochny cells and an internal factor of Kasl is observed at Addison-Birmera's disease. Less often the disease is associated with an autoimmune tireoidit, insulin-dependent diabetes, an autoimmune poliglandulyarny syndrome of the I type. The hyperreactivity caused by an organism sensitization serves as the reason of allergic gastritis.
- Other diseases of digestive bodies. Mucous a stomach inflames at irritation because of throwing of intestinal contents. The Biliarny reflux gastritis develops because of functional insolvency of a pilorichesky sphincter at a chronic duodenit, dyskinesia of biliary tract. Prerequisites to a reflux of bile are noted at diseases of the operated stomach, duodenal tumors.
- Chronic stress. The neurohumoral imbalance serves more often the contributing factor though ischemia at acute stressful reaction can provoke formation of erosion and even hemorrhagic gastritis. The chronic stress is followed by a long angiospasm, insufficient blood supply of mucous. The situation is aggravated with exhaustion of reserve opportunities and diskineziya of a GIT.
- Food errors. Violations of food behavior — one of the main prerequisites to development of chronic superficial gastritis. Constant receipt of greasy, spicy, hot food, dishes with extractive substances, carbonated drinks causes irritation of mucous and strengthens effect of other factors. Chemical damage or mechanical traumatizing is more rare provokes sharp process.
At advanced age involute thinning mucous, leading to decrease in local resistance becomes the major provocative factor. At sepsis, serious somatic illnesses, an oncopathology a prerequisite to an inflammation is chronic ischemia of a gastric wall. Yatrogenny genesis of a disease owing to radiation therapy of cancer of stomach, a gullet, other malignant neoplaziya of a GIT or mechanical damage of body is possible during gastroscopy, an ezofagogastroduodenoskopiya, a nazointestinalny intubation. In certain cases (for example, at hyper plastic gastritis) the etiology remains unspecified. It is not excluded that the hereditary origin has a number of the forms of pathology.
The mechanism of emergence of an inflammation of a stomach is connected with an imbalance of the damaging and protective factors. Effect of toxins, chemicals, autoantitet, allergens, firm food, tools and X-rays provokes local reactions. The more massive is the damaging influence, the more sharply inflammatory process. After a short phase of alteration microcirculation is broken, hypostasis, an ekssudation of intra vascular liquid and components of blood with development of classical catarrhal gastritis is noted. In more hard cases sharp dystrophy and a necrosis of fabrics is observed.
Synchronization of an acute inflammation is followed atrophic, hyper plastic, metaplastic, others dystrophic - regenerator changes of the ferruterous device. At small intensity of the damaging loadings a key role is played by the decrease in local resistance caused by both local, and general influences. The constant irritation of an epithelium food, alcohol, bile, endotoxins, violation of regulation of sekretorno-motor function promotes emergence of a chronic inflammation with gradual increase of patomorfologichesky changes.
Separate link of pathogenesis of chronic gastritis is violation of kislotoprodutsiruyushchy function. Under the influence of the ammonia emitted by helikobakteriya development of a gastrin amplifies, the maintenance of a somatostatin decreases that leads to hyperproduction of hydrochloric acid. As a result at the patient gastritis with the increased acidity develops. An atrophy mucous fundalny department of a stomach and autoimmune damage of obkladochny cages oppress secretion of hydrochloric acid at moderately expressed inflammation. This mechanism is the cornerstone of gastritis with the lowered acidity.
At systematization of clinical forms of gastritis consider features of a course of pathological process, morphological changes mucous, the leading etiologichesky factor, localization of an inflammation, a condition of sekretorny function, a disease stage, existence of complications. The fullest is Hyustonovsky classification of a disease taking into account kliniko-morphological criteria which were offered by R. Striklend and I. Mackay (1973):
- Inflammation type. On character of a current distinguish sharp and chronic options of gastritis. Separately consider special forms of a disease — allergic, hypertrophic, lymphocytic, granulematozny, other atypical inflammations.
- Defeat localization. Often the disease affects one of departments of body (fundalny, antralny gastritis). When involving in pathological process of all stomach more characteristic of sharp forms of pathology, speak about pan-gastritis.
- Etiology. Taking into account the most significant reasons allocate chronic autoimmune gastritis (type A), a helikobakterny inflammation (type B), chemical and toxic defeat (type C). At a combination of several factors the disease is considered as the mixed process.
- Nature of morphological changes. On depth of distribution and features of pathological process the inflammation happens catarrhal, fibrinozny, korrozivny, flegmonozny, erosive. At chronic gastritis atrophic processes often prevail.
- Features of gastric secretion. When carrying out systematization acid-forming function of a stomach is estimated. Depending on the content in gastric juice of hydrochloric acid distinguish gastritis with the lowered, increased, normal acidity.
Symptoms of sharp gastritis usually appear suddenly against the background of errors in a diet, reception of NPVS, poisoning. Patients are disturbed by epigastralny pains of different intensity, nausea, vomiting, an eructation, deterioration in appetite, increase of a chair. Violations of the general state at an acute inflammation are presented by weakness, dizzinesses, decrease in working capacity. At infectious genesis of frustration fever, a fever, cold, cough, mialgiya, artralgiya are possible. Feature of erosive option of a disease — existence of bleeding from a GIT which is shown in the form of bloody vomiting or a melena.
Symptoms of chronic gastritis depend on sekretorny activity of a stomach. The intensive pains in a nadchrevny zone arising in 20-30 minutes after food, chronic locks, heartburn, an eructation sour are characteristic of the inflammation which is followed by increase in acidity. At a long current of the patient increased fatigue, emotional lability, sleeplessness disturbs. At the patients having chronic gastritis with the reduced acidity, the pain syndrome is expressed slightly or is absent. Morning nausea, feeling of bystry saturation, weight in a stomach, diarrhea, a meteorizm, an eructation by air, bitter smack in a mouth, a gray raid in language is noted. Because of violation of digestion and absorption of food loss of body weight, muscular weakness, hypostases on shins is observed.
Gastritis can be complicated by stomach ulcer of a stomach and a 12-perstny gut. In case of erosive defeat of a wall of body developing of profuzny bleeding and hemorrhagic shock is possible. At a flegmonozny form of gastritis perforation of a gastric wall, cicatricial deformation of body is often observed, fistulas are formed. Owing to a lack of an internal factor of Kasl at a part of patients megaloblastny anemia develops. At atrophic gastritis proteinaceous and power starvation with a kakheksiya, gipoproteinemichesky hypostases, muscular dystrophy, encephalopathy is noted. The long course of a disease increases risk of formation of an adenocarcinoma of a stomach.
Usually in the presence of typical clinical signs diagnosis of gastritis does not represent difficulties. The main objective of a diagnostic stage is comprehensive examination of the patient for identification of the prime cause and definition of clinical option of a disease. The following tool and laboratory methods are considered as the most informative:
- Ezofagogastroduodenoskopiya. Survey mucous at EGDS reveals patognomonichny morphological features of a disease. Puffiness, hyperaemia, erosion, thinning and an atrophy of an epithelium, sites of a metaplaziya, strengthening of the vascular drawing are characteristic of gastritis.
- Stomach X-ray analysis. The contrast research with baric mix is shown. Existence of gastritis is demonstrated by a thickening of folds (more than 5 mm), existence of knots of a mucous membrane, increase in gastric fields, multiple erosion.
- Intragastric rn-metriya. By means of daily measurement of acidity in a stomach sekretorny function of body is estimated and the clinical form of gastritis is defined. The method can be also used for assessment of efficiency of antisekretorny therapy.
- The respiratory test on a helikobakter. For identification of H. pylori concentration of carbon is measured in the exhaled air. Results are positive at an indicator more than 4 ‰. In doubtful cases PTsR-diagnostics, definition of antibodies is recommended for a helikobakter in blood.
- Research of gastric juice. The method is directed to studying of sekretorny function of a stomach. During the analysis estimate the general acidity, content of enzymes, slime, other substances. At microscopy of a deposit reveal epiteliotsita, muscle fibers, etc.
In the general blood test symptoms of B12-scarce anemia are possible: decrease in erythrocytes and hemoglobin, emergence of megaloblast. At suspicion on the autoimmune nature of a disease carry out serological reactions for search of anti-parietal antibodies. Diagnostic determination of serumal levels of pepsinogens 1 and 2, a gastrina is significant. In a koprogramma a large amount of undigested muscle fibers, grains of starch, cellulose is found, Gregersen's reaction can be positive. In difficult cases MSKT of abdominal organs, ultrasonography of a gall bladder, a liver, a pancreas, an antroduodenalny manometriya is recommended. The most exact method of establishment of the morphological diagnosis — histologic a research of a bioptat.
Differential diagnostics is performed with functional dyspepsia, other gastrointestinal diseases (stomach ulcer, chronic pancreatitis, cholecystitis), intestines pathology (a tseliakiya, a disease Krone), a vitamin deficiency (pernitsiozny anemia, a pellagra), intestinal infections (salmonellosis, esherikhiozy, to a spr). Besides consultation of the gastroenterologist surveys of the infectiologist, hematologist, hepatologist are recommended to the patient. For an exception of a myocardial infarction consultation of the cardiologist is appointed, at possible cancer of a stomach — the oncologist.
Treatment of gastritis
Therapeutic tactics is defined by the factors which provoked development of gastritis and a clinical form of a disease. The complex differentiated therapy added with correction of a diet, refusal of smoking, alcohol intake is recommended to the patient. The basic scheme of conservative treatment usually includes the following groups of medicines:
- Antibacterial means. Apply standard schemes of an eradikation with use of macroleads, β-laktamny penicillin, nitroimidazoles, tetratsiklin which are surely combined with inhibitors of a proton pomp, bismuth medicines to destruction of helikobakteriya. At identification of other causative agents of infectious gastritis appoint antimicrobic, antifungal, antiparasitic means of various groups.
- Proofreaders of sekretorny function. When strengthening production of hydrochloric acid use inhibitors of a proton pomp, blockers H2-gistaminoretseptorov. For correction of sekretorny insufficiency carry out replacement therapy by pepsinsoderzhashchy means. To stimulate production of gastric juice, medicamentous therapy is supplemented with phytomedicines on the basis of a plantain, a pyridoxine, ascorbic, nicotinic, weak organic acids.
- Gastroprotektora. There are several groups of means for protection of an epithelium against the damaging influences. The principle of effect of the enveloping medicines is based on sedimentation of the thin film which is mechanically protecting mucous from damage. Colloidal suspensions also coagulate proteins of a helikobakter. Antatsida neutralize hydrochloric acid of gastric juice. Prostaglandins of group E fill shortage of natural protective factors.
At sharp gastritis the plan of treatment provides washing of a stomach, reception of sorbents, antidotes, infusional therapy. Sedative phytomedicines, tranquilizers are recommended to patients with the expressed neurovegetative frustration. At an autoimmune inflammation use corticosteroids. To patients with the expressed pain syndrome appoint miotropny spazmolitik, with care — analgetics. At hemorrhagic gastritis apply haemo statics to a stop of bleeding and completion of blood loss, transfuse whole blood, eritrotsitarny weight, plasma. At a duodenal gastralnom a reflux derivatives of ursodezoksikholevy acid, inhibitors of dopamine receptors are effective. For improvement of motility are shown pro-kinetics. Surgeries carry out at massive destruction of a gastric wall at patients with flegmonozny gastritis, developing of profuzny bleeding.
Forecast and prevention
The disease outcome at sharp process more often favorable, a chronic inflammation usually has a recidivous current with the periods of aggravations and remissions. The chronic atrophic gastritis leading to irreversible decrease in a kislotoobrazovaniye in a stomach, a malignization is most adverse in the predictive plan. Measures of prevention include restriction of spicy and greasy food, refusal of smoking and alcohol intake, reception of medicines only on doctor's orders, timely detection and treatment of diseases which can cause inflammatory process in a stomach.
1. Clinical gastroenterology//Zimmerman of YA.S. – 2009.
2. Gastroenterology: Stomach / Vakhtangishvili R. Sh. diseases, Krzhechkovskaya V. V. – 2007.
3. Clinical gastroenterology - Yakubchik T. N. – 2014.