Gastroduodenit – the combined inflammation of a mucous membrane of a stomach (is more often than its privratnikovy department) and a 12-perstny gut, characterized by violation of secretion and motility of digestive tract. Gastroduodenit proceeds as with the general (weakness, pallor, weight loss), and local manifestations (painful, dispepsichesky syndromes). Diagnostics is based on tool methods of survey mucous, assessment of a functional condition of a stomach and intestines, definition of degree of contamination a helikobakterny infection. Observance of a diet, a healthy lifestyle, medicamentous therapy by antibacterial, antatsidny and other medicines is the cornerstone of treatment of a gastroduodenit.
Gastroduodenit – the disease which is characterized by inflammatory changes mucous initial departments of a GIT (a stomach, a 12-perstny gut), leading to disorder of functions of these bodies, and in the absence of rational treatment – to complications in the form of development of stomach ulcer, etc. Gastroduodenit meets in various age groups, but it has the greatest distribution among children and teenagers. According to researches, gastroduodenit at children in group of younger school age occurs not less than at 45%, middle school age – at 73%. Decrease in incidence among the senior school students to 65% is connected with transition of a part of chronic gastroduodenit to stomach ulcer of a stomach and a duodenum. Distinctions in a morphological substratum of a gastroduodenit in different age groups are also noticed: at children and teenagers gastroduodenit proceeds more often with the increased acid-forming function while atrophic process is more characteristic of adults.
Reasons of a gastroduodenit
Disputes are still conducted whether are gastritis and duodenit uniform, inseparably linked pathological process or separate, independent diseases. During the researches the general pathogenetic mechanism of development of inflammatory changes in a stomach and initial departments of a small intestine is found out. A major factor of initiation of an inflammation contamination of H.pylori (HP), damage by microorganisms mucous a stomach and DPK with the subsequent disorder of all functions of the top departments of a digestive tract is considered. Nevertheless, the question of the defining role of a helikobakterny infection remains open – its prevalence among the population reaches 70% while incidence of various inflammatory diseases of a stomach and DPK is much lower. Scientists connect this fact as with specifics of a structure of the microorganism and various degree of its pathogenicity, and with congenital features of a human body – is noticed that gastroduodenit has the family predisposition connected with genetic weakening of barrier protective mechanisms of mucous.
The microorganism of Helicobacter pilory has a tropnost to a stomach epithelium (i.e. strikes only this body). Getting in mucous, bacteria begin to destroy cells of gastric glands that leads to change of acidity of gastric juice. Regulation of the interconnected functions of a stomach because of what there is no alkalization of sour gastric contents before its transition to a 12-perstny gut is broken. Constant damage duodenal mucous sour contents of a stomach leads to a metaplaziya (regeneration) of an intestinal epithelium in a gastric epithelium. After that mucous a duodenum becomes vulnerable to a helikobakterny infection because of what the inflammation becomes more active also in this department of a digestive tract.
The duodenum takes part in regulation of work of all digestive tract by production of biologically active agents and intestinalny hormones. Against the background of a chronic inflammation of DPK normal production of hydrochloric acid and digestive juice in a stomach and a duodenal segment, and also work of other digestive organs is broken that leads to a chronic inflammation in these departments of a GIT.
The great influence on a disregulyation of a gastrointestinal tract is exerted by a chronic stress, vegeto-vascular dystonia at children and teenagers. Violation of vegetative regulation provokes change of production gastric and digestive juice, reduces protective functions of mucous, leads to an inflammation persistention.
Classification of a gastroduodenit
Considering a variety of morphological substrata of inflammatory process and clinical manifestations, allocate several types of a gastroduodenit. By an etiology the disease is classified on primary and secondary process. Primary gastroduodenit develops under the influence of exogenous factors – improper feeding, influence on mucous aggressive chemical and temperature agents, infection of NR. Secondary, or endogenous gastroduodenit, arises against the background of frustration endocrine, immune and other systems of an organism, at diseases of other bodies of a GIT.
On the basis of morphological changes of mucous gastroduodenit it is subdivided on superficial catarrhal, erosive, hyper plastic and atrophic. When carrying out a biopsy allocate different extents of inflammatory process (easy, moderate, heavy), an atrophy and a metaplaziya of an epithelium. On brightness of clinical manifestations distinguish an aggravation of a gastroduodenit, full or incomplete remission. Also differentiate sharp and chronic gastroduodenit which differ in duration of clinical manifestations.
Symptoms of a gastroduodenit
Inflammatory process in a stomach and DPK usually proceeds as with symptoms of the general intoxication, and local changes of mucous. The general symptomatology of a gastroduodenit consists in weakness, increased fatigue, astenisation. Integuments are pale, decrease in body weight against the background of digestion violations is noted.
Painful and dispepsichesky syndromes are conducting in clinic of a gastroduodenit. Pain in an epigastriya is connected to a large extent with DPK dyskinesia because of what there is a duodeno-gastralny reflux with throwing of contents of intestines in a stomach. The dull ache aching most often arises in a couple of hours after food. Can irradiate to the okolopupochny area, podreberye. The pain syndrome at a gastroduodenita often is followed by nausea, an eructation sour or bitter, sometimes vomiting.
Depending on in what department inflammation focus is localized, allocate various clinical forms of a gastroduodenit. The most widespread yazvennopodobny option is usually characterized by a duodenum bulb inflammation in combination with antralny gastritis, stomach ulcers. Pains as ulcer, arising on an empty stomach or before food, characterized by seasonal aggravations are the cornerstone of a clinical picture of this option of a gastroduodenit. The Gastritopodobny option develops at an atrophy of a mucous membrane of a body of a stomach which gradually extends to DPK and a small intestine. Violation of absorption of nutrients and digestion is the cornerstone of clinical manifestations. The Holetsistitopodobny option of a gastroduodenit arises against the background of stagnation in a duodenal segment; constant pains in epigastralny area and the right half of a stomach, nausea, an eructation bitterness, swelling and rumbling of a stomach are inherent in it. At an inflammation of a nipple of DPK the pankreatitopodobny form of a gastroduodenit at which outflow of bile and pancreatic juice on the general bilious channel is broken develops. It is characterized by emergence of a pain syndrome after the use of greasy and spicy food, yellowness of skin and mucous.
Change of phases of an aggravation and remission is peculiar to a clinical picture of a gastroduodenit. Aggravations usually occur during the autumn or spring period, are provoked by violations of a diet, associated diseases. Disease severity at an aggravation depends on expressiveness of a clinical picture, brightness of endoscopic manifestations. Usually the aggravation lasts about two months. Symptoms of a disease regress during no more than 10 days, local morbidity at a palpation of a stomach remains within three weeks. After disappearance of symptoms of a gastroduodenit there occurs remission – incomplete in the absence of symptoms, but existence of objective signs, moderate inflammatory changes when carrying out EGDS. Full remission is characterized by lack of clinical and endoscopic signs of a gastroduodenit.
Diagnostics of a gastroduodenit
Consultation of the gastroenterologist is obligatory at suspicion on any inflammatory process of a GIT. Confirmation of the diagnosis of a gastroduodenit requires carrying out a number of additional researches of function of a stomach and duodenum. Ezofagogastroduodenoskopiya allows to find inflammatory process in pilorichesky department of a stomach and initial department of a 12-perstny gut. During this research make an endoscopic biopsy – with its help inflammatory process, an atrophy, a giperplaziya or a metaplaziya of an epithelium comes to light. The Antroduodenalny manometriya usually reveals DPK spasm with increase in pressure in a gut.
At a gastroduodenita carrying out gastric and duodenal sounding with sampling of contents, studying of activity of enzymes and biologically active agents in portions of material is obligatory. For definition of acidity of a stomach and a duodenum the intragastric rn-metriya is carried out – treatment at the increased and lowered acidity will considerably differ.
Diagnosis of a helikobakterny infection is surely performed: definition a helikobakter in Calais by IFA method, PTsR-diagnostics, definition of antibodies to a helikobakter in blood, the respiratory test. An informative method of diagnostics of NR is the morphological research of bioptat – at the same time in the thickness of mucous a large number of microorganisms is found. For diagnostics of a gastroduodenit smaller value has ultrasonography of abdominal organs – generally this method is applied to detection of the accompanying pathology.
Treatment of a gastroduodenit
Treatment of a heavy gastroduodenit has to be performed in office of gastroenterology. At development of a sharp state for full treatment there is enough one course of therapy and observance of a strict diet. Complaints to numerous episodes of a disease demand repeated consultation of the gastroenterologist and performing full treatment.
To the patient with gastroduodenity the medical diet is surely appointed. During the periods of an aggravation observance of special rules is required: food has to be mechanically, chemically and thermally sparing. It is impossible to use sharp, smoked and extractive substances. During remission the special diet is not required, rather healthy balanced diet. For the prevention of a recurrence it is recommended to refuse smoking, alcohol, carbonated drinks, strong coffee forever.
Medicinal therapy of a gastroduodenit depends on a clinical form of a disease. At the increased acidity of a stomach antatsidny medicines, inhibitors of a proton pomp are appointed; at lowered – fermental medicines and natural gastric juice. Detection of a helikobakterny infection demands obligatory purpose of antibacterial medicines which in combination with medicines of bismuth and inhibitors of a proton pomp allow to achieve almost full eradikation of the activator. Also complex therapy has to include spazmolitik, reparative medicines, phytotherapy. In the period of remission sanatorium treatment, the use of mineral waters is recommended.
The main problem under the authority of gastroduodenit is that many patients try to be treated independently, irrationally using symptomatic means, giving up the begun therapy when weakening symptoms of a disease, not having achieved full treatment. The correct and timely treatment of a chronic gastroduodenit is the best prevention of stomach ulcer. Even after achievement of permanent remission constant respect for the principles of a balanced diet, healthy lifestyle for the prevention of a recurrence is required.
Forecast and prevention of a gastroduodenit
The forecast at a gastroduodenita favorable only at regular inspection at the gastroenterologist and observance of its recommendations for healthy nutrition and a way of life. At patients who do not adhere to a diet do not take a full course of treatment at aggravations, chronic gastroduodenit passes into stomach ulcer of a stomach that threatens with considerable deterioration in a state and serious complications.
Prevention of a gastroduodenit has in many respects something in common with the basic principles of treatment. For the prevention of a disease it is necessary to lead a healthy lifestyle, to refuse such addictions as smoking and reception of alcohol, the use of a large number of strong coffee. It is necessary to eat properly – to include in a diet more fresh vegetables and fruit, porridges, low-fat meat and fish. It is necessary to refuse carbonated drinks, spicy and spicy food, fried dishes. These recommendations are the key to a healthy state and the correct functioning of a gastrointestinal tract.