Sections on diagnosis and treatment of chronic gastritis are written in accordance with the Federal standard for the provision of Medical Assistance in chronic gastritis. Moderator - Polukhina AV practicing physician.
Gastritis - a disease characterized by changes in the gastric mucosa and is accompanied by a variety of violations of its basic functions.
Chronic gastritis suffers 50-80% of the adult population, with age increases the incidence of gastritis.
Causes
- Microbial: Helicobacter pylori and other microbes
- Not microbial: autoimmune, alcoholic, after gastric surgery due to the influence of protivospalitenyh drugs (e.g., indomethacin, ibuprofen, aspirin, etc.) associated with exposure to chemical substances
- Unknown factors, including microorganisms.
Chronic non-atrophic gastritis in 85-90% of cases is caused by the microbe Helicobacter pylori.
The development of chronic atrophic (autoimmune) gastritis associated with genetically caused generation of autoantibodies to the cells of the gastric mucosa.
The most frequent causes of chemical (reactive) gastritis - casting of bile from the intestine to the stomach, and prolonged use of certain medications.
Causes of eosinophilic gastritis is unknown, some patients reveal asthma, eczema and other allergic diseases.
Granulomatous gastritis was detected in 10% of patients sarcoidosis7% of patients with Crohn's disease, Tuberculosis, mycosis, Foreign bodies in the stomach.
Reason giant hypertrophic gastritis is unknown.
Symptoms of chronic gastritis
- Pain in the epigastric region, occurring on an empty stomach. Pain can be acute or aching nonintensive cramping; sometimes occur shortly after eating
- Heartburn, acid regurgitation, less nausea, vomiting, gastric contents.
- The most frequent manifestations of gastritis in chronic course - heaviness in the epigastric region after eating, feeling overeating, overflow of the stomach, belching food and air, an unpleasant taste in the mouth, loss of appetite, are possible flatulence, Unstable chair
- Possible vomiting and diarrhea; appetite is often reduced
Diagnosis of chronic gastritis
- General blood and urine tests help detect signs of inflammation in the body during exacerbation chronic gastritis (remission assays will normally), hyperchromic anemia in chronic autoimmune gastritis.
- analysis of feces: perhaps occult bloodAnd undigested food residue with a reduced secretory activity of the stomach.
- EGD and taking biopsies for histological examination. When you can not perform EGD can be carried out X-ray examination of the stomach with contrast barium, but it is less informative.
- A study of the secretory function of the stomach.
- Identification of the microbe Helicobacter pylori. "The gold standard" is the histological examination of biopsy samples from their color in a specific pattern and subsequent microscopic examination. biological method (seeding microorganism on a nutrient medium) is also used.
- Manometry: at reflux gastritis detect an increase in pressure in the duodenum to 200-240 mm water column (Norm - 80-130 mm water column).
Differential diagnosis is carried out gastric ulcer and duodenal ulcer, Hernia of the diaphragm, esophagitis, tumors.
Crucial to clarify the diagnosis has EGD.
You can consult SFAS RF Medical Assistance in chronic gastritis, according to which this article is written.
Treatment
Treatment of chronic gastritis, caused by H. pilory
Gastritis caused by the microbe Helicobacter pylori are used antimicrobial therapy.
There are several standard regimens, comprising
- antibiotics,
- IPP (omez, nolpaza, pariet, emanera - substances used in treating gastrointestinal disorders associated with the release of hydrochloric acid)
- bismuth preparations (de-nol, ventrisol).
Treatment of other forms of chronic gastritis
In the absence of H. pylori and increased gastric secretory function:
- drugs lowering gastric acidity (Almagelum, Aluminum phosphate gel, Gelusil varnish, Maalox et al.)
- drugs that protect (enveloping) mucosa: sucralfate, bismuth dicitratobismuthate (also possesses antimicrobial action against Helicobacter pylori).
Treatment of chronic atrophic gastritis
Medication such gastritis performed only during exacerbation.
Replacement therapy of gastric secretory failure:
- gastric juice,
- Pepcid,
- hydrochloric acid, pepsin,
- acidin-pepsin (these drugs are contraindicated in the presence of erosions of the mucous membrane).
Replacement therapy with a decrease in pancreatic function:
- Holenzim,
- pancreatin + hemicellulase + bile components,
- pancreatin
- panzinorm forte.
Phytotherapy:
- herbal remedies, which have anti-inflammatory effects, - an infusion of plantain leaves, chamomile, peppermint, St. John's wort, valerian,
- plantaglyutsid.
Drugs that improve the nutrition of tissues, and enhancing the healing process:
- Nicotinic acid 1% solution intravenously,
- solkoseril,
- inosine,
- thiamine,
- pyridoxine,
- folic acid.
Treatment of reflux gastritis
Treatment is aimed at the normalization of gastric motility and binding bile acids, which in the first place achieved by diet (food 5-6 times a day in small portions, with the exception of fried, spicy, fatty food).
To prevent a throw into the stomach duodenal contents prescribed domperidone, metoclopramide short courses. Prolonged use of these drugs is not recommended because of serious side effects of the cardiovascular system.
A relatively new drug from the prokinetic group is Itopride (Ganaton), it normalizes the motility of the gastrointestinal tract and reduces the casting of bile into the stomach.
For neutralization of bile acids that have a damaging effect on gastric mucosa, use chenodeoxycholic acid and ursodeoxycholic example ursosan.
mucosa protection of bile acids - drugs that reduce the acidity in the usual daily dose (Aluminum-containing antacids, eg Almagelum possess the ability to bind bile acids, so they are more effective).
Diet in chronic gastritis
Read more article about a diet for gastritis with high and low acidity can be here
At low acidity prescribed diet №2:
- soup of cereals and vegetables, pureed soups to meat, mushroom, fish broth;
- lean meat (chopped, fried), boiled chicken, steam, steamed, fried cutlets without gross peel, lean ham, fish, low-fat boiled, well soaked lean minced herring, black caviar;
- milk (if not cause diarrhea), butter, kefir, yogurt, cream, sour cream, non-acidic, non-acidic fresh cheese, grated cheese is mild;
- boiled eggs, scrambled eggs fried;
- cereals, pureed or well boiled (buckwheat, semolina, rice);
- Flour dishes (except for baking), stale bread, white, gray, nesdobnye crackers;
- vegetables, cooked fruits, raw grated in the form; fruit, vegetable juices (as acid);
- Tea, coffee, cocoa on the water with milk, marmalade, sugar. Salt to 12-15 g
- add vitamins C, B1, B2, PP.
Nutrition for chronic gastritis fivefold, preferably in the form of puree.
With increased acidity prescribed diet number 1:
- pureed vegetables and dairy (except cabbage), grouts mucous Soup (but no meat or fish);
- vegetables cooked comminuted (pyurirovannom) form or in the form of steam puddings;
- pureed porridge with butter, milk;
- boiled lean meat, low-fat varieties boiled fish (cod, perch, pike), meat, fish, steam cutlets, boiled chicken without skin;
- butter, olive oil, sunflower oil;
- milk, yogurt non-acidic, cream, fresh low-fat, better pureed cottage cheese, sour cream non-acidic;
- scrambled eggs or omelets in the form of steam;
- white stale bread, white breadcrumbs nesdobnye;
- sweet varieties of fruits and berries, vegetables, fruit, berry juices, infusion of rose hips, jellies, compotes sweet berry fruits in a shabby, sugar, jam, tea, cocoa - weak, with milk;
- with the improvement of the general state of food produce cooked, but not shabby;
- sodium chloride is limited to 8 g;
- added vitamins A, C, B vitamins
Food often take 5-6 times a day, chewing it well; too hot or too cold food should be avoided)
