Gastritis

CHRONIC GASTRITIS

Timely treatment of gastritis will help to avoid the development of severe pathologies and irreversible effects on the body. When the first signs of the disease appear, you must immediately consult a doctor to immediately begin treatment for gastritis of the stomach. Therapy of gastritis is carried out depending on the patient's condition, stage and form of the disease. It is aimed at stopping the inflammatory process in the stomach and at eliminating the causes of the disease. The doctor will definitely recommend a diet, without which it will not be possible to get rid of gastritis forever.

Acute form

How to quickly cure acute bronchitis? With exacerbation of gastritis, it is necessary to get rid of the contents of the stomach and rinse it. After cleansing the stomach, fasting is prescribed for 1 to 2 days. During this period, you can drink in small sips of warm or cooled tea, alkaline water (Borjomi) and rosehip infusion. To relieve nausea, add a slice of lemon to the tea.

On the third day after the exacerbation, you can begin to take liquid warm food. It is best to start with mashed puree soup. Later on the menu includes mashed cereals, jelly, mashed lean meat, soft boiled eggs, and dry white bread.

If necessary, the doctor will prescribe enveloping agents (bismuth compounds) or painkillers Belladonna (belladonna). To strengthen the protection of the gastric mucosa and restore its tissues, De-Nol (bismuth tripotassium dicitrate) is prescribed.

The drug creates a protective film on the inner surface of the stomach, protecting it from hydrochloric acid. The film allows the body to recover faster after inflammation.

When severe inflammation is observed or the bacterial nature of the disease is confirmed, an antibiotic is prescribed (Oxacillin, Levomycetin, Cephalexin, Ampicillin, Tetracycline).

If, despite treatment, vomiting continues and dehydration intensifies, a 5% glucose solution with ascorbic acid and B vitamins is administered intravenously, in addition, saline solutions. Up to 2 L of sodium chloride (0.85%) is administered subcutaneously. These measures will prevent critical dehydration. In case of a life-threatening condition, drugs that stimulate the activity of the heart muscle (Cordiamine, Caffeine, Norepinephrine) are used.

Acute phlegmonous gastritis is cured by surgical intervention with drainage of a purulent focus. Treatment of acute gastritis should be carried out only after examination by a doctor and under his supervision. Self-treatment of an acute form of the disease can lead to fatal consequences.

Stomach emptying

The stomach is washed with warm water or a weak solution of baking soda. Soda solution is prepared from two glasses of boiled water and 1 tsp. baking soda.

First, the patient is given 3-4 cups of warm boiled water and induces vomiting. He is seated on a chair, bringing his knees together and tilting the body forward. Gently pressing the patient on the stomach in the stomach, fingers irritate the mucous membrane of the pharynx, causing a gag reflex.

The released water will have a sour taste. After vomiting, you need to give him a soda solution and re-induce vomiting. Washing with a soda solution will lower the acidity in the stomach.

If gastritis is caused by chemical poisoning, toxic substances must be removed from the stomach as soon as possible. In such cases, a thick probe is used and the stomach cavity is cleaned until the leached contents become transparent and lose the smell of chemicals.

To cleanse the stomach of acids, washing is performed using burnt magnesia with milk. For the same purpose, aluminum hydroxide may be prescribed. These drugs help neutralize aggressive substances. Caustic alkalis are washed out of the stomach with water with the addition of citrus or acetic acid juices. How to get rid of chronic gastritis?

Chronic gastritis

Eradication therapy is used to treat the chronic form of the disease.

It is a standard set of techniques designed to completely kill Helicobacter pylori bacteria in the stomach and duodenum.

Eradication therapy is mandatory for patients who have Helicobacter pylori gastritis (caused by the bacterium Helicobacter pylori). The bacterium is the main cause of the development of chronic gastritis.

Eradication therapy is used even in cases where the patient has no symptoms of the disease or they are mild. Such gastritis treatment prevents the development of stomach cancer and peptic ulcer. It stops the progression of precancerous changes in the mucous membrane and stops the inflammatory process.

Eradication is also recommended as a preventive measure for people who are blood relatives of patients with gastric cancer.

Eradication therapy involves the use of schemes based on proton pump inhibitors (PPIs) and De-Nol. IPPs are intended for the treatment of acid-dependent diseases of the gastrointestinal tract. They reduce the production of hydrochloric acid and reduce the acidity in the stomach.

Bismuth tripotassium dicitrate is the most powerful antibacterial agent against the bacteria Helicobacter pylori. There are no bacterial strains resistant to bismuth salts. Such properties of bismuth tripotassium dicitrate make it the main component of the treatment of chronic gastritis. In this case, De-Nol does not upset the stomach, like PPI.

Eradication therapy

According to the recommendations of the Third Maastricht Consensus, the first and second line treatment regimens are used for the treatment of Helicobacter pylori.

The triple first-line gastritis treatment regimen includes:

The recommended duration of therapy is 2 weeks. The appointment of triple regimens with Metronidazole is considered inappropriate, since the critical threshold for bacterial resistance to this drug has already been exceeded. The possibilities of the first line triple regimen are also limited due to the rapidly increasing resistance of the infection to Clarithromycin. Is gastritis treated with other drugs?

An alternative to the triple scheme, the “Third Maastricht Consensus” offers a standard four-component scheme. It includes:

The duration of the course is 10 days. The simultaneous use of the drug bismuth and metronidazole can overcome the resistance of the bacterium Helicobacter pylori to metronidazole.

Gastritis with reduced acidity is treated with a three-component first-line regimen with the inclusion of a bismuth preparation:

With low acidity, there is no need to use IPP.

Quadrotherapy

Quadrotherapy as a second-line regimen is prescribed in cases where treatment of gastritis according to the triple first-line regimen was unsuccessful and a month and a half after the end of the course of taking the drugs, the bacteria were not destroyed. In this case, replacement of metronidazole with furazolidone is allowed.

A four-component scheme is desirable for use in cases where a high resistance to Clarithromycin has been identified. It should be used when an allergy to Amoxicillin or Clarithromycin is detected, as well as to other antibiotics of their groups.

A four-component regimen is prescribed for patients who have previously taken macrolides for other reasons.

If quadrotherapy was used as a first-line scheme, triple second-line schemes can be used:

Tetracycline or furazolidone.

How to cure gastritis forever? It is strictly forbidden to reduce the recommended antibiotic dose by a doctor. Undetermined bacteria develop resistance to antibiotics used. With a repeated exacerbation of the disease, getting rid of bacteria will be much more difficult.

Therapeutic diet

In chronic gastritis, you need to try to eat often in small portions. In case of a disease with high acidity, foods that increase the production of hydrochloric acid should be minimized or discarded. These are rich broths, coffee, alcohol, tea, pickled, smoked, salted and fried dishes.

It is necessary to abandon canned foods, fresh or sauerkraut, radish, radish and onions, as well as fresh pastries, muffins, fatty meats, lard and spices. No need to eat acidic and solid foods. Salt dishes should be minimized. During the day you need to drink 1.5 - 2 liters of water.

Chips, crackers, fast food, carbonated drinks, convenience foods and confectionery are strictly prohibited. Dryer and snacks on the go should be avoided.

Milk cereals, milk soups, mashed vegetable soups, whole milk, jelly and non-carbonated alkaline mineral water are recommended. The temperature of the food should be close to room temperature. Too hot and cold foods are prohibited. From offal you can eat the liver and tongue. Fresh sweet fruits are allowed. With gastritis with low acidity, preference should be given to acidic fruits and juices.

Clinical manifestations of chronic gastritis

The clinical picture of chronic gastritis is characterized by both local and general disorders, which usually appear during periods of exacerbation. Local signs are characterized by symptoms of gastric dyspepsia (heaviness and feeling of pressure, fullness in the pit of the stomach, appearing or worsening with or shortly after eating, belching, regurgitation, nausea, an unpleasant aftertaste in the mouth, burning sensation in the epigastrium, often heartburn, indicating a violation of evacuation from the stomach and throwing the gastric contents into the esophagus). These manifestations more often occur with certain forms of chronic antral gastritis, which lead to impaired evacuation from the stomach, increased intraventricular pressure, increased gastroesophageal reflux and exacerbation of all of these symptoms.

In chronic gastritis of the body of the stomach, manifestations are infrequent and are reduced mainly to severity in the epigastric region that occurs during or shortly after a meal.

In patients with HP-associated chronic gastritis, which occurs for a long time with an increase in the secretory function of the stomach, signs of "intestinal" dyspepsia in the form of defecation disorders (constipation, weakness, unstable stools, rumbling, bloating) may appear. Often they are episodic in nature and often become the basis for the formation of irritable bowel syndrome (gastrointestinal, gastrointestinal reflux).

Of the common disorders, the following can be recorded: asthenoneurotic syndrome (weakness, irritability, disorders of the cardiovascular system - cardialgia, arrhythmia, arterial instability with a tendency to hypotension). With atrophic forms of chronic gastritis in the stage of secretory insufficiency, patients may develop a symptom complex similar to dumping syndrome (sudden weakness, pallor, sweating, drowsiness that occur shortly after eating). Sometimes these manifestations are combined with intestinal disorders, with an imperative urge to stool. Patients with chronic gastritis of the body and the development of B-12-deficient anemia develop weakness, increased fatigue, drowsiness, a decrease in vitality and loss of interest in life, pain and burning sensation in the mouth, tongue, symmetrical paresthesia in the lower and upper extremities. Patients with chronic antral, HP-associated gastritis in the stage of secretory hyperfunction may develop a “ulcerative-like” symptom complex, which often indicates a pre-ulcerated condition.

All these manifestations can serve as the basis for the diagnosis of chronic gastritis or to assess the stage of the disease or its complications.

Diagnosis of chronic gastritis includes:

  • endoscopic method with diagnostic biopsy
  • morphological methods: hematoxylin and eosin, histochemical stains, Giemsa stain without differentiation to HP, immunomorphological stain with antiserum for gastrin, somatostatin and histamine,
  • methods aimed at detecting HP: morphological, urease (clo-test, respiratory), immunomorphological for HP antigens, immunological, bacterial with culture on media,
  • radioimmunological method with the determination of gastrin and pepsinogen in the blood 1,
  • immunological method using immunosorbents: AT to parietal cells, AT to K / Na-ATPase enzyme in parietal cells, AT to Castle internal factor, AT to HP,
  • determination of acid production: fractional gastric sounding, types of pH meter,
  • laboratory method: general blood test, determination of the level of uropepsin in the urine.

Diagnosis Examples

  • Acute hemorrhagic gastritis K 29.0.
  • Chronic gastritis of antrum of the stomach (chronic antral gastritis) Helicobacter pylori * with increased secretory function * (or normal secretory function *) in the acute phase (fading exacerbation or remission) K.29.5.
  • Chronic gastritis of the body of the stomach (chronic fundal gastritis) autoimmune * with moderate (or severe) secretory insufficiency * in the phase of exacerbation (decaying exacerbation or remission) K 29.5.
  • Chronic mixed pangastritis Helicobacter pylori *
  • normal secretory function * (or moderately expressed secretory insufficiency *) in the acute phase (fading exacerbation or remission) K 29.5.
* to be specified only if there is evidence.

The principles of treatment of chronic gastritis

Given the presence of clinically and morphologically different forms of chronic gastritis, treatment methods also vary depending on the etiology, morphology, stage of the disease.

Dietary measures should include: the appointment of a sparing diet during an exacerbation of the disease, implying mechanical, chemical, volumetric restrictions. These restrictions apply only during the period of exacerbation, as it is stopped, nutrition should become full with the observance of the stimulating principle during the period of remission in patients with suppressed or low acid production.

Autoimmune fundal atrophic gastritis (type A)

The following stages of the disease are conditionally distinguished:

  • initial
  • detailed (active, progressive),
  • stage of stabilization of the process,
  • stage of complications (achilia with manifestations of impaired gastric digestion, with impaired motility of the output section of the stomach, with impaired hematopoiesis and the development of B12-deficient anemia, sometimes in combination with funicular myelosis, with severe hyperfunction and hyperplasia of antral G-cells and the development of neuroendocrine tumors (carcinoid).

If the diagnosis of autoimmune fundic gastritis is confirmed and the initial stage of the disease with preserved secretory function of the stomach is fixed in case of a serious violation of immune processes, an attempt can be made to treat glucocorticoid hormones (short courses, average doses not exceeding 30 mg of prednisolone per day, provided that immune tests are performed). In the absence of the effect of conducting a repeated course of such therapy, it is impractical, since repeated or prolonged treatment with glucocorticoid hormones induces atrophy of the gastric mucosa 3.

A similar treatment option persists in the progressive stage of the disease, as well as in patients with preserved secretory function of the stomach.

At the stage of stabilization of the process, in the absence of clinical manifestations, patients do not need treatment.

With the development of complications with impaired gastric digestion, gastric juice can be prescribed in one tablespoon per half a glass of water, in small sips during meals in combination with polyenzyme preparations (preferably creon or pancytrate).

In case of violation of motility - it becomes either continuous or “rapid”, since the pylorus is constantly open - its “locking mechanism” is violated, sometimes the appointment of gastric juice or in combination with drugs that affect the motility of the output section (motilak, motilium with transition to maintenance doses, for a long time - permanently, a lingual version of the drug can be used for episodic upset stomach evacuation).

With the development of B12-deficient anemia, vitamin B12 is treated (initial course of 2000 mcg, eight to ten injections daily). This rate essentially covers the annual need for vitamin B12. With anemia with the phenomena of funicular myelosis, the daily dose increases to 400-500 mcg. In the period of remission, maintenance therapy is carried out at 100 mcg twice a week. After four to six months from the start of treatment with vitamin B12, iron deficiency may develop or appear, in which case iron preparations should be added to the complex of therapeutic measures (in short courses).

When establishing the fact of hyperfunction and hyperplasia of antral G-cells, it is necessary to fix attention on focal foveolar hyperplasias of the gastric mucosa and, if carcinoid tumors are detected, remove them (the method of removal should correspond to localization, size, activity and prevalence in the wall thickness).

Chronic antral gastritis, HP-associated (type B)

The main principle of treatment of this type of chronic gastritis should be the destruction of HP bacteria in the mucous membrane of the stomach, as well as measures to stabilize the patient's condition and prolong the period of remission. According to the recommendation of the European Association of Gastroenterologists - Maastricht I (1996), all forms of active chronic gastritis were subject to eradication, and in accordance with the recommendations of Maastricht II (2000) - only atrophic gastritis. However, patients with HP-associated peptic ulcer, persons after resection of the stomach for cancer and peptic ulcer, as well as patients who should be treated “on demand”, fall into the same group. So, in general, this is a fairly large group of patients, and given that some patients with active forms of chronic gastritis have certain clinical manifestations associated with impaired evacuation from the stomach, as well as with a combination of chronic antral gastritis with reflux esophagitis, then the indications to treatment significantly expand.

Before starting treatment, the status of HP should be established, including information on the degree of infection (high, moderate, small), activity of the urease test, and activity of inflammation. Depending on the results obtained, the duration of treatment is determined - from seven to 14 days, or a dose of antibacterial drugs. The first-line combination used includes: a proton pump inhibitor in a full daily dose (40 mg) or two antibiotics: clacid (clarithromycin) - 1000 mg per day, amoxicillin - 2000 mg per day, or clarithromycin in combination with furazolidone - 400 mg per day. In patients with sharply reduced secretory function, bismuth should be used instead of acid secretion inhibitors (de-nol 240 mg twice daily). Evaluation of the effectiveness of eradication treatment should be carried out four to six weeks after the end of treatment. If eradication is not achieved, then combined treatment with the inclusion of four drugs (based on either secretion blockers or de-nol) using tetracycline up to 2000 mg per day, amoxicillin up to 2000 mg per day, furazolidone up to 400 mg per day, or with the use of antibiotics after determining the sensitivity of HP to them. The duration of treatment is determined by HP status.

Chronic chemical-induced toxic or biliary reflux gastritis (type C)

This diagnosis unites a large group of patients, including patients with a resected stomach, people who received non-steroidal anti-inflammatory drugs, and also patients with reflux of duodenal contents suffering from alcoholic illness. Therapy depends on the underlying causative factor. Since bile acids and lysolecithin have a damaging effect only in the presence of hydrochloric acid, depending on the severity of the clinical manifestations, acid secretion blockers (the choice of which depends on acid production) can be used. In reflux gastritis, the drug of choice is mahalfil 800 (in a daily dose of 3200–4800 mg or four to six tablets), the patient receives full therapeutic doses until the stage of remission is fixed, then it is necessary to continue taking the drug in maintenance doses: one or two tablets per day ( the binding ability of the bile acid preparation is not inferior to cholestyramine). Therefore, in this situation, Magalfil 800 is the drug of choice. If the question of the appropriateness of long-term treatment of NSAIDs is resolved and HP-associated antral gastritis is detected, then eradication treatment should be performed - this reduces the number of complications, or this therapy should be performed against the background of acid production blockers. Symptomatic therapy is carried out according to the usual principles and includes both dietary measures and prokinetics (motilak, motilium), normalization of the passage of the chyme along the intestines, use of gas absorbing preparations (silicon-containing), normalization of dysbiosis and stool with a tendency to constipation.

Other forms of chronic gastritis

Patients often need symptomatic treatment, depending on the leading symptom complex. With eosinophilic gastritis, it is necessary to clarify its pathogenesis. If it is a symptom of an "eosinophilic disease", then this disease should be treated, if there is a symptomatic option, it is necessary to look for the cause of the disease and eliminate it. Special forms of chronic gastritis, as a rule, do not have clinical manifestations and do not need symptomatic treatment, but rather require the development of certain observation tactics, frequency of examination and morphological dynamics, which ultimately determine the management tactics of patients.

Literature.
  1. Aruin L.I., Kapuller L.L., Isakov V.A. Morphological diagnosis of diseases of the stomach and intestines. - M .: "Triad-X", 1998. - 483 p.
  2. Aruin L.I. New international classification of gastric mucosal dysplasia // Ross. journal gastroenterol., hepatol., coloproctology. - 2002, No. 3. - S. 15-17.
  3. Minushkin O. N. The condition of the gastric mucosa of patients receiving glucocorticoid hormones due to collagen diseases and some diseases of the blood system. - M .: Diss. Cand. honey. sciences. - 1973.
  4. Rugge M., Leandro G., Levin K.J. et al. Gastric epithelial dysplasia // Cancer. - 1995, vol. 76. - p. 376-382.

O.N. Minushkin, Doctor of Medical Sciences, Professor
I.V. Zverkov,
UC MC UD President of the Russian Federation, Moscow

Structural rearrangement of the cells of the gastric mucosa occurs for one of three reasons:

1. Autoimmune damage: antibodies that destroy the cells of the stomach begin to be produced in the human body. Autoimmune inflammation ultimately leads to a decrease in the number of gastric glands and disruption of the functioning ones. As a result, the acidity of the gastric juice is reduced, the amount of pepsin responsible for the digestion of protein is reduced, the production of Castle factor is reduced, with the help of which the absorption of vitamin B12 occurs - B12-deficient anemia develops. Under conditions of low acidity, the stomach copes with its barrier function much worse and is no longer a reliable barrier to bacteria entering the food. Under such conditions, intestinal bacteria colonize the stomach and, under conditions of low acidity, nitrates are freely converted to nitrites. The latter are a powerful carcinogen. That is why atrophic gastritis, especially its severe forms, are regarded by gastroenterologists as a precancerous condition.

2. It is proved that in the vast majority of cases, the cause of the development of chronic gastritis is a bacterium called Helicobacter pylori. Helicobacter enters the body when several people use the same cutlery, as well as food and water, seeded bacteria, with kisses. In the stomach, the bacteria releases substances that destroy the protective mucous layer and enhance the production of hydrochloric acid and pepsin. As a result, the gastric mucosa is exposed to enzymes and acid, which leads to inflammation, erosion and ulcers in it.

3. Chemical-induced (chemical) reflux gastritis. Reflux - the reverse casting of content from the underlying departments to the overlying ones. In reflux gastritis as a result of incomplete closure of the pyloric sphincter, separating the stomach from the duodenum 12, the contents of the latter are thrown into the stomach. Thus, under the influence of bile acids and lysolecithin received from the duodenum, the cells of the mucous membrane are destroyed - atrophic gastritis develops.

Treatment of chronic gastritis.

The therapeutic tactics for chronic gastritis depend on what caused the disease and whether it proceeds with high or low acidity. It is known that in 90% of people in whom Helicobacter pylori was detected, gastritis does not manifest itself. In such cases, treatment is not required. In patients with a detected Helicobacter pylori infection and the presence of clinical symptoms of gastritis, eradication therapy is carried out with the aim of eliminating the causative bacterium of chronic gastritis (Helicobacter pylori).

In Russian practice, three treatment regimens turned out to be the most effective for this purpose. The first two of them are used in patients with high acidity, the last - in those patients who have atrophic gastritis with low acidity.

Three-component scheme. Treatment is carried out for 10-14 days simultaneously with three drugs:

  • Amoxicillin (Flemoxin Solutab®) 500 mg 4 times a day, or 1000 mg twice a day,
  • Clarithromycin (Klacid) 500 mg twice a day, or josamycin (Vilprafen®) 1000 mg twice a day, or nifuratel (Macmirror) 400 mg twice a day,
  • Proton pump inhibitors (Omeprazole 20 mg 1-2 times a day, rabeprazole (Pariet) 20 mg 1 time per day, pantoprazole (Nolpaza) 40 mg 2 times a day),

The four-component circuit. Treatment is also carried out within 10-14 days.

  • Amoxicillin (Flemoxin Solutab®) 500 mg 4 times a day, or 1000 mg twice a day,
  • Clarithromycin (Klacid) 500 mg twice a day, or josamycin (Vilprafen®) 1000 mg twice a day, or nifuratel (Macmirror) 400 mg twice a day,
  • Proton pump inhibitors (Omeprazole 20 mg 1-2 times a day, rabeprazole (Pariet) 20 mg 1 time per day, pantoprazole (Nolpaza) 40 mg 2 times a day),
  • Bismuth tripotassium dicitrate (De-Nol®, Ventriksol) 120 mg 4 times a day, or 240 mg twice a day.

Three-component regimen for the treatment of patients with chronic gastritis with low acidity. The course of treatment is 10-14 days.

  • Amoxicillin (Flemoxin Solutab®) 500 mg 4 times a day, or 1000 mg twice a day,
  • Clarithromycin (Klacid) 500 mg twice a day, or josamycin (Vilprafen®) 1000 mg twice a day, or nifuratel (Macmirror) 400 mg twice a day,
  • Bismuth tripotassium dicitrate (De-Nol®, Ventriksol) 120 mg 4 times a day, or 240 mg twice a day.

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