Gastritis 72462j

Chronic gastritis and peptic ulcer disease

gastritis Gastritis - a focal or diffuse inflammation of the gastric mucosa in response to its damage with disorders of the secretory, motor, and sometimes inkretory functions.

types of gastritis  

acute; chronic;

specific forms of gastritis :  hypertrophic;  lymphocytic;  eosinophilic;  granulomatous;  reactive.

International Classification of gastritis (Houston, 1994)  Nontrofic (type B) Nontrofic (type B)  Atrophic, autoimmune (type A)  Specific forms: -Chemical (reflux gastritis, type C) -Radiative -Lymphocytic -Noninfectious granulomatous -Eosinophilic -Some infections

Etiologic factors Exogenous:  Alimentary disorders  Smoking  Alcohol  Neuropsychiatric stress  Occupational hazard  The uncontrolled use of drugs

Etiologic factors Endogenous:  Chronic infection  Diseases of the nervous and endocrine systems  Cardiovascular and respiratory systems  Renal failure

Clinical syndromes    

Pain Gastric dyspepsia Intestinal dyspepsia Asthenic-neurotic

Laboratory studies:  complete blood count (deviation possible more prolonged chronic disease with symptoms of atrophic gastritis, iron deficiency or B12 deficiency anemia);  urinalysis;  fecal occult blood worms and eggs;  cytology of byoptites (during the first endoscopy, the dynamics - if necessary, after the end of treatment);  histological examination of biopsy samples (if necessary – in dynamics);  tests for Helicobaster pylory detection (fast urease test, breath test, smear-mark);  total protein and protein fractions of blood serum;  determination of glucose in blood and urine.

Instrumental study:  esophagogastroduodenoscopy with mandatory biopsy and brush cytology;  ultrasound of the abdomen;  X-ray examination: X-ray examination of esophagus, stomach, duodenum and other parts of the intestine, if necessary radiography of these bodies.

Differential diagnosis    

ulcer stomach cancer diseases of the biliary tract gastric polyposis

Drug treatment of autoimmune gastritis (type A)  1. Drugs that stimulate the secretory function of the stomach (Lymontar, Pentagastrin, Calcium Gluconate). 2. Replacement therapy (gastric juice pepsydyl, pepsin, pepsin-atsydyn, Abomin, Panzinorm, Hydrochloric Acid). 3. In the presence of pain and frustration Dyspepcyc Cerukal, Eglonil, Nospanum, Halidor. 4. Anti-inflammatory therapy (plantain leaves, Plantahlyutsyd, Venter). 5. Enzymes (Solizym, Oraz, Festal, Mezim forte). 6. Mineral water ("Mirgorodskaya", "Slov'yanivska" - in the form of heat for 15-20 minutes before meals, in small sips to 1/2-1 cup 2-3 times a day).

ulcer  Peptic ulcer disease - a chronic disease with cyclic flow and a tendency to progression, which is characterized by the formation of a defect in the lining of the stomach or duodenum due to the reduction of its security properties or increasing aggressiveness of gastric juice.

Classification of peptic ulcer 1. Localization ulcer: -ulcer -duodenal ulcer (bulbar, postbulbar) -combined gastric and duodenal ulcers; -hastroyeyunal ulcer (ulcer anastamoses). 2. Etiology: -HP - positive ulcer; -HP - negative ulcer. 3. Phase ulcerative process: -active (acute, fresh); -scarring; -stage of scar; -prolonged absence of scarring.

4. Accompanying morphological changes: -localization and activity of gastritis and duodenitis; -the presence and severity of mucosal atrophy -the presence of intestinal metaplasia; -erosions, polyps; -availability gastroezofagal or duodenogastric reflux. 5. Complications: -bleeding -perforation -penetration -stenosis -malignization

Variants of the course:  Light - periods of heightened at least once in 1-2 years, clinical manifestations expressed mild, easily treatable;  Moderate - aggravation 1-2 times a year, expressed clinical manifestations, in the pathological process involved other organs of digestion;  Severe - aggravation 3-4 times a year, pronounced clinical signs, which are difficult to treat, there are complications.

The role of microorganisms Helicobacter Pylori

Duodenal ulcer

gastric ulcer

erosive gastritis

Major syndromes of gastric ulcer  Pain - is caused by irritation of the ulcer surface aggressive content of gastric inflammation in ulcer area, regional spasm of smooth muscle, peryhastryt, peryduodenit.  Syndrome gastric dyspepsia, resulting heartburn, belching, nausea, vomiting.  Syndrome of intestinal dyspepsia, which is a sign of constipation, crampy pain in the gut .  Astenovegetativnogo, increased irritability, emotional lability, sleep disorders.

Laboratory diagnosis  Omplete blood count (to exclude bleeding);  Biochemical analysis of blood (in the presence of anemia to investigate the level of Fe + in blood and Ferum-binding ability of serum)  Blood (duodenum ulcers - most often in patients of group I, gastric ulcer - 3-A blood group)  Fecal occult blood;  Cytological examination of bioptites (at least 5 fragments from different parts of the stomach and duodenum;  Histological examination of the bioptites to exclude atypical cells in the center;  Determination of microbial type of H. pylori (urease test, cytology, histology)

Instrumental diagnosis  pH-metric study hastritis;  Endoscopy (at the first examination, the dynamics at the end of treatment);  Ultrasonography of the abdomen; X-ray study of the stomach, duodenum and intestines if indicated.

Differential diagnosis     

Cancer of the stomach; Diseases of the bile ducts; Chronic pancreatitis; Symptomatic ulcers; Myocardial infarction (abdominal form).

Treatment General principles -Refusal of bad habits (smoking, alcohol and coffee, cessation of NSAIDs) -Diet: health food, table number 1a-1. Foods to eat 5 times a day, the last time not later than 19:00.

Medication

1. Anticholinergic drugs (anticholinergics): selective (Atropine, Methacin, Platifillin) selective (Hastrotsypin, Pirenzepin) 2. Antacids (Almagel, Fosfalyugel, Maalox, Haviskon, Helyusyl varnish, etc..) 3. H2-histamine receptors (Cimetidine, Ranitidine, Famotidine, Roksatydyn); 4. Proton pump blockers (Omeprozol, Lanzoprazol, Pantoprazole, esomeprazole);

5. Means, which form a protective film (Sucralfate, De-nol, Smectite); 6. Helicobacter drugs: antibiotics (Amoxicillin, Flemoksyn-Solutab, Clarithromycin, Tetracycline, Metronidazole, De-nol); 7. Means that normalize gastric motor activity (Reglan, Eglonil, Motilium); 8. Reparant (Hastrofarm, Solcoseryl, Pentoxyl); 9. Means sedation (Amitriptyline, Rhaponticum, Chinese Magnolia, Dalargin).

Schemes triple therapy for the destruction HP 1. Pantoprazole 40 mg in the morning and 40 mg at night + Amoxicillin 500 mg 4 times a day + Clarithromycin 250 mg 2 times a day. Course 7 days, Eradication of HP 95%. 2. Pantoprazole 40 mg in the morning and 40 mg at night + Clarithromycin 250 mg 2 times daily + Metronidazole 400 mg 2 times a day. Course 7 days, Eradication of HP 95-97%.

4. Omeprazole 20 mg 2 times a day + Clarithromycin 250 mg 2 times a day + Metronidazole 400 mg 2 times a day. 5. Omeprazole 20 mg 2 times a day + Amoxicillin (flemoksyn-Solutab) to 1000 mg 2 times a day after meals + Metronidazole 400 mg 2 times a day.

Scheme of kvadryterapy  Pantoprazole 40 mg 2 times daily + Tetracycline 500 mg 4 times a day + De-nol 120 mg 3 times for 30 minutes before a meal and 4 th time in 2 hours after dinner + Metranidazol 400 mg 4 times a day.

Physiotherapy treatment For uncomplicated ulceral disease in acute phase fading: paraffin, ozokerytni, mud baths on the epigastric area, diathermy, inductothermy UHF therapy elektoforez and acupuncture.

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