Gastritis

Description:

Gastritis is an acute or chronic inflammatory and dystrophic disease of a mucous membrane of a stomach, and in some cases and deeper structures of a wall of a stomach, leading to digestion process disturbance.  
Gastritis is one of the most widespread a disease of bodies of a GIT. About 50% of the population have this illness. Among school students gastritis takes the second place. It is known that also animal have gastritis.
Allocate two main forms of gastritis: acute and chronic. These forms allocate depending on duration and intensity of action of the striking factors, and the nature of damage – inflammatory or atrophic.
Acute gastritis proceeds in forms of catarral, fibrinous, corrosion or phlegmonous gastritis. At an acute current defeat of deep anatomical structures is observed, up to a muscular layer of a wall of a stomach.
The long current, with periodic aggravations, with development of permanent structural disturbances is characteristic of chronic gastritis.
Topographical classification of an arrangement of the center:
1. Stomach body gastritis
2. Gastritis of fundal department
3. Gastritis of antral department
4. The pan-gastritis covering all stomach

Gastritis reasons:

Most often aged people from 24 to 40 years have gastritis, however people and other age categories can be ill. The disease develops as a result of set of many factors. For acute and chronic gastritis these factors are various.
Acute simple gastritis can be divided on exogenous and endogenous. The reasons of exogenous simple gastritis in most cases consider toxic influence on mucous a stomach of various substances, including medicines, and also feeding allergic responses. Endogenous gastritis develops against the background of sharply proceeding infectious process, radiation defeats, a burn disease, etc.
At hit erosive acute gastritis quite often develops in a stomach of strong acids, alkalis and other aggressive substances. An etiological agent of phlegmon of a stomach (phlegmonous acute gastritis) are the combined bacterial infections – staphylococcus, colibacillus, etc. Phlegmonous gastritis against the background of the breaking-up tumor of a stomach or at a stomach injury.
In development of chronic gastritis the major role is played by Helicobacter pylori infection, is frequent in combination with autoimmune mechanisms. Disturbance of a diet does not play a role in a disease etiology as it was considered to be earlier, but can aggravate a current and displays of chronic gastritis.
Modern classification of origins of gastritis:
1. Type A - autoimmune gastritis at which inflammatory process is started by reactions with antibodies to so-called obkladochny cells of a stomach. Chronic gastritis of type A is most often localized in fundal department of a stomach.
2. Type B - the bacterial, connected with planting Helicobacter pylori. It is the most widespread option of chronic gastritis, diagnosis of chronic gastritis of type B reaches 90% among all revealed cases. Gastritis of type B is localized in antral department.
3. Type C – chemical chronic gastritis. The origin of this form is connected with bile circulation disturbance owing to what it gets on a mucous membrane of a stomach, causing irritation.
Except the main types A, B and C there are mixed types which etiology is connected with the combined action of several factors.
An important role is played by heredity. Gastritis is seldom diagnosed separately, more often it is accompanied by other inflammatory diseases of the digestive system.

Gastritis symptoms:

The clinical picture at gastritis can not correspond to degree of manifestation of histologic changes. It is remarkable that even at strong inflammatory process can not be observed by any manifestations and vice versa, the expressed symptoms of a disease can be followed by unsharply expressed inflammatory and degenerative processes.
Acute gastritis is followed by such symptoms as pain in epigastriums 9 upper part of a stomach) which can irradiate in the left hypochondrium or in a back, nausea, vomiting, an eructation, a meteorism, a loss of appetite.
Clinical displays of acute gastritis can suddenly arise, after a severe stress, consumption of a large amount of alcohol, against the background of treatment by anti-inflammatory drugs, food toxicoinfection or after long and considerable disturbance of a diet.
Differential diagnosis is carried out with functional dyspepsia. Unlike acute gastritis which usually is a consequence of irritation of a stomach an infection or chemicals and quickly passes under the influence of treatment functional dyspepsia arises preferential under the influence of psychological factors and can react to treatment very badly.
Chronic gastritis. Often patients do not even suspect about existence at themselves chronic gastritis which proceeds asymptomatically throughout a long time. However, in the period of an aggravation, against the background of provocative factors, chronic gastritis after all has an effect the stupid, aching pains, insignificant nausea, seldom there is vomiting. These symptoms are followed by a loss of appetite, asthenic manifestations.
At atrophic or autoimmune gastritis B12 vitamin assimilation is broken that is shown by strong weakness, dizziness, persistent diarrheas, sores in language, unpleasant feelings in legs, disturbance of gait owing to disturbance of an innervation.  
However detection of the described symptoms does not give the grounds for the diagnosis of gastritis yet, carrying out additional methods of inspection is necessary.

Diagnosis:

For diagnosis and carrying out treatment of gastritis the patient has to be hospitalized in therapeutic or gastroenterological department.
The volume of diagnostic actions includes all-clinical inspections (at acute gastritis or in the period of an exacerbation of chronic gastritis the leukocytosis with shift of a formula to the left in the general blood test, increase in SOE takes place; at erosive gastritis there can be insignificant anemia), the analysis on Helicobacter pylori, the analysis of acidity of a gastric juice, a fibroezofagogastroduodenoskopiya.
The analysis on Helicobacter pylori is carried out in the following forms:
1. Respiratory test for Helicobacter pylori
2. Blood test on antibodies (IgG) against Helicobacter pylori
3. The analysis a calla for definition of fragments of Helicobacter pylori
Fibroezofagogastroduodenoskopiya (FEGDS) allows to vizializirovat a mucous membrane of a stomach, with a big accuracy to establish the diagnosis of gastritis, to define a form of a disease and localization of sites of an inflammation. Fibrogstroduodenoskopiya is also diagnostic procedure for an opreedeniye of a helikobakterny infection. For this purpose during inspection the doctor makes a biopsy. For this purpose the fragment of a mucous membrane of a stomach from which in laboratory the culture of bacteria is grown up undertakes or genetic material of this bacterium in stomach tissues by means of analysis PTsR comes to light.

Fibrogastroduodenoskopiya (FGDS) is a diagnostic medical procedure which holding consists in introduction through a mouth of a stylet and inspection of an internal mucous membrane  of a gullet, a stomach and a 12-tiperstny gut. Preparation for a fibrogastroduodenoskopiya consists in refusal of food and water in 12 hours prior to inspection, and also the termination of reception of medicines if the return is not stipulated by the doctor.
Carrying out FGDS requires the special equipment - the fiberscope + the monitor.
Position of the patient at inspection – lying on the left side. The elastic probe is entered through a nose or through a mouth, at first into a stomatopharynx then in a gullet and a stomach. After the end of inspection the doctor quickly removes the probe outside. Usually all inspection takes no more than 10-15 minutes.

Treatment of Gastritis:

Diet – the major component in treatment of gastritis.
At acute gastritis the dietary table No. 1 on Povznera, a table No. 2 is shown –
at chronic gastritis with the lowered secretory ability.  Fractional frequent food is recommended to patients. At the diagnosed patient lowered by section of a gastric juice groat and vegetable soups, not rich broths, light meat, low-fat grades of fish, fresh and boiled vegetables and fruit, porridges, eggs are shown. From bakery products stale bread, from drinks - rather weak tea is recommended.
The hyperoxemia of a gastric juice is the indication for appointment in food of such products as not acid dairy products, curdled milk, cottage cheese, boiled eggs, low-fat grades  of meat and fish in a boiled look. Consumption of boiled vegetables is authorized. Crude it is possible to eat only  salad, fennel and other greens. Soups are cooked on low-fat meat, with the wiped vegetables. It is possible to use sunflower oil, low-fat sausages, vermicelli, porridges, tea, coffee. Bread, besides, only stale, fresh is prohibited to the use. At any kind of gastritis the use is not recommended: alcohol, newly-baked flour products, rye bread, peas, haricot, lentil,
fried eggs, fat meat (pork), fat fish (mackerel, salmon), fried potatoes, French fries, onions, cabbage, firm cheeses, rural sour cream, chocolate, candies. Still it is impossible to eat fruit with a peel – even grapes.
Except a diet, at treatment of gastritis appoint medicines which mechanism of action is directed to decrease in production of hydrochloric acid in a gastric juice. Inhibitors of a proton deposit belong to this category of drugs
(for example, омепразол, esomeprazole) and blockers of H2-histamine receptors
(famotidine). For neutralization of already developed gastric juice antacids, a naprmer, маалокс, Almagelum, гастрогель and others are shown.  Considering the pathogeny of development of chronic gastritis plays not last role disturbance of motive function of a stomach and duodenum. For stimulation of motility of digestive tract use prokinetics (домперидон).
As the majority of chronic gastritises is connected with an infection
Helicobacter pylori, pathogenetic is justified purpose  of courses of an antibioticotherapia. There are several schemes of treatment of a helikobakterny infection. The triple scheme which is based on purpose  of inhibitor of the proton pump and two antibiotics is most often used: кларитромицин and amoxicillin. This therapy is appointed a course to 1-2 weeks, and control of efficiency after carrying out a course is estimated on the expiration of 1-1,5 months.
If use of the triple scheme did not lead to a full eradikation  of Helicobacter, therapy of the second line which includes appointment four drugs – a vismutatrikaliya dicitrate, inhibitor of the proton pump, metronidazole and tetracycline is appointed. Bismuth interferes with development of bacteria, limits production of their toxins, and thus increases efficiency of antibacterial drugs. At inefficiency and this treatment, the antibiotikogramma by results of which judge sensitivity of a helikobakterny infection to this or that antibiotic is carried out.  Lately researchers paid attention that Helicobacter pylori eradikation not always leads to disappearance of symptoms of gastritis. The chronic inflammation mucous a stomach proceeds also after destruction of a bacterium. At 50% of patients  symptoms of gastritis return within a year after carrying out an eradikation of Helicobacter
pylori. It is known that bismuth the trikaliya dicitrate renders good antiinflammatory effect at most of patients. Therefore one of versions of the solution of treatment of gastritis after an eradikation of Helicobacter pylori is use of drugs of bismuth.