Digestive tract infections

Description:

Infections of a GIT classify depending on their main localization, an etiology and a clinical picture. Distinguish infections of orotservikalny area (in this chapter are not considered), from diseases of a bacterial etiology to a stomach infection (gastritis, a peptic ulcer of a stomach and duodenum), an intestines infection - acute diarrhea (enteritis and a coloenteritis).

Symptoms of Infections of digestive tract:

All infectious gastrointestinal tract diseases are characterized by the general pathophysiological mechanisms. The next moments are the cornerstone: damage of a wall of a gut by microbic poisons; increase thereof permeability of an intestinal wall for the liquid and electrolytes coming to a gleam of a GIT and simultaneous disturbance of absorption and as a result of all this, dehydration and loss of potassium; the general intoxication (fever, tachycardia, weakness, etc.) as a result of the general inflammatory reaction of an organism to damage of a gut. In extremely hard cases perhaps direct receipt of microbes in blood and development of sepsis due to disturbance of integrity of the cellular covers protecting in normal conditions an organism of aggressive intestinal environment.

Reasons of Infections of digestive tract:

The main causative agent of infections of a stomach is H.pylori, in an insignificant part of cases H.heilmannii. H.pylori can be the etiological agent colonizes a mucous membrane of a stomach at a considerable part of adult population. For finally not established reasons (the increased virulence of separate strains of a microorganism, reduced resistance of an organism of the owner, external conditions) at a part of the infected people clinically expressed picture develops. Its main manifestations are:

    * chronic gastritis (pan-gastritis or antral);
    * peptic ulcer of a stomach and duodenum;
    * stomach adenocarcinoma;
    * stomach lymphoma.

The key moment in a pathogeny of an ulcer of a duodenum is development of the antral gastritis leading to decrease in secretion of somatostatin - the factor inhibiting products of gastrin. Hyperproduction of gastrin causes the high level of a kislotoobrazovaniye. The acid getting into a duodenum causes a metaplasia of an intestinal epithelium and, eventually, formation of a peptic ulcer. Formation of a peptic ulcer of a stomach is usually preceded by development of pan-gastritis.

Treatment of Infections of digestive tract:

It is so far convincingly shown that H.pylori eradikation  from a mucous membrane of a stomach not only leads to acceleration of healing of an ulcer, but also prevents its recurrence. Performing the antimicrobic therapy directed to an activator eradikation is shown in the presence of the following morbid conditions:

    * peptic ulcer of a stomach;
    * peptic ulcer of a duodenum;
    * stomach lymphoma.

At functional frustration (not ulcer dyspepsia), a reflux esophagitis efficiency of antibacterial therapy is unambiguously not confirmed.

Despite sensitivity of H.pylori in vitro to many AMP in clinic when performing monotherapy all known drugs possible to receive only low percent of an eradikation of the activator that caused the necessity of development of schemes of a combination therapy. The combinations applied earlier from two AMP ("double" therapy) were insufficiently effective.

According to modern recommendations (Maast-rikht2). distinguish therapy of the first and second line.

Three components enter therapy of the first line:

    * IPP * or bismuth ranitidine citrate;
    * кларитромицин;
    * amoxicillin or metronidazole.

In case of failure of therapy of the first line, appoint therapy of the second line which four components enter:

    * IPP
    * bismuth drug (subcitrate or subsalicylate);
    * metronidazole;
    * tetracycline.