Gastritis is a disease characterized by a change in the gastric mucosa and accompanied by various disorders of its basic functions.
Chronic gastritis affects 50-80% of the total adult population, and the incidence of gastritis increases with age.
- Microbial: Helicobacter pylori and other microbes
- Non-microbial: autoimmune, alcoholic, after gastric surgery, caused by anti-inflammatory drugs (for example, indomethacin, ibuprofen, aspirin, etc.) caused by chemical exposure
- Unknown factors, incl. microorganisms.
Chronic non-atrophic gastritis in 85-90% of cases is due to the Helicobacter pylori microbe.
The development of chronic atrophic (autoimmune) gastritis is associated with genetically determined production of autoantibodies to the cells of the gastric mucosa.
The most common causes of chemical (reactive) gastritis are bile reflux from the intestines to the stomach and long-term use of certain medications.
The causes of eosinophilic gastritis are unknown, in some patients reveal bronchial asthma , eczema and other allergic diseases.
Granulomatous gastritis is found in 10% of patients sarcoidosis, 7% of patients with Crohn’s disease , with tuberculosis, mycoses, foreign bodies in the stomach.
The cause of giant hypertrophic gastritis is unknown.
- Pain in the epigastric region, occurring on an empty stomach. The pains can be acute, cramping or aching, non-intensive; sometimes occur soon after eating
- Heartburn, belching sour, less nausea, vomiting gastric contents.
- The most frequent manifestations of gastritis in a chronic course are heaviness in the epigastric region after eating, a feeling of overeating, stomach overflow, belching food and air, an unpleasant taste in the mouth, loss of appetite flatulence, unstable chair
- Vomiting and diarrhea; appetite is often reduced
- A general blood and urine test will help detect signs of inflammation in the body during exacerbation of chronic gastritis (tests will be normal in remission), hyperchromic anemia in chronic autoimmune gastritis.
- Stool analysis: possible the presence of hidden blood, as well as undigested food residues with reduced secretory activity of the stomach.
- FGDS and biopsy specimens for histological examination. If it is impossible to perform FGDs, an X-ray examination of the stomach with barium contrast can be performed, but this is less informative.
- The study of the secretory function of the stomach.
- Detection of Helicobacter pylori microbe. The “gold standard” is the histological examination of biopsy specimens with their color according to certain patterns and subsequent microscopic examination. A biological method is also used (sowing a microorganism on a nutrient medium).
- Manometry: with reflux gastritis, an increase in pressure in the duodenum up to 200-240 mm water column is detected. (in normal – 80-130 mm water column).
Differential diagnosis is carried out with gastric ulcer and duodenal ulcer, diaphragmatic hernia, esophagitis, tumors.
FGDS is crucial for clarifying the diagnosis.
Treatment of chronic gastritis caused by H. pilory
In case of gastritis caused by the microbe Helicobacter pylori, antimicrobial therapy is used.
There are several standard treatment regimens, including
- IPP (omez, nolpaz, pariet, emaner – substances used in the treatment of gastrointestinal diseases associated with the release of hydrochloric acid),
- bismuth preparations (de-nol, ventrisol).
Treatment of other forms of chronic gastritis
In the absence of Helicobacter pylori and increased gastric secretory function:
- drugs that lower the acidity of gastric juice (almagel, phosphalugel, gelusil varnish, maalox, etc.)
- drugs that protect (envelop) the mucous membrane: sucralfate, bismuth dicitrate (also has an antimicrobial action against Helicobacter pylori).
Treatment of chronic atrophic gastritis
Drug therapy of such gastritis is carried out only in the period of exacerbation.
Replacement therapy of secretory gastric insufficiency:
- gastric juice,
- hydrochloric acid with pepsin,
- acidin-pepsin (these drugs are contraindicated in the presence of erosions of the mucous membrane).
Replacement therapy with reduced pancreatic function:
- Pancreatin + bile components + hemicellulase,
- Panzinorm Forte.
- herbal remedies that have anti-inflammatory effect – infusion of plantain leaves, chamomile, peppermint, St. John’s wort, valerian,
Preparations that improve the nutrition of tissues and enhance healing processes:
- nicotinic acid 1% solution intravenously
- folic acid.
Reflux gastritis treatment
The treatment is aimed at normalization of gastric motility and binding of bile acids, which is primarily achieved by diet (meals 5-6 times a day in small portions, with the exception of fried, spicy, fatty foods).
To prevent reflux into the stomach of duodenal contents, domperidone and metoclopramide are prescribed short courses. Prolonged use of these drugs is not recommended due to serious side effects from 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 flow of bile into the stomach.
For the neutralization of bile acids that have a damaging effect on the gastric mucosa, chenodeoxycholic and ursodeoxycholic are used. acids, for example, Ursosan.
Protection of the mucous membrane from bile acids – drugs that reduce the acidity in the usual daily dose (aluminum-containing antacids, for example, almagel, have the ability to bind bile acids, so they are more effective).
With low acidity prescribed diet number 2:
- soups from cereals and vegetable, mashed soups in meat, mushroom, fish broths;
- lean meat (minced, fried), boiled chicken, steam, stewed, fried cutlets without a rough crust, lean ham, boiled lean fish, well-soaked lean herring, black caviar;
- milk (if it does not cause diarrhea), butter, kefir, yogurt, cream, non-sour sour cream, fresh non-sour cottage cheese, non-sharp grated cheese;
- boiled eggs, fried omelette;
- porridge, well boiled or pureed (buckwheat, semolina, rice);
- flour dishes, (except for muffin), stale white bread, gray bread, lean crackers;
- vegetables, fruits boiled, raw in the ground form; fruit, vegetable juices (also sour);
- tea, coffee, cocoa on water with milk, marmalade, sugar. Salt to 12-15 g.
- add vitamins C, B1, B2, PP.
Food for chronic gastritis fivefold, mainly in a puree form.
With increased acidity prescribed diet number 1:
- pureed dairy and vegetable (except cabbage), cereal mucous soups (but not meat and not fish);
- vegetables cooked in chopped (pureed) form or in the form of steam puddings;
- pureed porridge with butter, milk;
- boiled lean meat, boiled fish of low-fat varieties (cod, perch, pike), meat, fish steam meatballs, boiled chicken without skin;
- creamy, olive, sunflower oil;
- milk, yogurt non-sour, cream, fresh low-fat, better grated cottage cheese, non-acid sour cream;
- soft-boiled eggs or in the form of steam omelets;
- white stale bread, white lean pastries;
- sweet varieties of berries and fruits, vegetable, fruit, berry juices, dogrose infusion, jelly, sweet berry compote, fruit in shabby form, sugar, jam, tea, cocoa – weak, with milk;
- as the overall condition improves, food is given boiled, but not shabby;
- salt limit up to 8 g;
- add vitamins A, C, vitamins of group B.
Food is often taken 5-6 times a day, chewing it well; avoid too hot or too cold food)