Gastritis - Causes, symptoms and treatment. MF.

Gastritis - inflammation of the mucous membrane( in some cases, deeper layers) of the stomach wall. Most often the cause of gastritis is the bacterium Helicobacter pylori, but the development of gastritis can be caused by malnutrition, constant stress, smoking, alcoholism. Symptoms of gastritis are pain in the stomach on an empty stomach or after eating, nausea, vomiting, constipation or diarrhea, etc. Diagnosis of gastritis is based on endoscopic examination of the stomach. Treatment is carried out through the appointment of a dietary diet, as well as medication - the use of antibiotics, drugs that reduce or increase the acidity of gastric juice and drugs that protect the stomach from hydrochloric acid.

Forms of gastritis

From the point of view of the course of the disease, gastritis can be acute and chronic .

Acute gastritis most often develops in a matter of hours or days and is a consequence of massive infection of Helicobacter pylori, or other bacteria( food poisoning), as well as the intake of chemicals that have a damaging effect on the gastric mucosa( acids, alkalis, alcohols).Such aggressive substances, in the final analysis, can lead to even ulceration and perforation of the stomach.

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The mechanism of the development of gastritis is as follows: in response to damage to the gastric mucosa, special substances are allocated that call for the "accident site" cells of the immune system responsible for the speedy removal of the pathogenic substance from the body. These cells of the immune system develop violent activity, which externally manifests as an inflammatory reaction. Thus, inflammation in gastritis is not only a manifestation of the destruction of the gastric mucosa, but an attempt by the body to restore its integrity.

There are several types of acute gastritis:

Simple( catarrhal) gastritis: develops as a result of ingestion of stale food contaminated with pathogenic microbes( food poisoning), with rotaviroza, allergies to a food product or as a result of damage to the gastric mucosa by certain drugs. With catarrhal gastritis, the mucous membrane is destroyed insignificantly( only the most superficial layer) and after the termination of the action of the irritating factor it is quickly restored.
Erosive gastritis: develops after getting into the stomach of some concentrated acids or alkalis( chemical burn of the gastric mucosa).With a corrosive gastritis, not only the surface, but also the deep layers of the gastric mucosa are destroyed, so this form of the disease often gives rise to a peptic ulcer or scarring.
Phlegmonous gastritis: is a purulent inflammation of the stomach that can develop as a result of ingress of a foreign object( for example, a fish bone) into the stomach wall, followed by infection of the area with a pyogenic infection. A distinctive feature of this type of gastritis is high fever and intolerable pain in the epigastric region. Phlegmonous gastritis requires immediate surgical intervention. Without medical assistance, the disease passes into peritonitis( extensive inflammation of the abdominal cavity organs) and ends with death.
Fibrinous gastritis: is very rare in the presence of sepsis( blood poisoning).

With the right treatment, acute gastritis( depending on the form) lasts up to 5-7 days, but the full restoration of the stomach occurs much later.

In most cases, acute gastritis is accompanied by an increase in the production of gastric juice and hydrochloric acid( gastritis with high acidity, hyperacid gastritis ).Often acute gastritis can go to chronic.

Chronic forms of gastritis

The transition of acute gastritis to chronic gastritis is facilitated by frequent relapses of the disease, poor-quality treatment, prolonged exposure to irritating gastric mucosa. Chronic gastritis can last a long time without showing any symptoms. The following factors can serve as the cause of the development of chronic gastritis, in addition to those described above:

Helicobacter pylori mucosal infection( gastritis type B)
Effect of self-immune cells against the gastric mucosa - autoimmune gastritis( type A)
Bile transfer from the duodenum to the stomach - reflux-gastritis( type C).

Helicobacter pylori - one of the causes of chronic gastritis

In chronic gastritis, the gastric mucosa is much deeper and more extensive than with acute gastritis. A characteristic feature of chronic gastritis is a gradual growth in the mucous membrane of the stomach connective tissue, replacing cells that produce gastric juice( atrophy of the gastric mucosa).Chronic gastritis is often accompanied by a decrease in the production of gastric juice and acid( hypoacid gastritis ).

For a long time( especially at the onset of the disease) chronic gastritis is asymptomatic. In the development of the disease, as a rule, there are periods of exacerbation and remission. During periods of exacerbation of chronic gastritis, short-term attacks of pain, discomfort at the top of the abdomen, a feeling of heaviness, nausea after eating, heartburn, which indicates a violation of the function of the natural "valves" of the stomach and throwing acidic stomach contents into the esophagus may appear. Also, there may be signs of disruption of food digestion in the intestine: episodes of constipation or diarrhea, bloating( flatulence), increased rumbling.
Helicobacter pylori infection, parasitizing in the stomach, disrupts the processes of mucosal renewal;Thus, when old cells die, new ones can not form. This leads to a gradual degradation of the gastric mucosa with loss of function of the glands producing gastric juice.

Causes of gastritis

Gastritis is manifested by inflammation and destruction of the gastric mucosa. Inflammatory reaction in the human body always develops in response to the effect on the healthy tissues of damaging factors. In the case of gastritis, it can be infection, chemicals, high or low temperatures.
In the vast majority of cases, the cause of gastritis is the infection of the gastric mucosa by the bacterium Helicobacter pylori. This mechanism of gastritis development was established quite recently, but its discovery has revolutionized the treatment and prevention of gastritis, peptic ulcer and stomach cancer. Infection Helicobacter pylori( Helicobacteriosis) selectively affects the mucous membrane of the stomach and causes its superficial destruction by the type of gastritis or deeper destruction, in the type of peptic ulcer. However, helikobaktery can peacefully exist in the stomach, without causing disease, until there are provoking factors: weakening of immunity, getting irritants into the stomach, hormonal disorders.

Also gastritis can develop as a result of a burn of the gastric mucosa by various chemical substances( alcohols, alkalis, acids), this is observed in people who abuse alcohol or if they accidentally ingest substances that aggressively affect living tissues( vinegar, acid, alkali).Some drugs( aspirin and other anti-inflammatory drugs, some antibiotics) can also provoke gastritis, while drugs from the group of anti-inflammatory drugs( Aspirin, Diclofenac, Indomethacin, etc.) cause gastritis not only due to direct irritation of the gastric mucosa, but alsodue to the violation of molecular mechanisms of protection of the gastric mucosa, so gastritis can occur even when these drugs are used as injections or ointments.

Very often the cause of gastritis is the wrong diet:

Hasty food and poorly chewed food or food "in dry clothes" injure the mucous membrane mechanically
Eating too hot or too cold food causes gastritis due to thermal damage to the gastric mucosa.
Eating piquant food( mainly spicy and strongly salty foods) irritates the gastric mucosa in a manner similar to that of corrosive chemicals.

Causes of autoimmune gastritis

Often gastritis develops due to increased aggressiveness of the immune system in relation to the gastric mucosa. It is established that in some cases the human immune system starts to work not against microbes, but against own cells of the body( autoimmune diseases).In the case when the immune system is attacked by the gastric mucosa, there is a so-called autoimmune gastritis .With autoimmune gastritis, cells of the gastric mucosa are destroyed by the cells of the immune system and the antibodies they release. In the development of autoimmune gastritis, an important role is played by hereditary factors and previous episodes of irritation of the gastric mucosa.

Causes of acute gastritis

The causes of acute gastritis can be errors in nutrition, food poisoning, irritating effect of certain drugs( salicylates, bromides, antibiotics, sulfonamides), food allergies( on strawberries, mushrooms, etc.), acute infections, metabolic disorders. Acute gastritis is characterized by a sudden appearance and severity of symptoms. It is often not possible to find out the causes of this disorder.

Causes of gastritis can be chemical, mechanical, thermal effects and bacterial infection. The inflammatory process can affect only the superficial layers of the mucous membrane or spread to the whole of its thickness, affecting even the muscular layer of the stomach wall.

Causes of chronic gastritis

Chronic gastritis is sometimes the result of further development of acute gastritis, but most often it develops under the influence of repeated and prolonged eating disorders, acute and rough food consumption, addiction to hot food, bad chewing, dry food, excessive consumption of spirits, long uncontrolled reception of medicines. In 75% of cases, chronic gastritis is combined with chronic cholecystitis, appendicitis and other diseases of the digestive system.

In most people, gastritis develops under the influence of all the factors described above: an abnormal diet reduces the gastric mucosa, which becomes susceptible to infection( helicobacteriosis), and the primary destruction of the gastric mucosa as a result of trauma and infection triggers autoimmune mechanisms that contribute to the further development of the disease.

Symptoms and symptoms of gastritis:

Often gastritis occurs asymptomatic , however, sooner or later, symptoms of gastritis all the same manifest: heaviness in the stomach after eating, upper abdominal pain on an empty stomach or after eating, nausea, vomiting,belching, loss of appetite, weight loss are the first possible symptoms of gastritis. Symptoms and signs of gastritis can appear and disappear depending on the development of the disease and the ongoing treatment.

Symptoms and signs of gastritis depend on the form of the disease.

General symptoms of gastritis : Patients note a feeling of heaviness and fullness in the epigastric region, nausea, weakness, tongue is coated with a greyish-white coating, there may be drooling or, conversely, severe dryness in the mouth.

Isolate chronic gastritis with normal and increased secretion( high acidity) - an anatcidic and hyperacid and with a secretory deficiency( low acidity) - a hypoacid gastritis.

Symptoms of chronic gastritis with increased or normal acidity: pain, heartburn, belching with a sour aftertaste, a feeling of heaviness after eating, sometimes constipation.

With gastritis with acidity , heartburn, acidic eructations, sometimes vomiting. Patients are concerned about pain in the epigastric region, night and hungry pain.

Symptoms of gastritis with low acidity: unpleasant taste in the mouth, decreased appetite, nausea, especially in the morning, belching, rumbling and transfusion in the abdomen, constipation or diarrhea.

Symptoms of chronic gastritis with low acidity: unpleasant taste in the mouth, salivation, nausea, a feeling of overflow in the epigastric region, signs of anemia, decreased appetite and weight, dyspeptic disorders with prolonged perennial flow - weight loss, general weakness.

Acute gastritis is characterized by symptoms:

abdominal pain: severe paroxysmal or persistent agonizing. It often depends on food intake: it increases on an empty stomach or after a while after eating;
nausea is constant or intermittent, often occurs immediately after eating;
heartburn - unpleasant burning sensation in the chest, occurs after eating;
burp with a sour smell, after eating or on an empty stomach;
multiple vomiting, first contents of the stomach with a sour smell and taste, then clean mucus, sometimes greenish or yellow and bitter to taste( bile);
increased salivation - the body's response to a digestive disorder;sometimes dry mouth( after several vomiting attacks due to dehydration)
stool disorder: constipation or diarrhea; Portal about health www.7gy.ru
from the whole body: severe general weakness, dizziness, headache, sweating, fever, lowering blood pressure, increasing heart rate - tachycardia.

Acute erosive gastritis, in addition to the symptoms of acute gastritis, manifests itself as signs of gastric bleeding:

Symptoms: abdominal pain on an empty stomach or after 1 to 1.5 hours after ingestion, heartburn, belching, nausea, vomiting
is a hallmark in the emetic masses of dark bloodin the form of clots or veins
dark, tarry stool also indicates the presence of internal bleeding.

Symptoms of chronic atrophic gastritis( including autoimmune gastritis)

decreased appetite,
unpleasant taste in mouth,
burp with an unpleasant putrefactive odor,
feeling of bursting, heaviness in stomach after eating,
blunt pain immediately after ingestion or after 15-20 minutes,
nausea after meals,
constipation or diarrhea,
bloating, rumbling in the abdomen, flatulence,
anemia, brittle and dry hair, nail bundle.
Often the above violations of the digestive process lead to weight loss, severe weakness, drowsiness, irritability of the person.

Chronic gastritis occurs with periodic exacerbations and remissions. During the remission, the symptoms of the disease practically disappear, but again appear during the period of exacerbation of the disease. Exacerbation of chronic gastritis can be seasonal in nature( for example, in spring and autumn), and can also be provoked by a violation of diet, smoking, alcohol, and the use of certain medicines.

Gastritis in children

In children, gastritis is less common than in adults. The main cause gastritis in children is Helicobacteriosis, malnutrition, food poisoning, rotavirus infection. In most children, gastritis develops after school attendance and disruption of normal diet.

In children, gastritis occurs in acute form. Symptoms of gastritis in children may be more pronounced than in adults: severe vomiting, abdominal pain, diarrhea, poor appetite.

Diagnosis and treatment of gastritis in children do not differ from those in adults.

Diagnosis of gastritis

Currently the main diagnostic method for gastritis is fibrogastroduodenoenoscopy( ) - examination of the gastric mucosa by probe and biopsy( taking a piece of mucosa for analysis).FGDS allows to distinguish gastritis from peptic ulcer. On the basis of the data obtained during FGDS, gastritis is divided into by erosive and non-erosive .

Erosive( corrosive) gastritis is a type of inflammation of the gastric mucosa( gastritis), which is accompanied by the appearance on it of erosions - areas of visible damage. This gastritis occurs against the background of treatment with certain medicines( mainly non-steroidal anti-inflammatory drugs), drinking, or getting into the stomach of chemically aggressive substances. This type of gastritis, as a rule, is acute, sometimes with episodes of bleeding. However, there may be a chronic course of erosive gastritis with periods of exacerbation and remission. With shallow erosion, a feeling of heaviness in the abdomen, pain, nausea may appear, with deep erosions appear bleeding patches. Erosive gastritis most often passes into peptic ulcer.

Non-erosive gastritis is divided into superficial and atrophic .With superficial gastritis, the gastric mucosa is damaged only superficially, and the glands of the gastric mucosa do not suffer. Non-erosive superficial gastritis is the initial stage of development of any form of gastritis.

With atrophic gastritis, stomach glands that produce gastric juice are damaged. Atrophy is a term for degeneration, degeneration of glands and their replacement with connective tissue. Depletion of the mucous membrane with normal glands does not pass without a trace, in their place often "come" glands, normal for the intestine, but not for the stomach - this is the so-called intestinal metaplasia.

In addition to the forms of gastritis described above, there are others that are much less common: Menritrium gastritis( an increase in the number of glands of the gastric mucosa), polyposis( hyperplastic gastritis), and infectious gastritis.

It is established that during gastritis gastric mucosa can be affected all over, and can only be in certain parts of the stomach. On the stomach, in which the inflammation developed,

Antral gastritis is a lesion of the final( pyloric) department, in which the main mass of glands producing mucus, which protects the stomach from its own acid, is located.
Fundamental gastritis is a lesion of the middle and upper parts of the stomach in which the glands producing hydrochloric acid are located.
Pangastritis - inflammation of the entire gastric mucosa.

EGF with gastritis

pH-metry is a diagnostic method that allows you to determine the acidity( pH) of the contents of the stomach. Determination of the pH of the stomach is extremely important for the appointment of proper treatment of gastritis.

Diagnosis of Helicobacteriosis - is carried out by two methods:

Helicobacter pylori in a sample of tissues taken during EGD
Determination of specific antibodies against Helicobacter pylori in the blood of the patient

Treatment of gastritis

Treatment of gastritis is primarily aimed at eliminating factors that cause the development or exacerbation of the disease(infection, malnutrition), stimulation of restorative processes in the gastric mucosa and prevention of new episodes of the disease( exacerbations).The treatment regimen for gastritis depends on the form of the disease. In general, treatment of gastritis includes the following components: diet, medication, measures to prevent exacerbation of the disease.

In an acute period of gastritis refrain from eating until the healing of the gastric mucosa occurs and the symptoms disappear;Drinking is permitted( tea, Borjomi).After that, gradually resume the usual meal: first with a sparing diet, then, when the mucous membrane of the stomach is completely restored, increasing the number of products consumed.

The main principles of treatment of gastritis are: reduction or elimination of alcohol and caffeine, as well as spicy food;refusal to smoke and use of drugs that reduce dyspepsia and heartburn. You may need to prescribe vitamin preparations. In some cases, the use of medicines is indicated.

The therapeutic food is of great importance in the treatment of gastritis. During the exacerbation of gastritis, food should be divided, 5-6 times a day. The diet is prescribed by a doctor depending on the acidity of the gastric juice. Appointed fizioprotsedury, treatment with mineral waters.

Drug treatment of gastritis includes drugs that reduce acidity( with gastritis with high acidity), antimicrobials, antispasmodics, drugs that help restore the gastric mucosa.

Diet for gastritis

Nutrition for gastritis depends on the form and course of the disease. In acute gastritis and chronic exacerbation a strict diet is shown, in the phase of remission of chronic gastritis diet can be expanded. With any type of gastritis, alcohol, smoking, fried, fatty, spicy food is categorically excluded. To starve, too, can not in any case.

The diet depends on the type of gastritis: if the acidity of the stomach is increased, it must be reduced, and if gastritis occurs with atrophy of the mucosa, the work of the remaining glands should be stimulated.

Diet with hyperacid acute gastritis( gastritis with high acidity), it is recommended to exclude :

Foods that stimulate the production of gastric juice: alcohol, carbonated drinks, grape juice, coffee, cabbage, rye bread, legumes, sausages, smoked fish
Foods that damage the already inflamed mucosa of the stomach: mushrooms, fatty meat( lamb, pork, duck), radish, bread of coarse grinding.
Food in very hot or cold form: hot food damages the gastric mucosa, the cold lasts longer in the stomach and causes an increase in the production of hydrochloric acid.
Food fried in oil;fatty foods, fresh pastries.
Limit the seasonings: salt, pepper, garlic, mustard.

What you can eat with hyperacidity gastritis:

Low-fat meat varieties in cooked form: chicken, pigeon, rabbit. It is recommended to pass the meat several times through a meat grinder or carefully and slowly to chew.
Low-fat fish: cod, hake, pink salmon;
Vegetable puree, grated vegetables: potatoes, carrots, beets, young peas;
Fruit puree, jelly, compotes: strawberries, raspberries, apples;
Porridge, well boiled in water( semolina, oatmeal, rice)
Milk, fresh low-fat cottage cheese;
Freshly prepared cabbage juice;
It is recommended to take alkaline mineral waters( Borjomi): one glass an hour before meals.
It is necessary to pay special attention to the reception of protein foods - proteins serve as a framework for the formation of new cells.
All food should be spiced and salted. The intake of food is carried out in small portions at regular intervals( 5-6 times a day).

With hypoacid gastritis( gastritis with low acidity, atrophic gastritis) , an important point of the diet is stimulation of gastric secretion. Meals should be taken at certain times( a strict meal schedule normalizes the process of secretion of gastric juice).Food should cause a sense of appetite, its reception should take place in a relaxed atmosphere, without haste. It is important to thoroughly chew food: on the one hand, chopped food will not injure the gastric mucosa, on the other hand, while we chew, produces a large amount of gastric juice and saliva, which contribute to the best absorption of food.

When hypoacid gastritis should be excluded:

Alcohol
Products fried in oil, baked dishes
Salted, spicy dishes
Mushrooms, coarse stiff meat
Cabbage, grapes and grape juice

What you can eat with hypoacid gastritis:

Meat: rabbit, chicken inthe form of boiled meat, low-fat cutlets, meatballs;meat broth, ear;
Fish fillet from low-fat fish;
Vegetable purees, grated vegetable salads from potatoes, beets, carrots, zucchini, spinach;
Sour cream, kefir, cottage cheese, milk, cheese;
Fruit juices( except grape juice), compotes, decoctions of dogrose, black currant;
Mineral water for 20-30 minutes before eating
Food intake is carried out at least 5 times a day. Therapeutic diet is observed for another 2-3 months after exacerbation. The patient should be in a quiet environment, with conditions for a good rest and sleep. It is recommended to take vitamin and mineral preparations.

Drug treatment for gastritis

Drug treatment for gastritis should be carried out in a complex way, and necessarily in parallel with the removal of factors that provoke acute gastritis or exacerbation of chronic gastritis and diet.

The most common cause of gastritis, as mentioned above, is Helicobacter pylori infection, so after detection of the bacteria, it is necessary to carry out treatment for its eradication. In the fight against Helicobacteriosis, antibiotics and drugs that reduce the acidity of gastric juice are used. Combinations of antibiotics are usually used to kill Helicobacter pylori: for example, clarithromycin + amoxicillin or clarithromycin + metronidazole, tetracycline may also be prescribed. Doses of antibiotics and treatment regimen should be prescribed by a doctor. Treatment with antibiotics continues for 7-14 days.

Omeprazole( an inhibitor of the proton pump - inhibits the action of enzymes involved in the synthesis of hydrochloric acid in the stomach) or Ranitidine( a blocker of histamine H2 receptors, blocks receptors that trigger the synthesis of hydrochloric acid) can be prescribed as a means of reducing the acidity of gastric juice. Lowering the level of acidity in the stomach helps to protect the cells of the gastric mucosa, reduce pain, and also increases the effectiveness of other medicines.

To reduce the increased acidity in the stomach and protect the mucosa from the destructive effect of acid used drugs from the group of antacids. Antacids act quickly. They envelop the mucous membrane of the stomach with an impermeable to acid, which reduces pain and brings the patient instant relief. However, antacids must be taken often( 5-7 times a day).Antacids are available in the form of suspensions( Almagel, Maalox) or tablets( Gastal).These drugs are relatively inexpensive and can be used by both adults and children.

Some hormones, especially Misoprostol( Cytotec) can reduce the secretion of hydrochloric acid by the glands of the stomach, which helps protect its mucosa. Misoprostol is sometimes prescribed to patients with gastritis, however, in no case can it be used during pregnancy, since misoprostol is a strong stimulant of labor.

To gastroprotectors - drugs that protect the gastric mucosa from hydrochloric acid, include, in addition, Sukralfat( Venter).When ingested, it forms a barrier between the cell layer and hydrochloric acid.

In the treatment of gastritis, bismuth preparations( Pepto-bismol, De-nol) which, like Sucralfate, form a protective coating on the mucosal surface are widely used, preventing hydrochloric acid from destroying the cells.

With autoimmune gastritis treatment is carried out by hormones that suppress immunity, which in this case works against the body.

Treatment of gastritis is a multifaceted process that includes both diet and medication, and strengthening of the body's defenses. Gastritis should not be considered a norm, although it occurs in a large part of the world's population, it must be treated, since untreated gastritis leads to such complications as peptic ulcer and even stomach cancer.

Complications of gastritis

Gastritis( with the exception of phlegmonous gastritis) does not belong to the group of dangerous diseases. However, gastritis gives rise to dangerous complications:

Gastrointestinal bleeding,
Peptic ulcer of stomach and duodenum,
Gastric cancer.

The effect of gastritis on the body as a whole is explained by the digestive process. Patients with gastritis begin to "be afraid of food", lose weight, some of the most eaten food comes out with vomiting or they after a meal suffer from heartburn. Against the backdrop of gastritis often develops vitamin deficiency, anemia.

Prevention of gastritis

Prevention of gastritis should be carried out constantly: refusal from alcohol and smoking, proper nutrition, regimen, exercise, stress control.