Gastritis: Symptoms and Treatment
Gastritis is a fairly common pathology, in which the stomach is exposed to a lesion, and in particular, its mucous walls. Gastritis, the symptoms of which overwhelmingly arise against the background of the action of a specific bacterium, which Helicobacter pylori acts to many readers, may also arise as a result of a number of specific factors (alcoholism, constant stress, smoking, improper nutrition, etc.).
Gastritis can actually occur in a variety of different variants of the flow, each of which has its own definition and specificity, but if we consider this disease from the point of view of its peculiarities, then there are two forms that are generally relevant for most diseases, and Namely — a sharp and chronic form.
Actually gastritis, as we have already determined initially, affects the gastric mucosa, and symptomatology with such a lesion may be absent, although this does not exclude its subsequent occurrence in a sick person, we will consider it in more detail below. An important feature is also the fact that the evolution of the symptoms that are relevant for the disease we are considering is unstable, and therefore the signs of gastritis, starting from the actual stage and features of the development of the disease, can periodically appear and disappear.
As a preventive measure, it is important to exclude smoking and alcohol, ensure proper nutrition, and also include in the regime of the day and exercise. To top it off, we add that gastritis is not an «ordinary» disease, because it can not be «run», because if there is no proper treatment or if there are insufficient measures in this direction, this disease can provoke a peptic ulcer in the future, or even act as a kind of Bridgehead for the development of stomach cancer.
Causes of the disease
A preexisting inflammatory process in gastritis, like any other similar type of reaction in the body, is formed as a response to the irritating (damaging) factors on healthy tissues. It is with gastritis that such factors are isolated infection and the effect of too low or high temperatures.
Predominantly, the primary cause of gastritis is the initially noted Helicobacter pylori bacterium. That mechanism of the development of the disease, which is formed as a result of its impact, was established not so long ago, although this discovery was a real revolution not only in determining the causes of diseases of the stomach (and this is not only gastritis, but also peptic ulcer and stomach cancer) And on the part of treatment suitable for such diseases in conjunction with appropriate preventive measures.
Helicobacter pylori selectively affects the mucous membrane of the affected organ, that is, the stomach, thereby provoking the destruction of this membrane, which in its essence is either superficial (in which it is advisable to treat gastritis), or deep (here it is already a question About variants, approximate in degree of damage to peptic ulcer).
The development of gastritis can also be triggered by exposure to certain chemicals, which include, in particular, acids, alkalis, alcohols, etc. Actually, initially we have identified some options for such an impact — for example, alcohol. Of course, as can be seen from the listed options, it is not the only one in such an impact, because it affects the body tissues and any other type of substance aggressively, even the same vinegar.
Then we can not exclude in the review the factors provoking the disease of interest to us, the use of some medications, and, what is noteworthy, the inflammation in gastritis provokes in this case anti-inflammatory drugs (for example, usual aspirin or diclofenac, etc.). Gastritis is caused by them not only due to the direct effect on the gastric mucosa upon ingestion, but also due to disorders that are at the level of the protective molecular mechanisms by which the gastric mucosa disposes. For this reason, gastritis can appear even in the situation of using this type of drugs in injection form or even in the form of ointments.
Nutritional regimen also plays a significant role in considering the factors of influence that are of interest to us in gastritis. To the reasons having a direct relation to this regime, the following:
- Mechanical damage to the gastric mucosa: the haste of eating; Food «dry-sour; Poor chewing of consumed food
- Thermal damage to the gastric mucosa: excessively hot or, conversely, cold food.
- Chemical Impact (in this context, it is a similar effect, but through food, not alkalis and other types of factors of this type : too salty food , Spicy and spicy food.
In many cases, the development of gastritis also occurs as a result of increased aggression from the immune system of the body to the mucosa. So, it is known that some situations lead to the fact that the actions of the immune system can focus not on microbes, as necessary, but on cells belonging to the organism itself. This option is relevant for certain types of autoimmune diseases.
Accordingly, if there is a similar attack from the immune system in relation to the stomach and its mucosa in particular, it is advisable to treat autoimmune gastritis. Symptoms that accompany this type of gastritis are the destruction, respectively, of mucosal cells. This occurs as a result of an «attack» by the cells of the immune system, as well as the antibodies they release. A significant role in the development of this type of gastritis is given to hereditary factors, as well as to factors previously leading to episodes of similar mucosal irritation.
Forms of acute gastritis
For acute gastritis, a characteristic feature is the formation of inflammatory changes within the region of the gastric mucosa, which we have already determined. This gastritis, in turn, can manifest itself in several forms, being simple (catarrhal), fibrinous, corrosive (necrotic or erosive), phlegmonous (or purulent). Each of the variants of the listed pathologies, as one can understand, is characterized by the peculiarities of the processes that are relevant to them.
Catarrhal (simple) gastritis
In this case there is puffiness and thickening of the stomach mucosa, its fullness. There is also a significant amount of mucus viscous consistency and erosion in combination with small-to-large hemorrhages.
The development of this form of gastritis occurs against the background of ingrown into the stomach stale food products with pathogens (which is defined as food-borne disease). In addition, the possibility of its development is also not excluded with the actual allergy in relation to a particular food product, with rotavirus (rotavirus infection) or on the basis of damage received by the stomach as a result of the use of certain medications. Catarrhal gastritis is accompanied by generally minor lesions that affect only the surface layer of the mucosa. As a rule, recovery comes quickly enough as a result of measures aimed at stopping the irritating mucous effect.
For this form of gastritis, it is characteristic to form necrotic changes within the gastric mucosa while simultaneously impregnating the necrosis area with exudate followed by the formation of a film on it.
In the case of a superficial form of necrosis, this film is characterized by looseness of the joint formed by it with the underlying tissues, and it can be eliminated without any special difficulties (which determines croupous gastritis ). In some cases, on the contrary, the urgency acquires a deep necrosis, that is, it is characterized by the penetration of fibrin through the entire depth of the stomach, as a result of which the film is densely fixed all to the same underlying tissues (it is already defined as diphtheritic gastritis ). In this case, the removal of the formed film is accompanied by the detection in its place of multiple ulcerative defects.
In general, this form of gastritis is diagnosed in extremely rare cases and accompanies this initial infection of the blood, against which, in fact, this gastritis develops.
This form of gastritis develops as a result of chemicals entering the stomach, which is accompanied by the simultaneous development of coagulative necrosis (that is, the necrosis of certain areas formed as a result of acid poisoning) and the development of colliquated necrosis (accompanying poisoning with necrosis salts).
In this case, both the mucosa (which is defined as corrosive gastritis ) and the layers of the walls located deeper are to be destroyed, resulting in multiple erosions, as well as acute and mostly perforated ulcers. Accordingly, here it is worthwhile to note the basis laid for this period for peptic ulcer, which is determined in general from the description, or the basis for the subsequent formation of scars.
Purulent (or phlegmonous) gastritis
The main condition for the development of this form of the disease under consideration is a violation of the overall integrity, which is subject to gastric mucosa with the subsequent transition of the inflammatory process to all layers of the gastric wall (which is defined as phlegmon of the stomach). Often, this form of gastritis occurs in combination with a ulcer or tumor during its disintegration, as well as with trauma. Injuries, in turn, can be very different, but with the concomitant lesion of the stomach wall by exposure to a foreign object. As an example, it is possible to define a fish bone, as a result of which the infected area becomes infected, it, in turn, is provided with pyogenic infection.
This variant of gastritis is distinguished by the fact that it is accompanied by a high fever in combination with intolerable pains, concentrated in the epigastric region. Also important is the need for immediate surgical intervention, otherwise its absence will lead to peritonitis (it is understood as a vast inflammatory process that affects the abdominal cavity organs). Eventually, the process of this process ends with a lethal outcome without taking the necessary measures.
Symptoms of acute gastritis
Before turning to a direct examination of the features of the clinical picture of acute gastritis, we note that this picture, as, indeed, the course of the disease in this variant, is determined for the most part by the nature of the particular damaging agent, along with the duration of the exposure and, in general, Such an effect on the part of the body itself.
The first symptoms of acute gastritis are mostly noted after about 6-12 hours from the time of the previous exposure to a pathogenic factor. Initially, «there is» in this case, the symptomatology, relevant for gastric dyspepsia. It includes the following manifestations:
- loss of appetite;
- pain, severity in the epigastric region (moderate)
- an unpleasant taste in the mouth
- nausea and vomiting (often repeated, impurities of bile and mucus are noted, vomiting is characterized by an unpleasant odor and general abundance)
- increasing weakness
When eating infected foods, the possibility of a liquid or mushy stool (about several times a day) is not ruled out. Also noted abdominal swelling, rumbling in it. In addition, the temperature can rise, not only within the subfebrile indicators, but also the febrile indices (within 38-39 degrees).
The most symptomatic of acute gastritis is manifested by food contamination with staphylococci and salmonella. In this case, the repetition of diarrhea is of multiple character, progression of weakness is noted with simultaneous increase of dehydration. Temperatures can reach 39 or more degrees (again, febrile temperature). Hospitalization here is required urgently.
Acute phlegmonous gastritis is characterized, first of all, by a pronounced fever with severe pain in the epigastric region, with vomiting, chills, rapid deterioration of the general condition of the patient, increased pulse, repetition of vomiting. In some cases, the presence of pus can be determined in the vomit. Also, patients are restless in this case, the face acquires a drained appearance, the muscles of the epigastric region are severely strained, the stomach is generally painful.
If we consider acute corrosive gastritis, then its course as a result of the use of concentrated poisons is accompanied by burning and severe pains that occur directly in the mouth, throat and esophagus, and also, in fact, in the stomach. Difficulty swallowing. Vomiting in this situation is constant, without relief, in the emetic masses themselves, mucus is detected with impurities of blood, in some cases even with particles of the mucosa of the esophagus or stomach.
Visually, it is possible to identify traces from the concomitant effects of a given type of poison in the area of the mouth and throat, which are manifested as burns. There is also marked reddening and swelling of the oral mucosa / pharynx. Poison to the larynx is accompanied by its edema, as well as manifestations of laryngospasm (sudden involuntary contractions of the larynx musculature, as a result of which the vocal cyst completely closes, inspiratory dyspnea appears).
As a result of the appearance of severe pain, the patient develops a shock, which lowers blood pressure and increases the pulse. The palpation of the abdomen determines the actual tenderness, swelling. Sometimes there is hemolysis (dissolution) of the poison as a result of its resorption (that is, absorption), which is accompanied by a change in the color of urine.
Predictions in the acute form
As for questions regarding the course of acute gastritis in conjunction with the prognosis for it, it can be noted here that an acute exogenous gastritis after a few days ends with a persistent recovery. As a special feature of the patient’s condition, indicating the transition of the disease to a safe flow with a tendency to reverse development of the actual process in this case, there is a general improvement in the state of health and appearance of appetite.
It is noteworthy that when infected products are used by elderly and weakened persons for them, as well as for those who already have a different type of serious illness, a significant danger of worsening of the general state against the background of development of acute gastritis is determined.
The most unfavorable in the course of the forecast is determined for those patients who have an acute form of a corrosive gastritis. For them within the next two or three days, the possibility of death due to the development of shock in combination with peritonitis due to perforation of the stomach is not excluded. Based on some data, the lethality may be of the order of 50%.
As an outcome for chemical damage to the esophagus / stomach, the possibility of esophageal strictures and cicatricial deformities of the stomach is determined, as a result of which there may subsequently be a need for some form of surgical intervention (for example, gastrostomy, esophagus, etc. .).
Acute phlegmonous gastritis also determines a poor prognosis, because in this case gastric perforation, pleurisy, purulent peritonitis, mediastinitis, abscesses and abdominal sepsis are not excluded.
Chronic gastritis refers to a prolonged course of gastritis, which develops a number of morphological changes that directly affect the gastric mucosa. Thus, in case of chronic gastritis, the cell-cell infiltration increases, the regenerative process of the glandular epithelium is broken, and the epithelium cells atrophy gradually develop, during which the normal glands are replaced by the connective tissue, then reconstructed according to the intestinal or pyloric type.
Structural changes that progress with chronic gastritis are also accompanied by malfunctions of the mucosa, which primarily affects the secretory function of pepsin and hydrochloric acid.
Do any conclusions about the prevalence of this type of gastritis flow in its actual scale is quite difficult. This is complicated, first of all, by the relative complexity of the process of diagnosing this type of gastritis, as well as the fact that often its development is subject to those forms in which there is minimal symptomatology, on the basis of which the patients simply do not consult a doctor.
Meanwhile, most researchers agree that chronic gastritis is an actual disease of the order for 80% of the world’s population. Remarkably, the importance of this type of disease determines the importance of not only the frequency of its overall prevalence, but also that some of its forms are the direct cause of the subsequent development of much more serious diseases, such as, for example, a stomach ulcer or its cancer.
Features of origin and the mechanism of development of a chronic type of gastritis are still not fully understood. Moreover, convincing statement of the fact that chronic gastritis develops against a background of acute gastritis, for today while is not present. The most widely spread on this account was a point of view based on the consideration of chronic gastritis as an independent disease, initially manifested in accordance with the criteria characterizing the chronic type of flow.
With regard to the classification of forms of gastritis, then everything is quite difficult. So, there are such forms of this disease, which are unconditionally recognized by morphologists, however, there is also the presence of those accepted forms that, to a large extent, do not belong to gastritis.
The principles on which the classification of this disease is based, as well as a number of terms within this classification, are ambiguous. For example, on one side such forms of chronic gastritis are defined: erosive gastritis, gastritis, non-erosive, and gastritis specific. On the other hand, two more variants are added to this list of forms, gastritis is corrosive and gastritis is phlegmonous, which, as we have previously considered, is isolated exclusively when considering the acute form of the disease. Specific type of gastritis is defined as gastritis hyperplastic.
A more detailed existing version of the classification, determined by one of the authors, uses a number of criteria, based on the consideration of which specific forms of forms are determined. So, such criteria include: the type of mucosa, the actual degree of development of the disease, the activity of gastritis, the relevance of metaplasia and its type.
Russian literature on these features highlights the currently recognized type of classification based on these criteria: superficial gastritis, chronic gastritis without mucosal atrophy, but with mucosal lesions, chronic atrophic gastritis with or actual epithelial alteration, gastritis Chronic atrophic-hyperplastic, as well as chronic gastritis hypertrophic.
Symptoms of chronic gastritis
Over a long period of time the course of chronic gastritis is characterized by its own asymptomatic. The development of the disease as a whole determines the presence in its course of periods in the form of exacerbation and remission. If you dwell directly on the symptoms of the disease, then, like the definition of varieties of its forms, it is also the subject of heated discussions.
Thus, some authors have suggestions that each of the forms of chronic gastritis has its own clinical picture, as a result of which it also has its own symptomatology. Other authors, again based on the previous statement, believe that the chronic gastritis itself does not have any specific clinical symptomatology, respectively, the symptoms can be isolated when diagnosing a specific form in which the definition of the type of gastritis in the form of a chronic disease is only the basis. This point of view is quite common in recent years.
To top it all, the results of histological and endoscopic examinations (regarding biopsy specimens of the antrum and fundus mucosa) for patients with chronic gastritis are an absolute inconsistency with various complaints relevant to them. Accordingly, based on the results obtained, it has been suggested that chronic gastritis itself is one of the most erroneous diagnoses established within the current millennium.
The points of view that we have just described are essentially extremes in considering the problem of interest to us, so it would be hardly possible to determine their fairness. In fact, chronic gastritis, like an established diagnosis, can in no case be based solely on symptomatology on a subjective scale, in particular this is important given the frequent absence of any manifestation of this disease (that is, its asymptomatic course in most cases) . The pain symptom itself is often also absent.
Meanwhile, many authors adhere to the fair point of view concerning the fact that patients with chronic gastritis and with its aggravation in particular, patients often face different types of complaints. This includes the marked pain sensations, and manifestations of this type such as heartburn, nausea, flatulence, belching, frustration of stool and appetite, etc.
It is also important that the clinic of manifestations of chronic gastritis with preservation of the acid-forming function and its increase is significantly different from patients with a chronic form of gastritis with a current secretory insufficiency during the course of the disease. Starting from the above features, it can be summarized that when the patient is thoroughly questioned and the correct interpretation of the complaints that he is experiencing, the real importance of their diagnostic value is determined.
For all forms of chronic gastritis, the perennial course is characteristic, in which the periods of exacerbation and remission are usually subject to alternation. In addition, over time, chronic gastritis in one form or another takes on a progressive course. Thus, for example, starting primarily from the antral section, the gastric type, changes in surface character later spread to the mucous membrane of the fundus, acquiring, again, with time, a diffuse character.
Predictions in chronic form
As a rule, the prognosis during this disease is favorable. In patients with him for a long time retained ability to work. In the case of chronic gastritis and gastroduodenitis in combination with high acidity, it is important to consider the possibility of developing a peptic ulcer, the course of which involves the localization of ulcers in the area of the duodenum. In the case of erosive gastritis, the possibility of gastric bleeding is not ruled out. At an atrophic diffuse gastritis, at which acidity is lowered, there is a risk of developing stomach cancer.
This form of gastritis is the earliest in the development of its chronic course. In this variant, the gastric mucosa has a normal thickness, in some cases with a slight thickening. Dystrophic changes are moderate. The secretion of mucus is already increased, and the process of producing pepsin and hydrochloric acid (it is lowered in this case) is also subject to certain changes. In general, the changes that are relevant for this form of the disease, expressed and total character do not have, as for example, with gastritis atrophic, but it is from this stage that the subsequent progression of the disease is not ruled out.
As for the symptomatology, surface manifestations of gastritis are not typical for the disease as a whole, that is, discomfort and abdominal pain are not observed on an empty stomach or after eating, metabolism and digestion processes also remain without characteristic disorders. Actually, it would be more correct to note the absence of symptoms of this form of the disease, only with rare and insignificant in its essence manifestations. Basically, superficial gastritis is detected randomly. Specific treatment at this stage of its course is not required, in general, it is possible to do with general restorative therapy, diet.
With atrophic gastritis, the gastric mucosa decreases significantly, as does the number of cells in the stomach that function. Atrophic gastritis can flow in an atrophic-hyperplastic form, a moderate or severe form.
As for the symptomatology, it consists in this case in the appearance after eating of a feeling of overcrowding of the stomach and the general severity in it. Pain may be absent. There is also an eructation after eating, later it has an unpleasant aftertaste, then a severe heartburn is added to these manifestations.
There is also a loss of appetite, a violation of the secretory function, affecting the work of the stomach and leading to the subsequent weight loss of the patient. In addition, gurgling in the abdomen, rumbling, alternating diarrhea and constipation is noted. In some cases, after eating, the patients notice excessive sweating, dizziness, weakness.
Somewhat later, the problems associated with the absorption process in the stomach and in the intestines of substances necessary for the body begin to accompany the course of the disease. Against this background there is a deficiency of vitamins. Thus, a deficiency of vitamin A leads to a deterioration in vision, pallor of the skin and dry skin. Because of vitamin C deficiency, there may be problems of a certain scale with teeth, nails, hair.
Gastritis with high acidity
It would be more accurate to define this heading as a chronic gastritis with high acidity (or else — secretion of hydrochloric acid). In addition, the symptomatology considered later is also relevant for chronic gastritis characterized by normal secretion.
This form is mostly diagnosed in young patients, while men are more likely to develop chronic gastritis in the form in question. Inflammation, which is formed within the gastric mucosa, is characterized by the superficiality of its lesion, only in some cases determining the presence in the antral region of elements of an atrophic form of gastritis. In frequent cases, inflammatory changes that are relevant for this variant of the course of the disease are supplemented by inflammatory changes in the area of the duodenal mucosa (otherwise it is defined as gastroduodenitis, information about which you can also find in the relevant section of our site).
Pain in treating a patient’s condition in this form of the disease is a frequent occurrence, but not mandatory. Most of this symptom occurs on an empty stomach (this symptom is also commonly defined as hunger pains), that is, after an hour and a half or two hours after the last meal. In addition, the occurrence of pain in the night is not excluded. As you can see, this symptom resembles the ulcerous nature of the processes in the stomach, and it is difficult to distinguish in practice one diagnosis from another on the basis of this characteristic as the main one, in some cases.
The differential nature of the treatment of pain for an accurate diagnosis requires consideration of the fact that the severity of pain in the chronic form of gastritis in combination with increased acidity of the stomach when compared with the pain associated with peptic ulcer disease is slightly less pronounced, In to a particular season (that is, they do not have a seasonal character). In addition, often pain in the examination of this form of the disease appear in certain variants of nutritional errors, respectively, and they subsided when the patient complies with the diet.
Heartburn is also a fairly common complaint when considering cases of the disease in its given form. Heartburn, as a rule, arises against the background of another, accompanying the considered variant, a disease — esophagitis. There is also a burp and nausea, a tendency to constipation, an unpleasant taste in the mouth.
An objective examination often does not reveal pronounced changes. Sometimes, when palpation (palpation), painful sensations may appear. At an elevated or normal level, as can be assumed from the general name of the form of the disease, there is acidity (secretion of hydrochloric acid). X-ray examination determines hypersecretion, violation of motility of the duodenum and stomach, thickening of the gastric mucosa. The presence of a significant amount of mucus or bile, edema and hyperemia of the mucosa reveals the procedure of gastric gastroscopy. Histological examination in the antrum reveals atrophic or superficial gastritis.
Gastritis with low acidity
Here, as before, the name can be supplemented with the definition of «chronic», and this time, unlike the previous form, the secretion of hydrochloric acid (and, in fact, acidity) is lowered, also the state of secretion in this variant can be determined and As «insufficiency.»
The considered form of chronic gastritis is one of the most common variants of gastritis, it is noted in middle-aged people, as well as the age of the elderly. In general, gastritis with a deficiency of secretion against the background of actual processes for it leads to the fact that the stomach loses its ability to break down food.
Predominantly, patients complain of a feeling of overflow and heaviness, noted in the area «under the spoon», these feelings appear after eating, and in some cases — even after a slight «snack». In addition, there is nausea and belching of eaten food, a decreased appetite, an unpleasant taste in the mouth, «transfusion» and rumbling in the stomach, flatulence.
Because of the acceleration of the passage along the intestine of food against the background of development as a result of the complete disappearance of the secretion of achillic gastritis, diarrhea often occurs, which, in severe cases, may eventually lead to a syndrome of insufficiency of absorption / digestion in combination with intestinal dysbacteriosis. In this variant of the course, intensive weight loss is observed in patients, anemia (a decrease in hemoglobin) and hypoproteinemia (a condition that results in an abnormally low level of protein in the blood plasma). As a supplement, we can identify the manifestations peculiar to hypovitaminosis, which consist in the formation of venom in the corners of the mouth, as well as in the defeat of the tongue, hair loss, brittle nails, skin peeling, etc.
Achilles gastritis as a result of a prolonged course, in turn, can later develop with the symptoms of hypocorticism in combination with the symptomatology, indicating the failure of functions of a different type of endocrine glands, which is accompanied by arterial hypotension, general weakness, decreased sexual function and other disorders. In some cases, electrolyte disturbances also develop, which, first of all, are caused by the actual shortage of potassium ions. The possibility of secondary manifestation of such diseases as enteritis and enterocolitis, pancreatitis and cholecystitis is also not excluded.
Secondary symptoms of chronic gastritis in this form with reduced acidity are also tachycardia, dizziness after eating, milk intolerance. In some cases, heartburn develops, which occurs against the backdrop of thrown into the esophagus of organic acids accumulated in the stomach. As a result, patients may complain of the appearance of a characteristic «metallic» taste in the mouth, which is also accompanied in this case by increased salivation.
Let’s return to the achilles gastritis discussed in the previous part of our article. Achilles gastritis, the symptoms of which often develop precisely as a gastritis of this form, that is, from a form with a low acidity, often acts as the final stage of gastritis, but already in a form with high acidity.
The most pronounced manifestations of symptoms are observed in those patients who develop gastric Achilles, which occurs as a result of a significant decrease in secretion, which is relevant in the context of the consideration of reduced acidity, and down to practical disappearance, than the actual Achilles is There is no hydrochloric acid and pepsin in the gastric juice.)
So, returning to the symptomatology, in the foreground in patients in this case there are dyspeptic manifestations of the disease. This includes an eructation with a characteristic taste of a rotten egg or simply belching with air. Often noted severity and discomfort in the epigastric region, nausea. The pain sensations generally noted in gastritis are not characteristic in this case, although in some cases, depending on the quality and quantity of food eaten, painful pain may appear in half an hour or hour after its adoption, they are not strong, but some inconveniences to the patient are all -takes bring.
With gastroduodenitis or when concentrating the inflammatory process within the area of the antrum of the stomach, you can note a greater severity of the pain syndrome. Also, patients have decreased appetite, which can achieve almost anorexia. In many cases, anxiety is noted in the form of gingivitis (dystrophic disease, inflammatory or otherwise), glossitis (which is an inflammation of the tongue).
Achilles gastritis is also accompanied by an unpleasant aftertaste in the mouth, it also happens that patients get vomiting on an empty stomach. Diarrhea, which is associated with the previously noted process of dysbacteriosis development against the background of microflora prevalence in the intestine provoking fermentation and festering, and with the exclusion of the normal secretory function of the glands of the stomach, is quite frequent manifestation, accompanying the course of this disease. The diarrhea in question is defined as achilic diarrhea.
It is noteworthy that disorders related directly to the functional activity provided by the intestine, and inherent in this form of gastritis, consist in the alternation of diarrhea with constipation, as well as manifestations of flatulence combined with a general disruption of processes associated with digestion of food.
This form of gastritis is a common cause of bleeding from the upper gastrointestinal tract, may be acute in nature of the course or chronic. In acute form, erosive gastritis develops as a result of a large type of injury or burns, head or blood loss, against liver or kidney failure, sepsis or shock. As a rule, the listed variants of conditions are quite difficult for the patient, and therefore the detection of dyspeptic phenomena in them is impossible in principle.
The first sign of acute gastritis of the form in question consists in the appearance of bloody vomiting, which is otherwise defined as hematemesis, or tarry in the consistency of the stool, whose name is defined as melena. The diagnosis is made by endoscopy, in which erosion is simultaneously subjected to electrocoagulation.
As for chronic gastritis in erosive form, which is also defined as hemorrhagic gastritis, it mainly develops as a result of the use of anti-inflammatory non-steroid drugs, with the use of alcohol, against the background of the actual Crohn’s disease or a viral infection.
It also happens that the development of this form of the disease occurs for no apparent reason, which is already defined as an erosive idiopathic gastritis. Symptomatology in general may be absent, in some cases there is discomfort in the epigastric region and nausea, although in general the treatment for this form of specialized care occurs when there is direct symptomatology indicating directly to bleeding: dizziness, fatigue and tachycardia, bloody vomiting and tarry stools .
This form of gastritis also applies to chronic gastritis, a complete definition of it can sound like gastritis of type C, bile reflux-gastritis or gastritis of a chemical-toxic-induced.
The main symptoms of this form include the following manifestations: weight loss, a feeling of heaviness immediately during or after food, nausea, vomiting with bile, bloating, constipation, diarrhea, an unpleasant taste in the mouth. Frequent manifestations are anemia and general weakness, dry skin, jaundices on the lips.
This diagnosis combines a large group of patients, including patients who used non-steroid drugs; Patients with an earlier operated stomach (i.e. with stomach resected); Patients with a diagnosis of duodenogastric reflux (or DGR), in which the contents of the duodenum, which is extremely aggressive in the action of bile, are thrown into the stomach.
As for duodenogastric reflux, it is caused by a violation of the closure function on the part of the gatekeeper, an increase in pressure in the duodenum, a chronic form of duodenitis.
In the treatment of this form of chronic gastritis, the primary causative agent that provoked the disease is guided, first of all, by determining the appropriate therapy for binding the bile acids and for normalizing the gastrointestinal motility.
This form of chronic gastritis is one of the varieties of chronic gastritis with the previously considered reduced acidity. The name of this form is determined on the basis of the inadequacy of the secretion function of parietal (parietal) cells of hydrochloric acid. That is, such a gastritis can be of two types: hypoacid gastritis, in which the release of acid, although not sufficient, is not at the «zero» level, or, in fact, an anacid, in which acid release does not occur at all. Considering the fact that the basis of this phenomenon forms the process of cell atrophy, provoked by their autoimmune lesion, anatzid gastritis is inherently an atrophic gastritis.
Low acidity, relevant in this case, is a very serious problem, because due to the presence of acid in the stomach, it forms a kind of bactericidal effect. Accordingly, the lack of acid leads to a simplification of the process of infection by certain microbes, as a result of which, as it is easy to guess, various types of pathology develop. In addition, reduced acidity leads to a poor-quality splitting in the stomach of proteins, because of which the products of their decomposition, accumulating here, can become the basis for the development of cancer.
Also, reduced acidity, with this kind of gastritis and in general, is the cause of a decrease in gastric motility and intestinal motility, and this, in turn, causes constipation. In addition to constipation, diarrhea, which is actual for the disease as a whole, eructation (occurs after eating), nausea, and pain in the area «under the spoon» are also not excluded. Remarkably, the symptoms of gastritis develop in adults of middle and old age, often this disease occurs in combination with inflammation of the kidney and gallbladder, colitis and chronic enteritis.
With hyperacid gastritis (one of the varieties of gastritis with high acidity), gastric mucosa is traditionally susceptible to inflammation, and the level of hydrochloric acid in it is increased.
As in most cases of the manifestation of the disease, hyperacid gastritis is accompanied by «hungry» pains, that is, pains against the background of a hungry stomach or pain occurring 2-3 hours after the last meal. The pains that appear in this case have a nicking or pulling character, they are concentrated in the area «under the pit of the stomach». As the reason for their appearance, the process of active erosion of the gastric mucosa by hydrochloric acid is determined. The pain is relieved after eating, but after a while after it, the feeling of heaviness and bursting again arises in the epigastric region.
Typical for the disease as a whole symptom is heartburn, which arises both without any predisposing causes to it, and when using specific products (smoked or fatty foods, black bread, etc.).
With hyperacid gastritis, the appetite in patients, as a rule, does not vanish. In some cases, immediately after eating, vomiting occurs. In the language there is a raid of gray-white color, the language is bright red at the same time.
In addition to these symptoms, one can also identify general irritability of patients, increased sweating, susceptibility to spasms of one or another specificity of origin. This form also negatively affects the general peristalsis of the intestines, which can cause constipation. Along with this, patients also face a feeling of intense burning that occurs in the stomach area, which occurs as a result of their consumption of acidic foods.
Symptoms of superficial gastritis determine the relationship with several variants of gastritis. So, its classical variants point to a combination of superficial, hypertrophic, erosive and hemorrhagic gastritis, and the combination is possible for both any of the forms listed above, and all.
The initial stage in the development of this disease is marked by the formation of inflammatory processes, mainly covering the superficial epithelial layer of the stomach. In some cases, simultaneously with the lesion of the epithelial layer, the stomach glands are also affected (in this case, their death does not occur, the functionality remains).
Subsequently, superficial gastritis can either be transformed into another form of gastritis, or continue to exist simultaneously with the developing erosive, hypertrophic or hemorrhagic form of the disease. Determine the exact model of the development of the clinic of the disease is not possible in principle, because the main features, this clinic components are determined based on a number of factors. The only, and quite logical statement in this situation is only that the progression of the disease will be accompanied by a general deterioration in the patient’s condition and aggravation of the actual symptomatology.
The mixed gastritis can be accompanied by various variants of acidity, that is, the state of the patient in this plan can be hypoacidic (with reduced acidity), hyperacid (with increased acidity) or normal, that is, without changing the acidity in any direction beyond the norm. As for the symptoms, it is similar to chronic gastritis in general. So, a seizure of gastritis, the symptoms of which patients experience in this form, looks as follows in terms of their manifestations:
- «sucking» in the area «under the spoon»;
- general discomfort in the upper abdomen (that is, in the epigastric region)
- feeling of fullness of the stomach;
- severity, more defined as pain;
- Irradiation of pain from epigastrium to the region of the left hypochondrium or to the back
- nausea, vomiting
- decreased appetite
- burping (food, air)
If it is a question of short ones during bouts that result from, say, usual overeating or the use of drugs that irritate the gastric mucosa, then in special and long-term implementation of specific therapy the need may not arise. Moreover, the exclusion of irritating factors may lead to the disappearance of concomitant symptoms.
Gastritis in children
Symptoms of gastritis in children are more pronounced than in adults. It is noteworthy that gastritis is diagnosed more often in children at a rather early age — in some cases it happens that at 5 or 6 years old, the diagnosis of gastritis of a chronic type of current is «behind the shoulders» of small patients. This may be due to a number of factors, ranging from ecology and nutrition and ending with the traditional effect on the stomach of infection in Helicobacteriosis, etc.
The disease can occur in children both in acute form and in chronic.
The development of acute gastritis occurs as a result of irritating gastric mucosa. The gastrointestinal tract in children finishes to form only to the age of seven, respectively, to provoke such irritation can almost any product, even those that do not in any way affect the health of adults. In addition, the peculiarity of the digestive system in children is that it is characterized by a low content of hydrochloric acid in the stomach, while its activity is practically insignificant. For this reason, even a single bacterium that gets into the body of a child with food can easily provoke a serious illness for him. If we are talking about adults, then in this case hydrochloric acid provides its own protection against various types of infection, suppressing the growth of bacteria entering the stomach and their subsequent reproduction.
It is also important to note that gastric motility in children is lowered, as a result of which mixing of food in the stomach takes a long time and is not intensive. As a result, with poor chewing, a lump of food for a long time can be in the stomach, irritating gradually its mucous.
As for the symptoms, acute gastritis in children is accompanied by pain (varying degrees of intensity) in the epigastric region, nausea and vomiting. Duration of the disease is about 2-3 days (less often — up to 10), its course may not require drug therapy. Completion of the disease is accompanied by a complete restoration of the gastric mucosa. What is noteworthy, children can suffer the order of several tens of attacks of acute gastritis during life, which will not affect their health in general.
Chronic gastritis in children is accompanied by a prolonged preservation of inflammatory changes in the mucosa, as well as periodic exacerbations of the disease. There is a certain tendency to accustom to seasonality of exacerbation — more often it is noted in autumn and spring. In addition, the urgency of the attack is also considered as a result of inaccuracies in the diet.
Symptoms of chronic gastritis are manifested in the form of dyspeptic disorders and abdominal pain that occurs about 15 minutes after eating. Characterized by pain duration and increased self-manifestation, while the pain is compressive, not paroxysmal (this option is more suitable for the course of peptic ulcer disease). With the use of «annoying» products (smoked, fried, spicy food, carbonated drinks, etc.), there is an increase in pain.
As for dyspeptic disorders, they consist of manifestations of heartburn, nausea, and stool disorders (constipation). The course of chronic gastritis is also accompanied by the appearance in the language of children in white plaque.
As a result of the chronic process, the condition of small patients changes as a whole: they become sluggish, quickly get tired, the temperature may rise slightly. Actual in this state of the processes lead to a violation of absorption of certain substances (vitamin B12, iron), resulting in the development of iron deficiency anemia with concomitant symptomatology: a change in taste, dullness of hair, brittle nails, pallor.
As the main method of diagnosing gastritis, which is used today, it is possible to determine the FGDS — the procedure of fibroadastroduodenoscopy, in which a special probe is used to examine the gastric mucosa in combination with simultaneous biopsy. Biopsy under this procedure (as well as in general) involves the removal of some of the mucosa for further analysis.
The data obtained at FGDS allow to determine the nature and form of gastritis and the general state of the area under study. In addition, an important point in the subsequent administration of gastritis treatment is the determination of the pH of the stomach, which is done with the use of pH-metry as a method of isolating a particular type of acidity.
To detect Helicobacter pylori, a sample of a part of the mucosa withdrawn from FGDs is used, or blood — in its study, it is determined whether it contains specific antibodies against the bacteria of interest.
Treatment of gastritis
Treatment of the disease is focused, first of all, on the elimination of those factors that provoke its development or exacerbation, which can occur in particular against the background of infection, disorders in nutrition and other reasons that we considered earlier. In addition, stimulation of the processes providing internal recovery, i.e., restoration of the gastric mucosa, is also provided. A separate direction is taken by preventive measures. In general, the components of gastritis treatment are as follows: drug treatment, diet, preventive measures for exacerbation of the disease.
Medical treatment is complex and, as we have already determined, requires consideration of a number of factors that provoked the disease. Helicobacteriosis in this case is eliminated using antibiotics in combination with drugs that reduce acidity. Antibiotics are mostly used in a combined version, for example, amoxicillin with clarithromycin, possibly with tetracycline, or metronidazole with clarithromycin, etc. Dosage of drugs is prescribed exclusively by a doctor, the duration of treatment, as a rule, is about a week or two.
Omeprazole (Omez) is often used to reduce acidity, acting as an inhibitor of the proton pump, acting depressingly on enzymes that are directly involved in the processes of synthesis of hydrochloric acid. Also for this purpose, Ranitidine, used as a blocker of H2 receptors, which acts on receptors, due to which the synthesis of hydrochloric acid is triggered, can be prescribed. It should be noted that a decrease in acidity is an important factor in the treatment, because it provides protection for gastric mucosal cells while reducing pain and increasing the overall effectiveness of other medication therapies.
In addition, the treatment of gastritis also suggests the possibility of using bismuth preparations, which provide the formation of a protective shell directly along the surface of the mucosa, thereby reducing / eliminating the possibility of destruction of its cells with hydrochloric acid acting on them.
As for the diet, then, again, it is determined based on the specific form of the disease and the characteristics of its course. Acute gastritis, for example, during remission allows to expand the diet, while for chronic gastritis there are more severe restrictions in this regard. Regardless of the variant of the course and form of gastritis, spicy / spicy food, alcohol and smoking are strictly forbidden. The essence of the diet is also determined from the acidity of gastritis. Thus, with increased acidity, it can be understood that it must be reduced; With mucous atrophy (reduced acidity) with gastritis it is important to ensure the functioning of those glands that have retained their functionality during the course of the disease.
Diet with increased acidity with gastritis implies the exclusion of products that stimulate gastric juice production: carbonated drinks and alcoholic beverages, grape juice, coffee, beans, cabbage, smoked products, sausages. Also excluded products, due to which affects the gastric mucosa, and so is in an inflamed condition: fatty meat, mushrooms, flour products of coarse grinding.
Observed in the food and the appropriate temperature regime of the consumed products. It is important to take into account that hot food is damaged by inflamed mucosa, food cold for a longer time remains in the stomach, due to which the production of hydrochloric acid increases. Again, it excludes fried in oil food, fresh pastries.
Accordingly, under this scheme, low-fat, cooked foods, fresh vegetables and fruits, cereals, fresh juices, compotes, milk, mineral waters (alkaline, Borjomi type) are subject to consumption. Foods in any form should be minimally salted and seasoned. A special emphasis is on protein foods, through which a «skeleton» is provided in the subsequent formation of new cells. Portions — small volumes, with an interval in small time intervals, about 6 times a day.
Diet with reduced acidity with gastritis is focused more on stimulating gastric secretion. Consumption of food should be in accordance with a strict schedule, that is, at certain times — due to this, the process in which the gastric juice is secreted is normalized in the required manner. The haste in eating is ruled out, it is important to thoroughly chew it. Grinding food in the latter case will not have a traumatic effect on the mucosa, while chewing food in itself stimulates the production of more saliva and gastric juice, due to which the food is digested in the best way.
If you have any symptoms that indicate gastritis, you should consult a gastroenterologist, you may need to consult a nutritionist.