Chronic gastritis and Chronic gastritis and peptic ulcer diseasepeptic ulcer disease

gastritisgastritis

Gastritis - a focal or diffuse Gastritis - a focal or diffuse inflammation of the gastric mucosa in inflammation of the gastric mucosa in response to its damage with disorders of response to its damage with disorders of the secretory, motor, and sometimes the secretory, motor, and sometimes inkretory functions.inkretory functions.

types of gastritistypes of gastritis

acuteacute;; chronic;chronic;

specispecificfic forms of gastritis : forms of gastritis : hypertrophic;hypertrophic; lymphocytic;lymphocytic; eosinophilic;eosinophilic; granulomatous;granulomatous; reactive.reactive.

International Classification International Classification of gastritis (Houston, 1994)of gastritis (Houston, 1994)

Nontrofic (Nontrofic (ttype B)ype B) Atrophic, autoimmune (type A)Atrophic, autoimmune (type A) Specific forms:Specific forms: -Chemical (reflux gastritis, type C)-Chemical (reflux gastritis, type C)

-R-Radiativeadiative-Lymphocytic-Lymphocytic-N-Noninfectious granulomatousoninfectious granulomatous-Eosinophilic-Eosinophilic--SomeSome infections infections

Etiologic factorsEtiologic factors

Exogenous:Exogenous:

Alimentary disordersAlimentary disorders

SSmokingmoking

AAlcohollcohol

Neuropsychiatric stressNeuropsychiatric stress

Occupational hazardOccupational hazard

The uncontrolled use of drugsThe uncontrolled use of drugs

Etiologic factorsEtiologic factors

Endogenous:Endogenous:

Chronic infectionChronic infection

Diseases of the nervous and endocrine Diseases of the nervous and endocrine systemssystems

Cardiovascular and respiratory systemsCardiovascular and respiratory systems

Renal failureRenal failure

Clinical syndromesClinical syndromes

PainPain Gastric dyspepsiaGastric dyspepsia Intestinal dyspepsiaIntestinal dyspepsia Asthenic-neuroticAsthenic-neurotic

Laboratory studies:Laboratory studies: complete blood count (deviation possible more prolonged chronic

disease with symptoms of atrophic gastritis, iron deficiency or B12 deficiency anemia);

urinalysis;

fecal occult blood worms and eggs;

cytology of byoptites (during the first endoscopy, the dynamics - if necessary, after the end of treatment);

histological examination of biopsy samples (if necessary – in dynamics);

tests for Helicobaster pylory detection (fast urease test, breath test, smear-mark);

total protein and protein fractions of blood serum;

determination of glucose in blood and urine.

Instrumental study:Instrumental study:

esophagogastroduodenoscopy with mandatory biopsy and brush cytology;

ultrasound of the abdomen; X-ray examination: X-ray examination of

esophagus, stomach, duodenum and other parts of the intestine, if necessary - radiography of these bodies.

Differential diagnosisDifferential diagnosis

ulcer ulcer stomach stomach ccancerancer diseases of the biliary tractdiseases of the biliary tract gastric polyposisgastric polyposis

Drug treatment of autoimmune gastritis Drug treatment of autoimmune gastritis

(type A)(type A) 1. Drugs that stimulate the secretory function of the 1. Drugs that stimulate the secretory function of the

stomach (stomach (LLymontar, ymontar, PPentagastrin, entagastrin, CCalcium alcium GGluconate).luconate).2. Replacement therapy (gastric juice pepsydyl, pepsin, 2. Replacement therapy (gastric juice pepsydyl, pepsin, pepsin-atsydyn, pepsin-atsydyn, AAbomin, bomin, PPanzinorm, anzinorm, HHydrochloric ydrochloric AAcid).cid).3. In the presence of pain and frustration 3. In the presence of pain and frustration DDyspepcyc - yspepcyc - CCerukal, erukal, EEglonil, Nospanum, glonil, Nospanum, HHalidor.alidor.4. Anti-inflammatory therapy (plantain leaves, 4. Anti-inflammatory therapy (plantain leaves, PPlantahlyutsyd, Venter).lantahlyutsyd, Venter).5. Enzymes (5. Enzymes (SSolizym, Oraz, Festal, olizym, Oraz, Festal, MMezim forte).ezim forte).6. Mineral water ("Mirgorodskaya", "Slov'yanivska" - in the 6. Mineral water ("Mirgorodskaya", "Slov'yanivska" - in the form of heat for 15-20 minutes before meals, in small sips form of heat for 15-20 minutes before meals, in small sips to 1/2-1 cup 2-3 times a day).to 1/2-1 cup 2-3 times a day).

ulcerulcer

Peptic ulcer disease - a chronic disease Peptic ulcer disease - a chronic disease with cyclic flow and a tendency to with cyclic flow and a tendency to progression, which is characterized by progression, which is characterized by the formation of a defect in the lining of the formation of a defect in the lining of the stomach or duodenum due to the the stomach or duodenum due to the reduction of its security properties or reduction of its security properties or increasing aggressiveness of gastric increasing aggressiveness of gastric juice.juice.

Classification of peptic ulcerClassification of peptic ulcer 1. Localization ulcer:-ulcer-duodenal ulcer (bulbar, postbulbar)-combined gastric and duodenal ulcers;-hastroyeyunal ulcer (ulcer anastamoses). 2. Etiology:-HP - positive ulcer;-HP - negative ulcer. 3. Phase ulcerative process:-active (acute, fresh);-scarring;-stage of scar;-prolonged absence of scarring.

4. Accompanying morphological changes:-localization and activity of gastritis and duodenitis;-the presence and severity of mucosal atrophy-the presence of intestinal metaplasia;-erosions, polyps;-availability gastroezofagal or duodenogastric reflux.

5. Complications:-bleeding-perforation-penetration-stenosis-malignization

Variants of the course:Variants of the course: LightLight - periods of heightened - periods of heightened at at least once in 1-least once in 1-

2 years, clinical manifestations expressed mild, 2 years, clinical manifestations expressed mild, easily treatable;easily treatable;

Moderate - aggravation 1-2 times a year, Moderate - aggravation 1-2 times a year, expressed clinical manifestations, in the expressed clinical manifestations, in the pathological process involved other organs of pathological process involved other organs of digestion;digestion;

SevereSevere - aggravation 3-4 times a year, - aggravation 3-4 times a year, pronounced clinical signs, which are difficult to pronounced clinical signs, which are difficult to treat, there are complications.treat, there are complications.

The role of microorganisms The role of microorganisms Helicobacter PyloriHelicobacter Pylori

Duodenal ulcerDuodenal ulcer

gastric ulcergastric ulcer

erosive gastritiserosive gastritis

Major syndromes of Major syndromes of gastric ulcergastric ulcer

Pain - is caused by irritation of the ulcer surface Pain - is caused by irritation of the ulcer surface aggressive content of gastric inflammation in ulcer aggressive content of gastric inflammation in ulcer area, regional spasm of smooth muscle, area, regional spasm of smooth muscle, peryhastryt, peryduodenit.peryhastryt, peryduodenit.

Syndrome gastric dyspepsia, resulting heartburn, Syndrome gastric dyspepsia, resulting heartburn, belching, nausea, vomiting.belching, nausea, vomiting.

Syndrome of intestinal dyspepsia, which is a sign Syndrome of intestinal dyspepsia, which is a sign of constipation, crampy pain in the gutof constipation, crampy pain in the gut..

Astenovegetativnogo, increased irritability, Astenovegetativnogo, increased irritability, emotional lability, sleep disorders.emotional lability, sleep disorders.

Laboratory diagnosisLaboratory diagnosis OOmplete blood count (to exclude bleeding);mplete blood count (to exclude bleeding); Biochemical analysis of blood (in the presence of anemia - Biochemical analysis of blood (in the presence of anemia -

to investigate the level of Fe + in blood and to investigate the level of Fe + in blood and Ferum-binding Ferum-binding ability of serum)ability of serum)

Blood (duodenum ulcers - most often in patients of group Blood (duodenum ulcers - most often in patients of group II, , gastric ulcer - 3-gastric ulcer - 3-AA blood group) blood group)

Fecal occult blood;Fecal occult blood; Cytological examination of biopCytological examination of biopttiittes (at least 5 fragments es (at least 5 fragments

from different parts of the stomach and duodenum;from different parts of the stomach and duodenum; Histological examination of the biopHistological examination of the biopttiittes to exclude atypical es to exclude atypical

cells in the centercells in the center;; Determination of microbial type Determination of microbial type of of H.H. pylori (urease test, pylori (urease test,

cytology, histology)cytology, histology)

Instrumental diagnosisInstrumental diagnosis

pH-metric study hastritis;pH-metric study hastritis; Endoscopy (at the first examination, the Endoscopy (at the first examination, the

dynamics at the end of treatment);dynamics at the end of treatment); Ultrasonography of the abdomen;Ultrasonography of the abdomen;

X-ray study of the stomach, duodenum X-ray study of the stomach, duodenum and intestines if indicated.and intestines if indicated.

Differential diagnosisDifferential diagnosis

Cancer of the stomach;Cancer of the stomach; Diseases of the bile ducts;Diseases of the bile ducts; Chronic pancreatitis;Chronic pancreatitis; Symptomatic ulcers;Symptomatic ulcers; Myocardial infarction (abdominal form).Myocardial infarction (abdominal form).

Treatment Treatment

General principlesGeneral principles-Refusal of bad habits (smoking, -Refusal of bad habits (smoking, alcohol and coffee, cessation of alcohol and coffee, cessation of NSAIDs)NSAIDs)-Diet: health food, table number 1a-1. -Diet: health food, table number 1a-1. Foods to eat 5 times a day, the last Foods to eat 5 times a day, the last time not later than 19:00.time not later than 19:00.

MedicationMedication 1.1. Anticholinergic drugsAnticholinergic drugs (anticholinergics):(anticholinergics):

selective (selective (AAtropine, tropine, MMethacin, ethacin, PPlatifillin)latifillin)selective (selective (HHastrotsypin, astrotsypin, PPirenzepin)irenzepin)

2.2. Antacids (Antacids (AAlmagellmagel,, FFosfalyugel, Maalox, osfalyugel, Maalox, HHaviskon, aviskon, HHelyusyl varnish, etc..)elyusyl varnish, etc..)

3.3. H2-histamine receptors (H2-histamine receptors (CCimetidine, imetidine, RRanitidine, anitidine, FFamotidine, amotidine, RRoksatydyn);oksatydyn);

4.4. Proton pump blockers (Proton pump blockers (OOmeprozol, meprozol, LLanzoprazol, anzoprazol, PPantoprazole, antoprazole, esomeprazole);esomeprazole);

5.5. Means, which form a protective film Means, which form a protective film ((SSucralfate, ucralfate, DDe-nol, e-nol, SSmectite);mectite);

6.6. Helicobacter drugs: antibiotics (Helicobacter drugs: antibiotics (AAmoxicillin, moxicillin, FFlemoksyn-Solutab, lemoksyn-Solutab, CClarithromycin, larithromycin, TTetracycline, etracycline, MMetronidazole, etronidazole, DDe-nol);e-nol);

7.7. Means that normalize gastric motor activity Means that normalize gastric motor activity (Reglan, (Reglan, EEglonil, Motilium);glonil, Motilium);

8.8. Reparant (Reparant (HHastrofarm, Solcoseryl, astrofarm, Solcoseryl, PPentoxyl);entoxyl);

9.9. Means sedation (Means sedation (AAmitriptyline, mitriptyline, Rhaponticum, Chinese Rhaponticum, Chinese MMagnolia, agnolia, DDalargin).alargin).

Schemes triple therapy for Schemes triple therapy for the destruction HPthe destruction HP

1.1. Pantoprazole 40 mg in the morning and 40 Pantoprazole 40 mg in the morning and 40 mg at night + mg at night + AAmoxicillin 500 mg 4 times a moxicillin 500 mg 4 times a day + Clarithromycin 250 mg 2 times a day.day + Clarithromycin 250 mg 2 times a day.Course 7 days, Course 7 days, EEradication of HP 95%.radication of HP 95%.

2.2. Pantoprazole 40 mg in the morning and 40 Pantoprazole 40 mg in the morning and 40 mg at night + Clarithromycin 250 mg 2 times mg at night + Clarithromycin 250 mg 2 times daily + daily + MMetronidazole 400 mg 2 times a day.etronidazole 400 mg 2 times a day.Course 7 days, Course 7 days, EEradication of HP 95-97%.radication of HP 95-97%.

4. Omeprazole 20 mg 2 times a day4. Omeprazole 20 mg 2 times a day+ Clarithromycin 250 mg 2 times a + Clarithromycin 250 mg 2 times a dayday+ Metronidazole 400 mg 2 times a + Metronidazole 400 mg 2 times a day.day.

5. Omeprazole 20 mg 2 times a day5. Omeprazole 20 mg 2 times a day+ Amoxicillin (flemoksyn-Solutab) to + Amoxicillin (flemoksyn-Solutab) to 1000 mg 2 times a day after meals1000 mg 2 times a day after meals+ Metronidazole 400 mg 2 times a + Metronidazole 400 mg 2 times a day.day.

Scheme of kvadryterapyScheme of kvadryterapy

Pantoprazole 40 mg 2 times daily + Pantoprazole 40 mg 2 times daily + TTetracycline 500 mg 4 times a day +etracycline 500 mg 4 times a day +DDe-nol 120 mg 3 times for 30 minutes e-nol 120 mg 3 times for 30 minutes before a meal and 4 th time in 2 before a meal and 4 th time in 2 hours after dinner + hours after dinner + MMetranidazol 400 etranidazol 400 mg 4 times a day.mg 4 times a day.

Physiotherapy treatmentPhysiotherapy treatment

For uncomplicated For uncomplicated ulceral diseaseulceral disease in acute phase fading: paraffin, in acute phase fading: paraffin, ozokerytni, mud baths on the ozokerytni, mud baths on the epigastric area, diathermy, epigastric area, diathermy, inductothermy UHF therapy inductothermy UHF therapy elektoforez and acupuncture.elektoforez and acupuncture.

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