Chronic gastritis
and peptic ulcer
disease
gastritis
Gastritis - a focal or diffuse inflammation
of the gastric mucosa in response to its
damage with disorders of the secretory,
motor, and sometimes inkretory functions.
types of gastritis
acute;
chronic;
specific forms of gastritis :
hypertrophic;
lymphocytic;
eosinophilic;
granulomatous;
reactive.
International Classification
of gastritis (Houston,
1994)
Nontrofic (type B)
Nontrofic (type B)
Atrophic, autoimmune (type A)
Specific forms:
-Chemical (reflux gastritis, type C)
-Radiative
-Lymphocytic
-Noninfectious granulomatous
-Eosinophilic
-Some infections
Etiologic factors
Exogenous:
Alimentary disorders
Smoking
Alcohol
Neuropsychiatric stress
Occupational hazard
The uncontrolled use of drugs
Etiologic factors
Endogenous:
Chronic infection
Diseases of the nervous and endocrine
systems
Cardiovascular and respiratory systems
Renal failure
Clinical syndromes
Pain
Gastric dyspepsia
Intestinal dyspepsia
Asthenic-neurotic
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:
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 diagnosis
ulcer
stomach cancer
diseases of the biliary tract
gastric polyposis
Drug treatment of autoimmune gastritis
(type A)
1. Drugs that stimulate the secretory function of the
stomach (Lymontar, Pentagastrin, Calcium Gluconate).
2. Replacement therapy (gastric juice pepsydyl, pepsin,
pepsin-atsydyn, Abomin, Panzinorm, Hydrochloric Acid).
3. In the presence of pain and frustration Dyspepcyc -
Cerukal, Eglonil, Nospanum, Halidor.
4. Anti-inflammatory therapy (plantain leaves,
Plantahlyutsyd, Venter).
5. Enzymes (Solizym, Oraz, Festal, Mezim forte).
6. Mineral water ("Mirgorodskaya", "Slov'yanivska" - in the
form of heat for 15-20 minutes before meals, in small sips
to 1/2-1 cup 2-3 times a day).
ulcer
Peptic ulcer disease - a chronic disease
with cyclic flow and a tendency to
progression, which is characterized by
the formation of a defect in the lining of
the stomach or duodenum due to the
reduction of its security properties or
increasing aggressiveness of gastric
juice.
Classification 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:
Light - periods of heightened at least once in 1-2
years, clinical manifestations expressed mild,
easily treatable;
Moderate - aggravation 1-2 times a year,
expressed clinical manifestations, in the
pathological process involved other organs of
digestion;
Severe - aggravation 3-4 times a year,
pronounced clinical signs, which are difficult to
treat, there are complications.
The role of
microorganisms
Helicobacter Pylori
Duodenal ulcer
gastric ulcer
erosive gastritis
Major syndromes of
gastric ulcer
Pain - is caused by irritation of the ulcer surface
aggressive content of gastric inflammation in ulcer
area, regional spasm of smooth muscle,
peryhastryt, peryduodenit.
Syndrome gastric dyspepsia, resulting heartburn,
belching, nausea, vomiting.
Syndrome of intestinal dyspepsia, which is a sign
of constipation, crampy pain in the gut .
Astenovegetativnogo, increased irritability,
emotional lability, sleep disorders.
Laboratory diagnosis
Omplete blood count (to exclude bleeding);
Biochemical analysis of blood (in the presence of anemia -
to investigate the level of Fe + in blood and Ferum-binding
ability of serum)
Blood (duodenum ulcers - most often in patients of group I,
gastric ulcer - 3-A blood group)
Fecal occult blood;
Cytological examination of bioptites (at least 5 fragments
from different parts of the stomach and duodenum;
Histological examination of the bioptites to exclude atypical
cells in the center;
Determination of microbial type of H. pylori (urease test,
cytology, histology)
Instrumental diagnosis
pH-metric study hastritis;
Endoscopy (at the first examination, the
dynamics at the end of treatment);
Ultrasonography of the abdomen;
X-ray study of the stomach, duodenum
and intestines if indicated.
Differential diagnosis
Cancer of the stomach;
Diseases of the bile ducts;
Chronic pancreatitis;
Symptomatic ulcers;
Myocardial infarction (abdominal form).
Treatment
General principles
-Refusal of bad habits (smoking,
alcohol and coffee, cessation of
NSAIDs)
-Diet: health food, table number 1a-1.
Foods to eat 5 times a day, the last
time not later than 19:00.
Medication
1. Anticholinergic drugs (anticholinergics):
selective (Atropine, Methacin, Platifillin)
selective (Hastrotsypin, Pirenzepin)
2. Antacids (Almagel, Fosfalyugel, Maalox,
Haviskon, Helyusyl varnish, etc..)
3. H2-histamine receptors (Cimetidine,
Ranitidine, Famotidine, Roksatydyn);
4. Proton pump blockers (Omeprozol,
Lanzoprazol, Pantoprazole, esomeprazole);
5. Means, which form a protective film
(Sucralfate, De-nol, Smectite);
6. Helicobacter drugs: antibiotics (Amoxicillin,
Flemoksyn-Solutab, Clarithromycin,
Tetracycline, Metronidazole, De-nol);
7. Means that normalize gastric motor activity
(Reglan, Eglonil, Motilium);
8. Reparant (Hastrofarm, Solcoseryl,
Pentoxyl);
9. Means sedation (Amitriptyline,
Rhaponticum, Chinese Magnolia, Dalargin).
Schemes triple therapy for
the destruction HP
1. Pantoprazole 40 mg in the morning and 40
mg at night + Amoxicillin 500 mg 4 times a
day + Clarithromycin 250 mg 2 times a day.
Course 7 days, Eradication of HP 95%.
2. Pantoprazole 40 mg in the morning and 40
mg at night + Clarithromycin 250 mg 2 times
daily + Metronidazole 400 mg 2 times a day.
Course 7 days, Eradication of HP 95-97%.
4. Omeprazole 20 mg 2 times a day
+ Clarithromycin 250 mg 2 times a
day
+ Metronidazole 400 mg 2 times a
day.
5. Omeprazole 20 mg 2 times a day
+ Amoxicillin (flemoksyn-Solutab) to
1000 mg 2 times a day after meals
+ Metronidazole 400 mg 2 times a
day.
Scheme of kvadryterapy
Pantoprazole 40 mg 2 times daily +
Tetracycline 500 mg 4 times a day +
De-nol 120 mg 3 times for 30 minutes
before a meal and 4 th time in 2
hours after dinner + Metranidazol 400
mg 4 times a day.
Physiotherapy treatment
For uncomplicated ulceral disease
in acute phase fading: paraffin,
ozokerytni, mud baths on the
epigastric area, diathermy,
inductothermy UHF therapy
elektoforez and acupuncture.
Thanks for your
attension!
