Gastro - Causes, Symptoms and Treatment .MF .
gastro - (gastroduodenitis; gastro- stomach duodenum duodenum + + -it - inflammation) - an inflammatory disease of the mucous membrane of the duodenum and the pyloric stomach area.Gastroduodenit manifested as nausea, unpleasant taste in the mouth, pain in the epigastric region and feelings of fullness.Gastroduodenita Symptoms are very similar to symptoms of gastritis: is loss of appetite, belching, rumbling in the stomach, diarrhea, or conversely constipation.
Depending on the predominant etiologic agent is isolated:
primary (exogenous) gastroduodenitis;
secondary (endogenous) gastroduodenitis.
As the prevalence of isolated:
Depending on the acidity levels vary gastroduodenity:
gastroduodenitis with normal secretory function;
gastroduodenitis with reduced secretory function;
gastroduodenitis with increased secretion.
gastroduodenita have many causes.There are endogenous and exogen
Among endogenous causes gastroduodenita attaches great importance to increased acid production, decrease mucus formation, disruption of hormonal regulation of secretion.In addition, the development of gastroduodenita predispose liver disease and biliary tract, endocrine pathology.
Among exogenous etiological factors distinguish the physical appearance of gastroduodenitis, such as receiving a sharp, hot or cold food, chemical (pesticide exposure).The most important factor is getting into the digestive tract of Helicobacter pylori bacteria.
How is gastro
Under the influence pathologic etiological factors on the gastric mucosa and duodenal ulcer develops an inflammatory reaction, which leads to disruption of physiological regeneration of the mucosa and development of atrophy.All these factors lead to a violation of the secretory and motor functions.As a rule, gastroduodenite point increase in the tone and motility of the stomach, duodenum dyskinesia.
gastroduodenitov Symptoms are varied and depend on the degree of structural changes in the mucous, their location, stage of the pathological process, the functional state of the stomach and metabolic disorders in the body.Common signs gastroduodenita are weakness, fatigue, disturbed sleep, frequent headaches.Objectively observed at gastroduodenite pale skin, symptoms of vitamin A deficiency.Intensity of symptoms depends on the degree of metabolic processes in the body.
Endoscopic examination at gastroduodenite
endoscopically at gastroduodenite usually exhibit focal or diffuse mucosal hyperemia, edema, hypertrophy of the folds, and so on. D.
Sometimes mucosa appears pale, thinned, with flattened folds.This is typical of atrophic process, but the presence or absence of atrophy and its degree can be estimated only histologically.
Histological examination at gastroduodenite
Histological examination of the gastric mucosa and duodenal ulcers is mandatory gastroduodenita diagnostic method that allows to reliably estimate the degree of inflammatory, degenerative processes.
Evaluation of the secretory function of the stomach in gastroduodenite
Evaluation of gastric secretory function can be carried out using the method of intragastric pH-metry.
Intragastric pH monitoring to evaluate the pH in the region of the body and antrum of the stomach with the help of a special probe with two built-in electrodes.Normal pH in the stomach area of the body is fasting in children older than 5 years 1.7-2.5, after the introduction of a stimulant (histamine) - 1.5-2.5.Antrum performing neutralizing acid is normally a pH above 5, ie the difference between the pH of the body and antrum normally above 2 units.Reducing this difference indicates a decline in neutralizing the ability of antral and duodenal acidification potential.
secretory function is considered to be reduced if all the indicators decreased in the basal and stimulated fractions.The secretory function is considered to be increased if increased even individual performance in at least one of the factions.
chronic gastroduodenitis in children often occurs with normal or elevated secretion, a decrease in performance with good response to the stimulant is a manifestation of the individual standards.True reduction of gastric secretion is characterized by refractory to the introduction of a stimulant and is typical of severe atrophic gastritis forms that are rarely found in children.
Examination of motor function at gastroduodenite
Evaluation of motor function is carried out on the basis of antroduodenalnoy manometry.Also evaluate gastric motility can be on electrogastrography (EGG), as well as ultrasound of the stomach with a pre-filling it with water.
stomach X-ray examination with barium is not a method of diagnosis CGD, but can be used to evaluate the evacuation function in the differential diagnosis with other diseases (congenital malformations, pyloric stenosis, tumor, chronic duodenal obstruction, and so on. D.).
diagnosis of Hp infection with gastroduodenite
diagnosis of Hp infection is mandatory to specify the type of gastroduodenitis and subsequent treatment.There are 2 groups of diagnostic methods helikobakterioza:
histological method is reliable enough and is the gold standard in the diagnosis of helikobakterioza.
Bacterioscopy - detection of Hp in cytological smears on the glass with a biopsy, staining methods are the same.
treatment gastroduodenitis long, consistent, landmark.Includes a rational overall, food and motor mode, a diet, antacids at elevated acid production (vikalin, almagel), means stimulating reparative processes, multivitamin, according to testimony - antispasmodic, sedative drugs, herbal medicine, mineral water, in cases of secondary gastroduodenita with decreased acid productionshows enzyme preparations.It should be a comprehensive treatment of associated diseases of the digestive system.
gastroduodenita Treatment starts with diet.
Diet for gastroduodenite
Soups of cereals and vegetables, pureed, in meat, mushroom, fish broth;lean meat (chopped, fried), boiled chicken, steam, steamed, fried cutlets without rough peel, lean ham, low-fat boiled fish, well soaked lean minced herring, caviar;milk (if not cause diarrhea), butter, kefir, yogurt, cream, sour cream, non-acidic, non-acidic fresh cheese, grated cheese, mild;boiled eggs, scrambled eggs fried;porridge, boiled or mashed well (buckwheat, semolina, rice);Baking dishes (except for baking), stale bread, white, gray, nesdobnye crackers;vegetables, boiled vegetables, grated raw in form;fruit, vegetable juices (as acid);Tea, coffee, cocoa in the water with milk, marmalade, sugar.Salt to 12-15, the added vitamins C, B1, B2, PP.
When eating comply with the following rules:
- Food and drink should not be too hot or too cold;
- Never swallow solid food, not chew it thoroughly
- There are preferably several times a day gradually.
Since chronic gastroduodenitis different cyclic course of the disease exacerbation alternating with periods of remission, treatment should be carried out in accordance with the following principles:
- during the acute period of bed rest is prescribed to the patient, usually at least 7-8 days;
- require mandatory compliance with the diet.Proper nutrition helps to ensure that chronic gastro faster treatable and does not cause too severe pain;
- to neutralize Heliobacter Pilori conduct drug therapy, which involves taking bismuth tripotassium dicitrate, amoxicillin, metronidazole and macrolides.The treatment course lasts from 7 to 10 days;
- if gastro led to gastric hyperacidity, the patient is recommended to take omeprazole and H2-blockers of histamine receptors;
- excellent results show physiotherapy, health resort treatment, and physical therapy.
Drug treatment gastroduodenitis.Treatment regimens gastroduodenitis
Since one of the key reasons for the appearance of gastroduodenitis - infection, the treatment is not without antibiotic treatment.
drug of choice for treatment gastroduodenitis:
1. de-nol, and metronidazole (course lecheniya10-14 days) + tetracycline antibiotics (treatment days 7-10);
2. omepravzol clarithromycin and metronidazole in combination with (treatment 7 days);
3. metronidazole plus amoxicillin (lecheniya10 days course) + ranitidine (2 times a day before meals for 2 weeks);
The choice of treatment depends on the circuit characteristics of the course gastroduodenitis.When the first symptoms gastroduodenita consult a doctor gastroenterologist for consultation and prescription of treatment.
chronic gastroduodenitis in children
Chronic nonspecific inflammatory gastro characterized by the restructuring of the gastric mucosa and duodenal ulcers, as well as secretory and motor-evacuation disorders.
Children, unlike adults, isolated lesion of the stomach or duodenum is observed relatively rarely, in 10-15% of cases.Were significantly more common combined lesion of these departments.The duodenum, being hormonally active body, has a regulating effect on the functional activity and the evacuation of the stomach, pancreas and biliary tract.
Causes gastroduodenita the child
leading role belongs to nutritional reasons: irregular and poor nutrition, abuse of spicy food, food "dry rations" and psychogenic factors.The significance of these factors is increased in the presence of a genetic predisposition to diseases of gastroduodenal zone.Stressful situations in the family, school, social circle is often implemented in the form of vegetative-vascular dystonia that affects the secretion, motility, blood flow, regenerative processes and synthesis of gastrointestinal hormones.Also, have a value of long reception of drugs (corticosteroids, NSAIDs), food allergies, and other factors that reduce the local specific and non-specific defense of the mucous membrane.
One of the main causes of chronic gastroduodenitis in children and adults - infection of Helicobacter pylori.Duodenitis develops on the background of gastritis caused by Helicobacter pylori, and intestinal epithelial metaplasia of the duodenum.Helicobacter pylori colonizes portions metaplazirovannogo epithelium and causes them to the same changes as in the stomach.Outbreaks are unstable to gastric metaplasia exposed duodenum content, which leads to the appearance of erosions.Therefore gastroduodenitis associated with Helicobacter pylori, erosive more often.
All these factors have a toxic-allergic effects and induce morphological changes in the duodenal mucosa.In these circumstances, the role of acid-peptic mucosal damage in the event of evacuation-motor disorders and reducing intra-duodenal pH.Damaging factors first cause irritation of the mucous membrane, and in the future - dystrophic and atrophic changes in it.At the same time changes the local immunity develops autoimmune aggression, impaired synthesis of hormones that regulate motor and secretory function pancreatobiliary system.In the latter there is also inflammatory changes.This leads to a decrease in the synthesis of secretin and saturated bicarbonate pancreatic juice, which in turn reduces the alkalization gut contents and promotes development of atrophic changes.
Symptoms gastroduodenitis in children
Chronic gastroduodenitis different polymorphic symptoms and is often combined with other gastrointestinal diseases, and therefore not always possible to distinguish symptoms caused by gastroduodenitis, the symptoms caused by comorbidities.
gastroduodenitis in the acute phase appears aching cramping pain in the epigastric region, occurring in 1-2 hours after eating and often radiating to the hypochondrium (mostly right) and umbilical region.Eating or antacids reduces or relieves pain.Pain may be accompanied by a feeling of heaviness, fullness in the epigastric region, nausea, hypersalivation.The mechanism of pain and dyspepsia main role belongs to the duodenum dyskinesia.Because of this amplified duodenal reflux, causing bitter belching, and sometimes vomiting with an admixture of bile, less heartburn.
On examination, patients are paying the attention of pale skin and low body weight.Language coated with white and yellowish-white coating, often with teeth imprints on the lateral surface.On palpation of the abdomen to determine the tenderness piloroduodenalnoy region, at least - around the navel, in the epigastrium and hypochondria.Characteristic symptom of Mendel.Many patients with positive symptoms Ortner and Kera.
In children with chronic duodenitis frequently noted vegetative and psycho-emotional disorders: recurrent headaches, dizziness, sleep disturbance, fatigue, due to the violation of the endocrine function of the duodenum.Autonomic dysfunction may manifest clinical dumping syndrome: weakness, sweating, drowsiness, enhanced intestinal peristalsis, resulting in 2-3 hours after a meal.A long break between meals can occur and symptoms of hypoglycemia in the form of muscle weakness, tremors, sharply increased appetite.
Taking into account the peculiarities of development and the preferential localization of the pathological process identified a number of options for chronic gastroduodenitis with typical clinical manifestations.
- yazvennopodobnom chronic gastro (mostly bulbit): the most common option is often combined with antral gastritis (antroduodenit) and gastric ulcer.At the heart of its development are factors that lead to an increase in the aggressiveness of gastric contents and acidification of the duodenum.For bulbita in the acute phase is characterized by yazvennopodobny pain.Pain localized in the epigastric region, there are fasting or 1,5-2 hours after meals and at night.A distinct seasonality of exacerbations.
- Gastritopodobny chronic gastro , combined with fundic atrophic gastritis and enteritis.In this embodiment, the diffuse atrophic process may spread to the duodenum.When combined with chronic duodenitis enteritis disease manifests symptoms of food intolerance, impaired digestion and absorption.
- Holetsistitopodobny chronic duodenitis , developed on the background of duodenostasis.Cholecystitis contributes to the emergence and progression of inflammatory and degenerative changes in the duodenum due to chronic duodenal obstruction functional or organic origin.When duodenostasis prevail persistent or paroxysmal pain in the epigastric region and right of the navel, bloating, rumbling, nausea, belching bitter, vomiting bile.
- Pankreatitopodobny local duodenit (papillomas, okolososochkovy diverticulitis).Papillomas often develops as a consequence of the spread of inflammation to the major duodenal papilla with duodenitis or may be part of the inflammatory process, localized in pancreatobiliary system.Diverticulitis - defeat diverticulum, located mainly in okolososochkovoy zone.