Examination of a patient with gastritis in the clinic. Gastritis: symptoms, diagnosis and treatment

Any inflammatory disease first happens in an acute form. For the transition to a chronic course, the process takes time, lack of treatment.

Diagnosis of chronic gastritis - inflammation of the gastric mucosa, is based on the receipt, analysis of the aggregate data of the conversation with the patient, external examination and internal clinical, instrumental, laboratory, bacteriological and biochemical studies.

Chronization of acute inflammation of the stomach occurs for some time. It can be a year - one and a half, or several months - the rate of development of the disease and its transition to chronic stage directly depends on a combination of several factors:

lifestyle;
the nature of the diet;
the presence of bad habits;
occupational hazards of a chemical, physical or psychological nature;
individual characteristics the patient;
genetic predisposition;
familial cases.

The diagnosis of “chronic gastritis” can be suspected in oneself if one feels sick for several months after eating, sometimes before bouts of vomiting. Also, patients may indicate a decrease in overall tone, fatigue, drowsiness, irritability, dyspeptic symptoms. Among them, the most common are appetite disorders, belching with an unpleasant odor, problems with stools: constipation or diarrhea.

Particular attention should be paid to the connection of such symptoms with the nature of the food taken. The use of sour, salty, fried menus, carbonated drinks, alcohol leads to a significant deterioration in the condition.

Diagnosis of chronic gastritis

Observing the above changes in general well-being in yourself or loved ones, you should immediately seek help from a doctor. Usually, this is a general practitioner who, after examining and talking with the patient, decides what additional examinations and highly professional consultations are needed.

Despite the apparent simplicity and frequency of gastritis, including chronic ones, the diagnosis of this disease is a time-consuming process, special tests and research methods. To successfully get rid of the pathology or significantly improve the condition and achieve long-term remission, it is necessary to full examination to accurately establish the etiology (cause) of inflammation of the gastric wall.

Patient examination plan

A gastroenterologist acts according to a specific plan in order to collect as much objective data as possible in favor of one or another cause of inflammation. The pathogenesis of the disease depends on the trigger. Therefore, chronic gastritis is usually classified according to several parameters. Depending on the cause, the disease is divided into mechanical, physical, chemical, bacterial or combined inflammations.

According to the degree of pathological changes in the gastric mucosa, atrophic, hypertrophic gastritis is classified. The nature of inflammatory changes is manifested by the appearance of a diffuse lesion of the inner lining of the stomach - catarrhal gastritis. Foci of local deep lesions are characteristic of the ulcerative form of pathology.

The severity of subjective symptoms, objective signs of indigestion, deterioration of the general condition characterizes the stage of development of gastritis: exacerbation or remission. The totality of the data of all tests of the patient's examination leads to the establishment of the final diagnosis, which is encoded in the ICD.

Examination of a patient with suspected chronic gastritis includes diagnostics with the collection of anamnesis, examination of the patient, the appointment of instrumental methods for studying the state of internal homeostasis, digestion and secretion.

Objective data of examination of patients

After the examination, the doctor can confirm the opinion about the presence of gastritis if:

on palpation of the abdomen, pain in the epigastric region is noted;
pallor is noted skin;
the tongue has signs of being coated with a whitish or yellowish coating;
bad breath;
on palpation lower third the stomach feels rumbling, there are signs of excessive gas formation in the intestines;
in the corners of the mouth there may be ulcerations - seizures.

It is imperative to appoint an instrumental examination, which includes several important, informative methods.

FGDS - fibrogastroduodenoscopy

A rather painful procedure, during which a special probe with a video camera is inserted through the esophagus into the stomach cavity. The doctor sees the image of the mucous membrane of the stomach, esophagus and duodenum on the monitor screen and can objectively establish the presence of inflammatory changes, their nature, the amount of gastric juice.

During the procedure, the following diagnostic manipulations can be additionally performed:

collection of material for biopsy;
measuring the pH of gastric juice;
taking a sample for bacteriological analysis for the presence of Helicobacter pylori.

Biopsy

A tiny piece of the stomach lining is plucked off with a special tool to be examined in the laboratory. This will make it possible to judge the presence or absence of oncological changes in tissues, the depth of the process, to differentiate the localization of the growth of cell layers, and to preliminarily establish the presence of a bacterial pathogen.

pH meter

During an internal study of the stomach, it is possible to check the level of acidity of gastric juice - to conduct pH-metry. The results of pH measurements make it possible to differentiate gastritis by the level of hydrochloric acid production and its effect on the nature of the disease: hyperacid or hypoacid gastritis.

Useful video

How the disease is detected can be found in this video.

Diagnosis of Helicobacter pylori

This is a set of measures to identify the microbe in the stomach. This includes the results of a biopsy study, pH measurement, inoculation of material in a bacteriological laboratory in order to obtain a pure culture of a microorganism and establish its species, and the results of a breath test.

breath test

The patient is asked to exhale air twice into a disposable container: the first time before taking a special drug, the second time after taking urea. This allows you to establish the presence and degree of activity of Helicobacter pylori in the stomach.

Mandatory step for complete diagnosis chronic gastritis is considered an evaluation of the results clinical trial feces, blood and urine.

Blood analysis

The level of hemoglobin, color index, leukocytes - all these data must be evaluated for the final diagnosis. Severe violations digestion and absorption of nutrients in the stomach can lead to pernicious anemia, an increase in the number of white blood cells.

Analysis of feces and urine

The results of these studies help to assess the degree of pathological changes in internal homeostasis: the development of inflammation, anemia, dysbacteriosis, disorders of food digestion, metabolism and excretion of bile pigments.

X-ray method

It should be used at the stage of differential diagnosis. The patient is asked to swallow a radiopaque substance - barium compounds. It fills the cavity, while on the X-ray, all violations of the relief of the mucous membrane of the stomach and duodenum become visible. This method is especially valuable for diagnosing peptic ulcer disease, oncological pathologies.

Differential Diagnosis

At the final stage of diagnosis, it is necessary to conduct a comparative analysis of the symptoms, the results of an objective study in order not to make a mistake with the diagnosis of "chronic gastritis".

This disease should be distinguished from peptic ulcer of the stomach and duodenum, pancreatitis, dyskinesia of the gallbladder and bile ducts, pathological neoplasms of these organs. Symptoms of chronic gastritis may be similar to those of an ulcer of the antrum or fundus of the stomach or duodenal portion of the gastrointestinal tract.

Pancreatitis with localization of inflammation in the head part, presenting to the entrance to the duodenum, can also be characterized by subjective symptoms similar to gastritis. In combination with gallbladder dyskinesia, dietary errors, occupational harmful factors, such inflammations can be multilocal in nature and masquerade as chronic gastritis.

The most commonly diagnosed disease is chronic gastritis. It accounts for almost 90% of all gastrointestinal diseases. In 70% of cases, it is combined with other pathologies. digestive system. Chronic gastritis has an ICD code 10 (k29.3-29.5)

Etiology and pathogenesis

The etiology of the disease has long been studied. Modern doctors believe that chronic gastritis may be the result of acute gastritis. The appearance of the disease is facilitated by prolonged non-compliance with the diet: the abuse of seasonings, coffee, low-quality foods, eating a large amount of food at a time.

Clinical studies have proven that regular consumption of alcoholic beverages leads to the formation of chronic gastritis. In all patients suffering from alcoholism, pathological transformations of the stomach tissues were observed.

Often, people with chronic gastritis have inflammation of the mouth and throat, recurrent rhinitis and sinusitis. However, their negative impact on the course of the disease should be associated with manifestations of allergies, and not with infection.

Many experts recognize the influence of nervous factors on the appearance of chronic gastritis. Stressful situations favor an increase in the production of gastric secretions, and can provoke the formation of shallow ulcers. It is noted that most patients with diabetes mellitus also suffer from chronic gastritis.

There is evidence that genetic factors also influence the appearance of chronic gastritis. In close relatives of patients with a severe course of the disease, it is diagnosed more often than in those whose relatives were healthy. It is noticed that men are less likely than women to suffer from chronic gastritis.

It is impossible to find out the direct cause of the disease. A chain of etiological circumstances is usually noted, and it is very difficult to establish which of them is the main one.

The pathogenesis of this disease has some peculiarities. Initially, the disease destroys the pituitary barrier of the stomach walls, resulting in damage to the mucous membrane. The number of glandular cells is rapidly falling, connective tissues begin to grow and structures unusual for the stomach are formed, which secrete a mucous secret. This stage of chronic gastritis is characterized by an inflammatory process.

Over time, the pathology penetrates into the deepest layers of the mucosa, and dysregenerative disorders are added to the inflammation. Pathological changes the walls of the stomach grow irreversibly, and do not have the ability to recover both independently and during treatment.

Classification of chronic gastritis

Chronic gastritis has three varieties:

Type A. This is autoimmune chronic gastritis. It is qualified by the presence of immunoglobulins to stomach cells that produce hydrochloric acid. With this pathology, a high level of gastrointestinal hormones in the blood plasma is recorded, and a significant part of the gastric tissues is affected.
Type B. Occurs due to the development of infection on the mucous membrane and the influence of pathogenic bacteria. The place of transition of the stomach to the initial area is captured mainly small intestine. The disease is characterized by a decrease in the level of gastric hormone in plasma. With infectious chronic gastritis, there are no disturbances in the functioning of the immune system.
Type C. The disease develops as a result of the abnormal influence of certain drugs or chemical products. Also, the release of duodenal secretions into the body of the stomach can also serve as the cause of chronic gastritis of this type.

In 1989, another classification of chronic gastritis was created by the German Association of Pathologists:

Helicobacter;
Lymphocytic;
autoimmune;
Mixed;
Chemical-induced;
Other forms.

Modern gastroenterologists practically do not use it, since the types of chronic gastritis are too diverse.

Chronic gastritis is the most dangerous type of disease. It is a potential cause of cancer.

Symptoms of chronic gastritis

Manifestations of the disease are caused by the work of the secretory glands. But some signs of chronic gastritis are inherent in all types of the disease.

Disorder of the digestive organs. With high acidity, a bitter taste in the mouth, nausea, vomiting, or belching after eating. With low acidity, a violation of the functioning of the intestine. Decreased appetite.
With the development of chronic gastritis, the function of assimilation of vitamins and beneficial trace elements is disrupted. This is manifested in the paleness of the skin, hair loss, fragility and peeling of the nail plates.
Fatigue and drowsiness are also integral symptoms of chronic gastritis.

Regardless of the variety, all patients report increased flatulence and discomfort in the abdomen.

Diagnosis of chronic gastritis

If found characteristic symptoms chronic gastritis, you should consult a doctor for an accurate diagnosis.

Where does it hurt

The disease is characterized by pulling pains under the tongue. Often they occur at the time of eating, or immediately after it. Sometimes pain occurs during sleep, or 1-2 hours after eating.

Almost all patients with chronic gastritis complain of stabbing pain in the solar plexus, or in the left hypochondrium. It mostly occurs on an empty stomach. Or right after a meal.

What needs to be examined

Diagnosis of chronic gastritis begins with a conversation with a doctor and examination. After collecting an anamnesis, the doctor determines the condition of the skin and probes the gastric region. In the presence of chronic gastritis, pain from palpation intensifies.

For infectious chronic gastritis, laboratory tests of feces and blood for the presence of antibodies to Helicobacter pylori are important.

How to examine

A more accurate diagnosis of chronic gastritis involves different research methods.

Radiography. Before the procedure, the patient drinks a contrast liquid. The specialist examines the stomach in several positions. X-ray allows you to consider the relief of the stomach, detect the presence of chronic gastritis and assess the degree of tension of the gastric walls.
ultrasound. Before the procedure, you should not eat for 12 hours. The method helps to accurately study the affected areas. Its disadvantage lies in the impossibility of taking material for laboratory research.
FGS. The procedure is performed on an empty stomach. A thin endoscope is inserted through the esophagus into the stomach of the patient. This allows you to establish the areas and intensity of mucosal damage and determine the likelihood of internal bleeding.
pH meter. Manipulations are carried out using a probe or through an endoscope. The method allows to determine the characteristics of acidity.
Bacterial tests help determine the presence of Helicobacter pylori.
A biopsy for chronic gastritis involves cutting off a small area of gastric tissue from different parts of the organ. It is usually carried out simultaneously with FGDS. The procedure is painless and cannot cause bleeding.

Who to contact

If you suspect chronic gastritis, you should visit a local therapist. After taking the necessary tests, and making a primary diagnosis, he will write out a referral to a narrow specialist dealing with gastrointestinal pathologies - a gastroenterologist.

Treatment

Unauthorized intake of drugs without consulting a doctor is unacceptable, the treatment of chronic gastritis is prescribed by a specialist.

Medications

The choice of drugs varies significantly depending on the location and type of disease and the individual characteristics of the patient.

To normalize stomach acid levels:

With reduced acidity, drugs are prescribed that increase acid secretion (Abomin). It is also recommended to drink a glass of chloride mineral water before meals.

The high acidity of the gastric secretion in chronic gastritis requires the use of drugs that inhibit the production of acid (Phosphalugel, Ranitidine, Atropine).

When infected with Helicobacter pylori, antibiotic therapy is used. With this treatment, several drugs can be used (Amoxicillin, Klacid, Azithromycin) and De-nol in parallel. Control tests for the presence of bacteria are carried out 3-5 weeks after therapy.

Motilium, Passazhiks and Ganaton are used to stimulate the motility of the gastric walls. In addition to their intended purpose, these drugs help eliminate nausea.

To protect the mucosa from the aggressive effects of acid, Gastrofarm, Neosmectin are prescribed.

Creon and Pancreatin are used to saturate the gastric environment with enzymes and improve food digestion.

Folk remedies

Treatment of chronic gastritis can be carried out by methods traditional medicine. Good results are brought by treatment with green apples. To do this, the fruits are peeled and ground in a blender. The resulting slurry can be consumed in unlimited quantities. The only rule that must be observed is not to eat after taking them for 2.5-3 hours. The first month you should eat apple gruel daily. In the second month, you can reduce the intake to 3 r. at 7 days. In the third, a single weekly dose is sufficient.

Treatment folk remedies also provides for the use of freshly squeezed carrot and apple juice in a ratio of 1/1, in the morning on an empty stomach.

Honey is also an indispensable assistant in the fight against chronic gastritis. Tablespoon bee product, eaten in the morning and evening before meals, can normalize acidity and reduce inflammation. The therapy is carried out for 30 days.

Decoctions and infusions medicinal herbs also able to get rid of this disease.

Take 1 part of the inflorescences of yarrow, chamomile and St. John's wort, valerian root, hay leaves, plantain and calendula. Pour a liter of boiling water, and heat over a fire for 5-7 minutes without boiling. Cool the resulting broth, strain and drink 100 ml three times a day before meals.

Nutrition for chronic gastritis

Diet for chronic gastritis is a key point in therapy. When compiling the diet, the content of hydrochloric acid in the gastric juice is taken into account. The greatest restrictions are imposed at the beginning of the disease, but over time, new dishes are added to the patient's menu.

During the period of increased symptoms of chronic gastritis, the stomach should be spared as much as possible, protecting it from aggressive and thermal effects. The diet during the period of exacerbation in chronic gastritis should consist of steamed dishes, ground in a blender, or mashed.

On the first day of exacerbation, therapeutic fasting is recommended, it is allowed to drink only water. The next day, kissels and cereals are introduced into the diet. The diet for chronic gastritis is gradually supplemented with cutlets cooked in a double boiler, mashed soups and white crackers.

What is prohibited in chronic gastritis

Coffee, lemonades, sour juices;
Fresh vegetables;
Mushrooms;
Baking, fresh pastries, rye bread;
Sausages, semi-finished products, smoked products;
Condiments and spices;
Fatty, spicy, fried foods and marinades.

What can be done with chronic gastritis

Chicken meat, beef;
Dairy products;
Omelette;
Boiled cereal milk porridge;
Rosehip broth, tea, special mineral waters;

Sunflower and butter are added just before serving.

Approximate diet

Nutrition for chronic gastritis should be fractional, and portions are small.

Indicative menu:

Breakfast: Boiled wheat porridge, rosehip broth, dried white bread;
Snack: Baked pumpkin puree, tea;
Dinner: Pureed vegetable soup, chicken mousse, non-acidic berry compote;
Snack: Tea with biscuits;
Dinner: Low-fat cottage cheese, tea with milk;
Before going to bed, it is recommended to drink a glass of kefir with bifidobacteria.

Nutrition for chronic gastritis involves reducing the calorie content of food to 3000 Kcal.

Complications and consequences

Chronic gastritis ICD 10 (k29.3-29.5) is not terrible in itself, the consequences to which it can lead are terrible.

If there are problems with digestion, other organs suffer. They do not receive the substances necessary for the uninterrupted functioning.

Left unattended, chronic gastritis affects the functioning of the gallbladder, and may well lead to cholecystitis.

With inflammation of the gastric tissues, a decrease in hemoglobin levels and a lack of iron and B vitamins are often observed.

Chronic gastritis may well develop into pancreatitis and duodenitis.

In addition, it accompanies a number of aesthetic problems:

Hair loss;
Fragility and peeling of the nail plate;
icteric color of the skin;
Pungent odor from the mouth.

If the doctor's prescriptions and a sparing diet are not followed, a prolonged pathological effect on the walls of the stomach can provoke complications of chronic gastritis:

Ulcer;
internal bleeding;
Oncology;
Bulbit.

The consequences of the disease can be life-threatening, so it is important to identify the risks in time and start a full-fledged treatment.

Prevention of chronic gastritis

Prevention of chronic gastritis is to follow the diet, and timely oral hygiene.

It is recommended to abandon products that adversely affect the gastric mucosa (alcohol, tobacco). Monitor the quality of the products used and their purity.
It is necessary to eliminate professional risks that negatively affect the gastric tissues and the body as a whole (inhalation of alkali fumes, work in hazardous industries).
An integral measure to prevent chronic gastritis is the timely elimination of foci of infection (rhinitis, sinusitis, tonsillitis).
Diseases of cardio-vascular system and circulatory organs also affect the condition of the gastric mucosa. They disrupt the supply of the gastric walls, as a result of which oxygen starvation of cells develops and the activity of gastric juice production decreases.

People suffering from chronic gastritis should undergo a clinical examination twice a year to prevent the possibility of irreversible consequences.

Chronic gastritis in children

In children, chronic gastritis occurs in 12-16% of cases. It occurs as a result of hasty absorption of food and poor chewing. Dry food, snacks and non-compliance with the regimen also contribute to the development of chronic gastritis.

Children are characterized by the same forms of chronic gastritis as adults. Hilkobakterny bacterium occurs in 50% of sick children.

Chronic gastritis in children is diagnosed based on the clinical picture and the examination methods performed:

radiography;
FEGDS;
sounding;
Laboratory tests of blood, urine and feces.

With abundant incessant vomiting, the child is prescribed Domperidone;
Pain sensations are stopped by no-shpa;
Bacterial chronic gastritis is treated with antibiotics.

Compliance with a strict diet in the first days of the disease is a prerequisite for therapy. The first meal is allowed after 10 hours, until this time, plenty of drinking is shown.

Therapeutic activities for children include physiotherapy and a period of rehabilitation in the sanatorium zone.

Patients with chronic gastritis should be examined by a pediatric gastroenterologist twice a year. Annual gastroscopy is also shown.

Chronic gastritis in pregnant women

Experts say that 65% of expectant mothers suffer from this disease, and chronic gastritis is diagnosed in 90 cases. The disease has a negative impact not only on the body of a pregnant woman, but also affects the development of the baby.

It often happens that chronic gastritis diagnosed in childhood did not manifest itself in adolescence. But with the onset of pregnancy, under the influence of hormonal failure and displacement of organs, exacerbation of chronic gastritis manifests itself. Its manifestations can be different, there are no symptoms inherent in pregnant women.

Forms of chronic gastritis in pregnant women can be "disguised" as early toxicosis. Then added aching pain "in the pit of the stomach", impaired stool, round-the-clock nausea and vomiting.

To make a diagnosis, a clinical examination and a conversation with the patient are sufficient. Occasionally, the FGS procedure and the simultaneous sampling of gastric secretions are performed. Gastroscopy is performed in exceptional cases to exclude the presence of peptic ulcer. Ultrasound helps to assess the tone of the walls of the stomach and exclude (confirm) diseases of the liver and pancreas.

Since the reception medicines future mothers is limited, dietary nutrition becomes the basis of treatment.

With severe pain, No-shpa is prescribed, and in order to prevent and maintain the body, it is recommended to take bifidumbacterin.

As a therapy for chronic gastritis, you can use and folk recipes, but before use, consultation with a gynecologist and gastroenterologist is necessary.

Often, chronic gastritis is the result of stressful situations and nervous overstrain, in such cases a consultation with a psychotherapist is recommended, but only the patient makes the decision to visit.

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Ministry of Health of the Republic of Buryatia

GAOU SPO "Republican Basic Medical College

them. E.R. Radnaev"

Course work

Topic:Diagnosticschronic gastritis

Ulan - Ude, 2015

Introduction

Gastritis is an inflammation of the gastric mucosa, in which there is a violation of the restoration of the mucous membrane, the secretion of gastric juice changes and the contractile activity of the stomach is disturbed.

Over the past 20 years in Russian Federation there is an increase in the proportion of diseases of the stomach in the structure of diseases of the digestive system, among which chronic gastritis dominates.

Chronic gastritis is a polyetiological disease, characterized by an inflammatory process in the gastric mucosa, accompanied by morphological changes in the latter (atrophy, impaired regeneration), impaired motor, secretory and endocrine functions of the stomach and a certain clinical picture. Simultaneously with inflammation of the stomach in chronic gastritis, other internal organs are also affected, that is, the disease is not local, but general, systemic.

Chronic gastritis is one of the most common human diseases. It affects from 30 to 85% of the working population of industrialized countries, and the incidence is high in childhood. It is believed that the prevalence of chronic gastritis depends on race, place of residence of people and their age. Chronic gastritis type A is quite rare (about 10% of all atrophic gastritis), mainly in two age groups: in the elderly and in children. Chronic gastritis type B accounts for about 90% of all chronic gastritis, and young and middle-aged men suffer from it much more often than women, but after 60-65 years these differences disappear.

The urgency of the problem is not limited to the prevalence of chronic gastritis. The disease is dangerous due to its etiological relationship with stomach cancer and ulcers. And although the prognosis for chronic hepatitis is generally favorable, the disease negatively affects the quality of life of patients, their ability to work and socio-psychological adaptation. In addition, the long course of the disease is accompanied by dysfunction of other digestive organs, as well as the formation of actual psychogenies, persistent inadequate mental reactions to the disease, and personality disharmony.

To study the diagnosis of chronic gastritis according to literary sources.

1. Study prevalence

2. Study the etiology and pathogenesis

3. Study the classification according to ICD 10

4. Find out the symptoms, diagnosis, complications

PREVALENCE

Chronic gastritis - chronic inflammation of the gastric mucosa - one of the most "popular" stomach diseases in our country. Almost all patients and a significant part of doctors between the symptoms of gastric dyspepsia (belching, heartburn, nausea, vomiting, stomach fullness after eating and pain in the epigastric region) and the diagnosis of gastritis put an equal sign. Therefore, to the patient's question: "What diseases do you have or have you had before?" - in 8 cases out of 10, "chronic gastritis" is noted. This is partly due to the fact that the diagnosis of the disease in most cases is carried out clinically, i.e. on the basis of complaints, without the use of instrumental research methods.

Approximately 50% and even more of the working-age population of developed countries suffer from this disease, and the incidence increases markedly with age.

ETIOLOGY

According to the etiology, chronic gastritis is divided into three main forms:

Type B (bacterial) - antral gastritis associated with contamination of the gastric mucosa with Helicobacter pylori bacteria

Type C (chemical) - develops due to the reflux of bile into the stomach during duodenogastric reflux

Type A (autoimmune) - fundic gastritis; inflammation is caused by antibodies to the lining cells of the stomach.

In addition, there are also mixed - AB, AC and additional (drug, alcohol, etc.) types of chronic gastritis.

Topographically distinguish:

Gastritis of the body of the stomach

Gastritis of the antrum

Gastritis of the fundus of the stomach

pangastritis

In 1990, at the World Congress of Gastroenterology in Sydney (Australia), the following main characteristics of the "Sydney system" of gastritis classification were adopted:

Etiological characteristic:

Autoimmune gastritis type A;

Associated with HP - bacterial gastritis - type B;

Reactive gastritis - type C.

Topographic feature:

Antral gastritis;

fundic gastritis;

Pangastritis.

Chronic gastritis very often occurs in patients with gastroenterological pathology. In this case, it will be expressed by inflammation of the gastric mucosa; concomitant factors - a violation of motor, secretory and some other functions. Very often, chronic gastritis develops against the background of appendicitis, chronic cholecystitis or colitis.

If gastritis proceeded in an acute form and was not completely cured, then as a result of further development it can turn into chronic form. But in most cases, the cause of chronic gastritis is such external factors, as long-term malnutrition (deficiency of vitamins, protein, iron, etc.), the use of spicy, too hot or rough food, a violation of the diet, etc.

Chronic gastritis can be caused by certain factors present inside the human body. Some diseases internal organs(kidney disease, gout, etc.) lead to the fact that the gastric mucosa begins to secrete uric acid, urea, indole, skatole, etc. Metabolic disorders, which also lead to the development of chronic gastritis, are triggered by diseases such as diabetes and obesity. Diseases of the gallbladder, pancreas and thyroid gland also lead to various disorders and changes in the state of the gastric mucosa.

Prolonged exposure to irritating factors leads to functional secretory and motor disturbances in the activity of the stomach, which, in turn, leads to inflammation, dystrophy, and disruption of the regeneration process in the epithelium of the surface of the layers of the gastric mucosa. These areas may later atrophy or completely rebuild.

PATHOGENESIS

Chronic gastritis most often develops as a result of constantly existing violations of rational nutrition (both quantitatively and qualitatively): non-compliance with the diet, constant use of dry, poorly chewed, too hot or cold, fried, spicy food, etc. Chronic gastritis may develop with prolonged use of certain drugs (eg, glucocorticoids, NSAIDs, antibiotics, sulfonamides). In recent years, importance has also been attached to hereditary predisposition, since chronic gastritis is more often detected in children with a family history aggravated by gastrointestinal diseases. Helicobacter pylori plays a significant role in the development of chronic gastritis. This microorganism is often detected in other family members of a sick child. Helicobacter pylori is able to break down urea (with the help of the urease enzyme), the resulting ammonia affects the surface epithelium of the stomach and destroys the protective barrier, opening gastric juice access to the tissues, which contributes to the development of gastritis and ulcerative defect of the stomach wall.

CLASSIFICATION ACCORDING TO ICD 10

K29.0 Acute hemorrhagic gastritis

Acute (erosive) gastritis with haemorrhage

K29.1 Other acute gastritis

K29.2 Alcoholic gastritis

K29.3 Chronic superficial gastritis

K29.4 Chronic atrophic gastritis

Mucosal atrophy

K29.5 Chronic gastritis, unspecified

Chronic gastritis: antral. fundamental

K29.6 Other gastritis

Giant hypertrophic gastritis Granulomatous gastritis Menetrier's disease

K29.7 Gastritis, unspecified

K29.8 Duodenitis

K29.9 Gastroduodenitis, unspecified

The most widespread in our country is the classification of chronic gastritis, proposed by S.M. Ryss (1966). According to this classification, chronic gastritis is divided into:

1. On an etiological basis:

a) primary (exogenous):

b) secondary (endogenous);

2. By morphological features:

a) superficial gastritis;

b) gastritis with lesions of the glands without atrophy;

c) atrophic gastritis (moderate and severe, with a restructuring of the intestinal type):

d) hypertrophic gastritis;

3. By localization:

a) common (pangastritis);

b) limited (antral or fundal);

4. On a functional basis:

a) with normal (or increased) secretion;

b) with secretory insufficiency (moderate or severe);

5. According to clinical signs:

a) an exacerbation phase;

b) remission phase.

Special forms of chronic gastritis: rigid, giant hypertrophic (Menetrier's disease), polyposis, erosive (hemorrhagic), eosinophilic (allergic).

The development of chronic gastritis is based on a genetically determined defect in the restoration of the gastric mucosa, damaged by the action of irritants.

There are two main forms chronic course diseases: superficial and atrophic gastritis. For the first time, these terms, based on the results of endoscopic studies of the gastric mucosa, were proposed in 1948 by the German surgeon R. Schindler. These terms have received universal recognition and are reflected in the ICD-10 classification of gastritis. The division is based on the factor of preservation or loss of normal glands, which has an obvious functional and prognostic significance.

CLINICAL PICTURE

Many gastroenterologists believe that chronic gastritis is not accompanied by a typical clinical picture. However, a carefully collected anamnesis (history of the disease, its manifestations) in many cases makes it possible to single out, perhaps not very bright, but characteristic signs of this disease (for all forms). The clinic of chronic gastritis is often manifested by pain syndrome, gastric dyspepsia but may be asymptomatic. The general condition of the patient with chronic gastritis in most cases does not suffer.

This is a fairly characteristic sign of chronic gastritis. There are pains after eating, and are associated with a certain type of food, less often appear on an empty stomach, at night or regardless of food, they are dull, aching in nature, do not radiate, increase when walking and standing. Acute paroxysmal pains are not characteristic of chronic gastritis, their appearance should be alarming regarding the development of any complications ( peptic ulcer and etc.). Sometimes in patients, even after taking a small amount of food, there is a feeling of pressure in the pit of the stomach, a feeling of fullness in the stomach. In rare cases, the pain may be more intense (with erosive gastritis). In a few cases, the pain syndrome in children is mild. Sometimes the pains have the character of a crisis - acute and severe pain in the epigastric region, which is preceded by profuse indomitable vomiting. In a number of patients, the pain syndrome resembles ulcerative (pain occurs 1 1/2-2 hours after eating, on an empty stomach and at night). Half of the patients with chronic gastritis have no pain syndrome. Asymptomatic course is especially characteristic of secondary forms of the disease.

GASTRIC DYSPEPSY SYNDROME

It includes loss of appetite, bad taste in the mouth, belching, nausea, bloating, sensation of rumbling and transfusion in the abdomen. This syndrome is caused by a violation of gastric digestion and absorption due to insufficient secretion of gastric juice, enzymes and hormones produced in the gastric mucosa. Constipation and a tendency to them are more often observed in patients with Helicobacter pylori gastritis and with high or normal gastric secretion, and flatulence, rumbling and a tendency to loose stools, periodic diarrhea after taking milk or fat - in patients with reduced secretion. Often, the tongue in patients with chronic gastritis is coated with a white or yellow-white coating with imprints of teeth on its lateral surface.

HYPOVITAMINOSIS SYNDROME

It is a consequence of insufficient digestion and absorption and is manifested by signs of a deficiency of various vitamins, more often of group B (cracks and seizures in the corners of the mouth, increased peeling of the skin, premature hair loss, brittle nails).

ASTENO-NEUROTIC SYNDROME

It is often determined in patients with chronic gastritis. It is characterized by increased irritability, suspiciousness, sweating, paresthesia (impaired skin sensitivity, "crawling"), chilliness of the extremities, neurogenic pain in the heart, etc.

ELECTROLYTE DISORDER SYNDROME

It is observed mainly in atrophic gastritis with reduced secretory function of the stomach. Depending on the specific features, there may be a deficiency of potassium (accompanied by malnutrition of the heart muscle and changes in the ECG), calcium (characterized by osteoporosis, brittle bones), iron (iron deficiency anemia).

ENDOCRINE INSUFFICIENCY SYNDROME

Occurs with gastritis not so often, very variable, often unsharply pronounced. Sometimes it is manifested by a violation of sexual function, especially in men.

FEATURES OF SOME FORMS OF GASTRITIS

CHRONIC SUPERFICIAL GASTRITIS WITH NORMAL OR INCREASED GASTRIC SECRETION

It is more often found in young and middle age, mainly in men. It is characterized by intense pain in the epigastric region that occurs on an empty stomach, heartburn, sometimes sour belching, a feeling of heaviness in the epigastric region after eating. Often, patients with this form of gastritis experience constipation.

CHRONIC EROSIVE GASTRITIS

It is characterized by the presence of numerous superficial ulcerations of the gastric mucosa with frequent hidden gastric bleeding, which leads to moderate anemia. Pain in the epigastrium, heartburn, belching may be, but sometimes absent. Of primary importance in the diagnosis of this form of gastritis is endoscopic examination of the stomach (gastroscopy) and clinical analysis blood (decrease in hemoglobin and the number of red blood cells).

CHRONIC ATROPHIC GASTRITIS WITH LOW ACIDITY

This is the most common form of gastritis. It usually diffusely affects the entire gastric mucosa. Main clinical symptoms: unpleasant taste in the mouth, loss of appetite, nausea, especially in the morning, belching with air, feeling of rumbling and transfusion in the abdomen after eating, stool disorders, more often diarrhea, sometimes constipation. With a long course in severe cases of the disease, weight loss, polyhypovitaminosis (insufficient absorption of various vitamins), dysfunction of the endocrine glands (general weakness, hypotension, sexual dysfunction), hypochromic anemia, etc.

Chronic atrophic gastritis with secretory insufficiency is often accompanied by enteritis, colitis (inflammation of the small and large intestines), pancreatitis, cholecystitis and other chronic inflammatory diseases digestive organs. The occurrence of these concomitant intestinal dyskinesias and inflammatory lesions of other organs of the digestive system is explained, on the one hand, by a disorder of gastric digestion, the accelerated entry of insufficiently digested food masses into the intestines and pathological reflexes of its mucous membrane, and on the other hand, a violation of the production of special hormones (which are synthesized in mucous membrane of the stomach and intestines), regulating the functions of the digestive system.

CHRONIC HYPERTROPHIC GASTRITIS

Complaints in this form of gastritis are not specific and may coincide with complaints in other forms of gastritis (pain, belching, nausea, etc.). The main criterion for making such a diagnosis is a gastroscopic examination, which reveals a sharp thickening and increase in the folds of the gastric mucosa and hypertrophy of the glands.

CHRONIC HELICOBACTER GASTRITIS

This form of gastritis, as we have already noted, is caused by the microbial pathogen Helicobacter pylori. The following complaints prevail in the clinical picture of this form: general weakness, feeling of heaviness, fullness of the stomach, dull pain in the epigastric region, unpleasant taste in the mouth, loss of appetite, belching with air, unstable stool. The onset of Helicobacter pylori gastritis can sometimes be manifested by ulcer-like symptoms: moderate hunger pains, night pains, nausea and even vomiting after meals, sour belching and heartburn. These symptoms are due to increased gastric secretion and motor-evacuation disorders that occur immediately after infection with this type of bacteria.

COMPLICATIONS

Complications that may arise as a result of the development of chronic gastritis should be mentioned separately, since they can be quite serious and lead to death. Although with timely, systematic and proper treatment many undesirable and disastrous consequences can be avoided and even a complete recovery can be achieved.

The following possible complications caused by the development of the disease are distinguished:

1. Increased atrophy and achilia.

2. Transformation into peptic ulcer.

3. Transformation into cancer.

Among possible complications There are five most likely groups:

1. Anemia. Develops with erosive and atrophic gastritis.

2. Bleeding. Occurs with erosive gastritis.

3. Pancreatitis, cholecystitis, hepatitis, enterocolitis. These diseases may occur in connection with the exacerbation or development of certain forms of chronic gastritis.

4. Pre-ulcerative condition and ulcer. Especially likely with piluroduodenitis.

5. stomach cancer. Any form of advanced chronic gastritis can lead to this disease. It has already been proven that cancerous tumors primarily appear in patients with a primary lesion of the antrum and anthrocardial expansion (on the border between healthy and diseased cardiac expansion, as well as on the border between healthy and diseased tissue). In addition, if the family has already observed cases of cancer, then the risk of this complication increases by 4 times. The first signs of the development of a cancerous tumor are the following: causeless weakness, rapid satiety with food, loss of appetite, a change in the nature of a pre-existing symptom, the appearance of a syndrome of small signs. Absence immunological reaction and Rh+ blood type II can also be signs of early cancer.

DIAGNOSIS METHODS

There are several main types of examination for gastritis:

1. Objective.

2. Non-invasive diagnostics (clinical blood test, feces for the Gregersen reaction, etc.).

3. Invasive diagnosis ( histological method, rapid urease and enzyme immunoassay, phase-contrast microscopy and bacteriological method).

4. X-ray.

5. Probe diagnostics (histamine test).

6. Fibrogastroscopy (FGS) and fibroesophagogastroduodenoscopy (FEGDS).

7. Thermography.

Objective diagnosis

Objective diagnosis provides little information, since it relies only on external symptoms gastritis - such as severe weight loss, pale skin, etc. In chronic autoimmune gastritis with a syndrome of poor digestion and absorption, bleeding gums, premature baldness, brittle nails, dry skin (especially in the corners of the mouth), hyperkeratosis, white or yellow plaque are observed in the language. With Helicobacter pylori gastritis, pain occurs during palpation.

Increased drowsiness and fatigue are observed with autoimmune gastritis. In this case, the patient quickly loses weight, appetite decreases sharply, symmetrical paresthesias appear in the extremities. In addition, there are pallor of the skin, plaque on the tongue and palate, some symptoms of a neurological nature. In some cases, there are problems with vision, often there is a burning sensation of the tongue and mouth.

A more accurate diagnosis can be made only after a deep examination using additional methods diagnosis.

non-invasive diagnostics.

This method is based on the study of analyzes of feces, blood, serum of exhaled air. This type of examination includes a breath urease test using labeled urea and an enzyme immunoassay (Read-Fast Test).

The enzyme immunoassay is indirect and refers to rapid tests. This method of examination allows you to detect antibodies to the bacterium Helicobacter pylori (Hp) in the patient's blood. The results of the analyzes are established very quickly, this does not require laboratory conditions and complex apparatus for special processing. However, the presence of antibodies in the body cannot serve as absolute evidence of the development of infection in the human stomach. In addition, on early stages the development of infection tests do not give any results. These tests are usually used during mass research (during the outbreak of epidemics, etc.).

Invasive diagnosis.

The histological method, both bacteriological and rapid urease, as well as phase-contrast microscopy, refers to an invasive diagnostic method. These tests are based on the study of the mucous membrane and gastroduodenal zone of the stomach with the detection of Hp bacteria in the human stomach. The biopsy of the gastric mucosa is subjected to the study.

The histological method is considered the most effective in diagnosing Helicobacter infection and at the same time simple in terms of implementation. The test does not deteriorate during transportation and storage, and studies of the results obtained can be carried out under normal conditions without any special laboratory equipment.

The rapid urease test method consists in the fact that a substance is introduced into the stomach, which leads to an increase in the pH environment, certain results affect the color change. The test can last several minutes, and sometimes a day. Effective results are obtained only if the patient is infected and the bacteria are actively spreading. The test is very easy to perform and has a high guarantee of detecting Hp bacteria.

In practice, several types of rapid urease test are used: CLOtest (Delta West Ltd, Bentley, Australia); Denol-test (Yamanauchi); Pyloritek (Serin Research Corporation, Elkhart, India); Hpfast (GI Supply, Philadelphia, USA).

In case of severe infection of the gastric mucosa, the test results are ready in 1 hour (+++). With moderate infection after 2 hours (++). With a slight infection, the test will give results after 2 hours or a day (+). To be sure of a negative test result (-), it is necessary to wait for the appearance of a color change for more than 24 hours.

The method of phase-contrast microscopy makes it possible to detect the presence of Hp bacteria in the human body in a matter of minutes. This test is highly accurate, since the results are studied in the laboratory in the endoscopy room using a phase contrast microscope. The fresh biopsy specimen obtained during the study is placed on a special glass, covered with another glass moistened with immersion oil. Further studies are carried out by the phase contrast method. A hundredfold magnification reveals the presence or absence of Hp bacteria, which are spiral-shaped, curved microorganisms. If there are any, then it is possible to make an indisputable diagnosis of gastritis. Processing of test results can be carried out only in laboratory conditions and with the help of special equipment, which excludes the possibility of using this method under normal conditions.

The method of bacteriological research is considered one of the most complex and therefore quite expensive. It consists in determining the sensitivity of the human body in relation to various drugs for the presence of infection.

This method of examination is necessary for differentiation with peptic ulcer and cancer, but it is impossible to detect the development of gastritis in a similar way. If a peptic ulcer or tumors are not detected by the results of an x-ray, then other methods are used to further diagnose gastritis.

Probe diagnostics.

Probing has been practiced in our country for a long time in the diagnosis of gastritis, although recently this method has become a little outdated. However, with its help, you can study the state of the stomach in sufficient detail. The probe is a thin tube equipped with a micro-camera and sensors. The patient swallows this tube, so the probe enters the stomach and the doctor gets the opportunity to examine his condition.

Sounding includes three phases. The first phase is carried out on an empty stomach, when the patient does not eat for 6-8 hours before the start of the session. The second phase occurs an hour after the introduction of the probe: basal secretion is established, that is, the reaction of the intestinal organs to mechanical stress. The third phase takes place after artificial stimulation. Parenteral secretagogues are used to stimulate the stomach, although in the recent past various doses of food have been given to the patient as stimulants. Parenteral causative agents of secretion - special preparations (pentagastrin, histamine, in some cases eufillin or insulin).

Histamine is administered in an amount of 0.008 mg per kilogram of the patient's weight, with an average weight, the amount of the drug administered is approximately 0.4-0.5 mg. Taking histamine allows the doctor to determine the condition of the stomach according to the following parameters:

General acidity;

The total amount of gastric juice secreted in 2 hours (the norm is 150-200 ml);

An increase in the content of pepsin in gastric juice produced in 1 hour, or, in scientific terms, the debit-hour of pepsin;

The amount of acid produced in 1 hour, or debit-hour of hydrochloric acid.

The method using histamine for gastric sounding is called the submaximal histamine test. This method will allow you to accurately establish the diagnosis in 97 cases out of 100.

There is also a method using daily monitoring. Its essence lies in the fact that several probes are placed in the patient's abdominal cavity at once, which are much smaller than those used in the histamine test. Daily monitoring lasts much longer than a histamine test, and allows you to thoroughly examine the state of internal organs abdominal cavity.

Probe diagnostics allows you to make a very accurate diagnosis, therefore it is widely used in most clinics in our country.

FGS and FEGDS

Fibrogastroscopy with biopsy is one of the main methods in the diagnosis of gastritis, as well as in the examination of the stomach for possible development malignant tumor. With this method, it is possible to carefully examine 45 sections of the stomach with a full guarantee of establishing possible precancerous signs.

Fibroesophagogastroduodenoscopy is one of the effective methods examination of the condition of the stomach, esophagus, duodenum. It is used in many clinics, although it is considered that this method is somewhat outdated. Examination of the internal organs of the abdominal cavity is carried out using flexible liquid crystal endoscopes with fiber optics, which is a kind of camera. FEGDS is used mainly as a starting test at the initial stages of the development of the disease and at the first complaints of the patient. Indications of this method can be emergency and planned.

conclusions

Chronic gastritis is sometimes the result of the further development of acute gastritis, but more often it develops under the influence of various factors (repeated and prolonged malnutrition, consumption of spicy and rough foods, addiction to hot foods, poor chewing, dry eating, drinking strong alcoholic beverages). The cause of chronic gastritis can be qualitatively malnutrition (especially deficiency of protein, iron and vitamins); long uncontrolled reception medicines that have an irritating effect on the gastric mucosa (salicylates, butadione, prednisolone, some antibiotics, sulfonamides, etc.); industrial hazards (lead compounds, coal, metal dust, etc.); diseases that cause oxygen starvation of tissues (chronic circulatory failure, anemia); intoxication in diseases of the kidneys gout (in which urea, uric acid, indole, skatole, etc. are secreted by the gastric mucosa); action of toxins in infectious diseases. In 75% of cases, chronic gastritis is combined with chronic cholecystitis, appendicitis, colitis and other diseases of the digestive system.

Most frequent symptoms chronic gastritis are a feeling of pressure and fullness in the epigastric region after eating, heartburn, nausea, sometimes dull pain, loss of appetite, unpleasant taste in the mouth. Most often, the acidity of gastric juice decreases. At a young age, mainly in men, the acidity of gastric juice can be normal and even increased. Pain, often heartburn, sour belching, a feeling of heaviness in the epigastric region after eating, and sometimes constipation are characteristic.

Collecting theoretical material, studying all the subtleties of the topic of chronic gastritis, I gained knowledge that will no doubt be useful to me in my profession.

Doing all the work, I relied on my knowledge gained in the process of studying. I experienced some difficulties when working with the information of the term paper, and yet I managed to present the material, as it seems to me, in full.

Finishing my coursework I can say that I have mastered all the skills and abilities I need when working with patients.

Bibliography

1. Aruin L.I., Kapuller L.L., Isakov V.A. Morphological diagnostics diseases of the stomach and intestines. - M.: "Triada-X", 1998. - 483 p.

2. Aruin L.I. New international classification of gastric mucosal dysplasia // Ross, journal of gastroenterol., hepatol., coloproctology. - 2002, No. 3. - S. 15-17.

3. Encyclopedic dictionary medical terms. - ed. B.V. Petrovsky. - M.: Soviet Encyclopedia, 1982. - T. 1. - 464 p.

four. . Aruin L.I., Grigoriev P.L., Isakov V.A., Yakovenko E.P. Chronic gastritis. Amsterdam, 1493. 362 p.

5. Minushkin O.N., Zverkov I.V. Chronic gastritis. / Attending doctor. - 2003, No. 5, p. 24--31.

6. Ivashkin V.T. Lapina T.L. Chronic gastritis, principles of diagnosis and treatment. //R.M. Zh. - 2001; 2; 54-61.

7. Osadchuk M.A., Pakhomov A.L. Kvetnoy I.M. Chronic gastritis with functional dyspepsia: pathological features of clinical manifestations. //Ros. J.G.G. K. - 2002; 5; 35-39.

8. Pajares-Garcia J. Helicobacter pylori gastritis with and without dyspepsia: morphological or clinical unit. //Ros. J.G.G. K. - 2002; 6; 76-80.

9. Livzan M.A., Kononov A.V., Mozgovoy S.N. EX-helicobacter gastritis: neologism or clinical reality. /Experimental and clinical gastroenterology. - 2004; 5; 55-59.

10. Clinical lectures on gastroenterology and heptology / Edited by A.V. Kalinina, A.I. Khazanov, in 3 volumes. Volume

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Laboratory research

The list of tests for gastritis is limited by the specifics of the identified health disorders. Gastritis tests are designed to identify the existence of pathology, fix acidity, check for the presence of harmful bacteria, and possibly diagnose concomitant diseases. Assign a diagnostic analysis of feces, urine and complete blood count.

Blood analysis

By using general analysis blood is checked for biochemical composition. For general bioanalysis, blood is taken from a finger. You can evaluate the results within two hours.

A blood test for gastritis is taken on an empty stomach, it is advisable to exclude in advance fatty foods and alcohol. If a person after infectious disease, donating blood is allowed no earlier than a week break. After evaluating the composition, the doctor will see the flow inflammatory process, weakened immunity, pathology.

Check the position of red blood cells, ESR, hemoglobin level, white blood cell count. In chronic gastritis, the indicators are below the norm. The level of protein is controlled, its degree determines the existence of inflammatory formations. The presence of pepsinogen level I-II is fixed, the enzyme indicates the nature of the formations. ESR in gastritis is a fundamental indicator for pathology and the development of the inflammatory process. The speed of movement and sedimentation of erythrocytes allow us to draw important conclusions. An erythrocyte is a red blood cell that delivers oxygen to tissues, and the red color is due to hemoglobin.

Fecal analysis

Stool sampling provides data on the presence of bloody and purulent discharge. Certain type fatty acids, starch allows you to recognize the occurrence of inflammatory or infectious diseases gastrointestinal tract. Prerequisites for atrophic gastritis is the identification in the feces of a large amount of digested connective tissue of muscle fibers, starch.

For the correct collection of feces, a clean container is provided, it is advisable to exclude products containing iron in advance, stop taking drugs that affect the gastrointestinal tract. Storage is not allowed.

Analysis of urine

Urinalysis becomes confirmatory, additional. Now it is possible to consolidate the main diagnosis and see concomitant diseases. Useful information about the content of protein, organic substances, cellular components gives a complete picture of the work of the kidneys, immunity and other body systems. Urinalysis shows general state body, allows you to find infection and toxic substances.

Hardware diagnostics of gastritis

If the therapeutic examination and laboratory research help to state the fact of the disease, the nature of the formations, then with hardware diagnostics the essence of the defects, the stages of spread and deviation are determined. When gastritis is prescribed: FGDS, ultrasound of the stomach, x-ray, PH-metry, thermography.

Fibroesophagogastroduodenoscopy (FGDS) is safe for the patient, popular as a monitoring of any organ of the gastrointestinal tract. Lasts no more than 10 minutes, allows for a number of additional effective action. Using a probe with an endoscope, the doctor examines the internal surfaces and understands the cause of the occurrence. pain. In addition, this instrument is used to take tissue samples for examination, remove small cysts stop bleeding. A simplified FGS procedure is also applied.

Ultrasound examination of the stomach (ultrasound) allows you to see the stomach without gastroscopy. Gastritis diagnosis is carried out using a picture displayed on the monitor screen. For a detailed examination, the sensor is moved along the surface of the abdomen, changes are detected at different angles.

Probing is a popular procedure for diseases of the gastrointestinal tract. The duration of the procedure is up to 2.5 hours and is a step-by-step process. A tube is used to check the ability of the stomach to produce enzymes and gastric juice. First, the stomach is completely emptied with a special tube. Then, at ten-minute intervals, four portions of the basal secretion are taken. The fluid produced by an empty stomach is subject to further study. In some cases, a trial breakfast is introduced: broth or decoction. Similarly, they provoke the production of secretion after exposure to food. After a short pause, the secretion is collected again. Today, the procedure for inserting a probe is no longer so painful and you should not be afraid. The tubes are thin, making it easy to perform the assigned functions. By color, smell, acidity, the nature of the disease is clear. An unusually viscous liquid clearly indicates gastritis.

X-ray diagnosis of the stomach with a contrast agent has a lot of contraindications, but the indicated diagnosis of gastritis is painless. Contraindications are mainly associated with x-rays: pregnancy, allergic reactions on the active ingredients, intestinal obstruction. The stomach is translucent with a beam, having previously filled it with a dye. As a coloring agent, barium sulfate, iodine or baking soda that are not amenable to lumen x-rays. Due to the presence of a coloring matter, the walls of the stomach and possible changes in the mucosa are clearly visible in the pictures. They take detailed pictures of the area of interest, obtaining detailed information for diagnosis. Examination for gastritis takes up to five minutes, which is indispensable for urgent hospitalization with acute pain.

Intragastric pH-metry is used as a test for the formation and neutralization of gastric acidity. With the help of a special swallowing tube, previously inserted through the mouth, a thin electrode is inserted. The second electrode is fixed on the patient's wrist. They take indicators at different points of the gastric mucosa. At the same time, the doctor observes the indicators on the monitor. The tour lasts up to 45 minutes. Ph-metry is of three types: urgent, when the situation in several parts of the organ is checked with an electrode inserted through the mouth; daily - the probe is inserted through the nose, an acidogastrometer apparatus is put on the belt and changes are monitored for a day or more; capsule - a perfect technique when a person swallows a capsule that transmits information to a pH meter. The capsule subsequently dissolves and is naturally eliminated from the body.

Computed tomography of the gastric region allows scanning without swallowing the dye and invasive intervention. Diagnosis is safe even for humans old age. Obtaining sections of the affected organ makes it possible to determine changes in the walls of the stomach, deformation, tumors and polyps. Before scanning, the walls of the stomach are straightened by filling with an inert gas. It is easy to assess the elasticity of tissues, narrowing and thickening of the walls, neoplasms. All information is recorded on a computer, allowing the doctor to return to it at any time to make the correct diagnosis.

Thermography of the stomach is an innovative method, thanks to which color pictures are displayed on the monitor, based on the difference in human temperatures. Human thermal radiation is converted into electrical signals displayed on the monitor. Each shade in the picture corresponds to a certain temperature and, comparing with the scale, the doctor sees comprehensive information about the onset of tumors and circulatory disorders. In comparison with the reference data, the presence of inflammation is indicated by an increase in temperature, and low temperature may occur when there is interference with normal blood circulation, a tumor is determined.

To diagnose gastritis and other diseases of the gastrointestinal tract, a comprehensive examination is prescribed. Taking into account the specifics of a particular case, the doctor offers alternative options, each of which provides clarifying information for the final medical verdict. Ignoring research appointments is not recommended. The effectiveness of treatment by 99% depends on the correct diagnosis, there are no insignificant circumstances in this case.

X-ray examination does not allow diagnosing the main forms of chronic gastritis, but it can be used to exclude ulcers, cancer, polyposis and other diseases of the stomach, to identify duodenal gastric reflux, giant hypertrophic gastritis, chronic obstruction of the duodenum.

X-ray signs of chronic obstruction of the patency of the duodenum are the delay of the contrast mass in its lumen for more than 45 s, the expansion of the lumen, the presence of duodenal gastric reflux.
With giant hypertrophic gastritis (Menetrier's disease), the mucosal folds are sharply thickened in a limited area (with a local variant) or throughout the stomach (with a diffuse variant). The wall of the stomach in the affected area is elastic, peristalsis is visible.

Fibroesophagogastroduodenoscopy

FEGDS, in addition to examining the mucous membrane of the stomach and duodenum, allows you to take biopsy material for morphological and histological studies, followed by an accurate diagnosis of the form of chronic gastritis. To unify histological conclusions, a visual analogue scale was proposed, according to which it is possible to assess the degree of Helicobacter pylori contamination, the degree of infiltration by polymorphonuclear leukocytes and mononuclear phagocytes, the stage of atrophy of the antrum and fundus of the stomach, and the stage of intestinal metaplasia. The most accurate representation can be obtained by examining at least five biopsies: two each from the antrum and fundus and one from the angle of the stomach.

Non-atrophic (superficial) gastritis. The mucous membrane is shiny (sometimes with a coating of fibrin), edematous, hyperemic, hemorrhages into the mucous membrane are possible.
atrophic gastritis. The mucous membrane is thinned, pale gray in color, with translucent blood vessels, the relief is smoothed.

With moderate atrophy, wider areas of slightly thinned mucous membrane alternate with areas of whitish atrophy various shapes small sizes. With pronounced atrophy, the mucous membrane is sharply thinned, in places with a cyanotic tint, easily vulnerable. The wrinkles disappear completely.

Chemical (reactive) gastritis. The pylorus gapes, the mucous membrane of the stomach is hyperemic, edematous. There is a significant amount of bile in the stomach. In the area of the anastomosis, erosions can be found, which can be multiple in drug-induced (NSAID) gastritis.
Giant hypertrophic gastritis (Menetrier's disease). Giant folds are found in the stomach, resembling the convolutions of the brain, a large number of mucus; the mucous membrane is easily vulnerable, erosions and hemorrhages are often found.

Study of the secretory function of the stomach

The study of the secretory function of the stomach is carried out by the method of fractional gastric sounding or intragastric pH-metry with a multichannel probe using parenteral stimuli (histamine, pentagastrin).

floor manometry

The technique of floor-by-floor manometry of the upper digestive tract consists in the introduction of a catheter and registration of pressure changes. With chemical (reactive) gastritis, an increase in pressure in duodenum up to 200-240 mm w.c. Art. (norm 80-130 mm water column).

Examination of a patient with gastritis in the clinic. Gastritis: symptoms, diagnosis and treatment

Diagnosis of chronic gastritis

Patient examination plan

Objective data of examination of patients

FGDS - fibrogastroduodenoscopy

Biopsy

pH meter

Useful video

Diagnosis of Helicobacter pylori

breath test

Blood analysis

Analysis of feces and urine

X-ray method

Differential Diagnosis

Etiology and pathogenesis

Classification of chronic gastritis

Symptoms of chronic gastritis

Diagnosis of chronic gastritis

Where does it hurt

What needs to be examined

How to examine

Who to contact

Treatment

Medications

Folk remedies

Nutrition for chronic gastritis

What is prohibited in chronic gastritis

What can be done with chronic gastritis

Approximate diet

Complications and consequences

Prevention of chronic gastritis

Chronic gastritis in children

Chronic gastritis in pregnant women

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