What causes gastric erosion and how to treat it? Erosion of the stomach - damage to the mucous membrane with dangerous consequences

The mucous membrane of the stomach can be subjected to various damages. Quite often, conditions such as mucosal erosion and. Let's talk about the differences between these diseases.

Erosion is called superficial damage to the gastric mucosa. The defect in this case develops only in the upper layers, without affecting the submucosa.

The formation of an ulcer is the appearance of a defect not only in the mucosa, but also in the muscle layer of the stomach wall.

Development mechanism

The mechanisms of development of erosion and gastric ulcers are the same. In the case of erosion, the pathological process stops earlier. For the formation of an ulcer, a longer exposure to damaging factors is required.

Causes that can cause erosion of the gastric mucosa:

• constant exposure to too cold or too hot food and drinks;
• food with a lot of spices;
• taking medications that irritate the mucous membrane;
• Availability foreign body in the stomach;
• increased production of hydrochloric acid;
• irregular nutrition and irritation of the mucous membrane with gastric juice.

Under the influence of these factors, the cells of the mucosa begin to collapse, and this area loses its protective properties. Formed wound surface called erosion. The process can stop at this stage, and with proper treatment, the erosion heals completely. If the impact of causative factors continues and there is no treatment, erosion turns into an ulcer.

In addition to the above reasons, the following contributes to the formation of an ulcer:

These reasons contribute to an increase in erosion and penetration of the defect into the muscular layer of the gastric wall, and an ulcer develops.

Symptoms

Clinical manifestations of erosion and gastric ulcer will vary. The ulcerative process is a more serious condition than erosive, and can lead to the development of dangerous complications.

In the presence of erosive damage, a person will be disturbed by discomfort during meals. Perhaps the development of dyspeptic phenomena in the form of nausea, unstable stool.

On examination, no pathological changes not found. There are no complications from erosion.

With peptic ulcer, the clinic will be more extensive:

• pain occurs not only during meals, but also a few hours after it;
• heartburn, nausea develops, loose stools periodically appear;
• when viewed at the height of the pain attack, one can detect the retraction of the muscles of the abdominal wall in the stomach area.

An ulcer is characterized by the development of complications. They can appear almost immediately after the formation of an ulcer or after a few years.

1. Perforation and penetration ulcer defect. These two complications are the destruction of the muscular layer of the gastric wall and the formation of a through hole. The contents of the stomach enter the abdominal cavity and causes peritonitis.
2. Stenosis of the outlet of the stomach. This is a late complication that develops several years after the formation of the ulcer. It is caused by deformation of the muscle wall around the ulcer. As a result, the opening leading to the duodenum narrows, resulting in impaired passage of food. The food bolus remains in the stomach and rots.
3. Stomach bleeding. This complication develops when an ulcer damages a large blood vessel. In this case, the patient has signs of internal bleeding: pale skin, pressure drop, increased heart rate. Typical symptoms of gastric bleeding are vomiting coffee grounds» ( Brown color) and tarry stools (liquid and black).
4. Ulcer malignancy is the most dangerous complication. This is the degeneration of a peptic ulcer into a cancerous tumor.

With erosion, symptoms are observed regardless of the time of year. Ulcers are characterized by seasonality, exacerbations appear in spring and autumn.

Diagnostics

1. A diet is prescribed, which involves the exclusion of alcoholic and carbonated drinks, fast food, richly seasoned food. Food temperature should be moderate. Food should be as uniform as possible.
2. To alleviate discomfort during meals, antacids are prescribed - Almagel, Gaviscon. They cover the area with erosion with a protective film, thanks to which food does not irritate it.
3. To restore the mucous membrane, drugs with a regenerating effect are used, for example, Methyluracil. With the help of a gastroscope, you can apply Methyluracil or Solcoseryl directly to the damaged area.

Treatment of peptic ulcer is more complex and takes longer:

Treatment can take several months or even years, but does not provide a 100% recovery. Gastric ulcer has a chronic course and is prone to recurrence.

Effects:

• As a rule, erosion with full treatment disappears without a trace.
• The ulcer heals for a long time, and relapses of the disease often occur.

Damage to the stomach mucosa that does not affect the submucosa and muscle layers is commonly referred to in gastroenterology as gastric erosion.

In terms of frequency of occurrence, pathology belongs to one of those encountered in gastroenterology. Every sixth to seventh study patient endoscopic method, detects erosive processes in the organs of the digestive system.

The disease was first described by the Italian founder of pathological anatomy Giovanni Morganier in the middle of the 17th century. The disease has since undergone several generations. diagnostic methods and methods of treatment, but the nature of the pathology and the features of its symptoms remained the same.

Causes of the disease

Understanding the cause of gastric erosion opens up the correct treatment regimen. It is especially important to clarify the etiology in primary and secondary causes to relieve symptoms. All causative factors of the disease fit into systematic categories.

1. Excessive or incorrect oral intake medicines capable of initiating erosion processes. These include cardiac glycosides, non-steroidal anti-inflammatory drugs.
2. The mucous membrane is irritated by both temperature and mechanical factors, so the use of spicy, too coarse and hot food is fraught with erosive processes in the mucosa.
3. Alcoholic drinks cause damage to the mucosa, and smoking triggers the mechanism of damaging factors that contribute to the rapid flow of erosion. A cigarette smoked on an empty stomach can not only affect the mucous membrane, but also endanger the life of the patient.
4. Liver pathologies (cirrhosis) cause spasms in the blood vessels stomach. Due to the anatomical proximity and unity of the functional system, circulatory disorders are the cause of erosive processes.
5. Production and domestic work associated with the use of harmful and toxic substances. Entering the human body different ways(through the skin, respiratory and digestive system) toxins are the source of erosion of the stomach.
6. in the stomach tend to be covered with erosion or the onset of oncology is accompanied by irritation of the mucous membrane, therefore it is difficult to determine the primacy of the process in this case.
7. Operational and traumatic processes with the stomach are the root cause of erosion of the gastric mucosa.
8. Erosion of the gastric mucosa is naturally a consequence of deviations in the content of carbohydrates in the blood, observed in diabetes mellitus.

Symptoms

The clinical picture of gastric erosion has many similarities with peptic ulcer. For this reason, an accurate diagnosis can be established after several diagnostic methods.

Erosion usually appears on endoscopy as small spots on the mucosa, like sores. Often the disease proceeds without symptoms or the nature of the manifestation of symptoms is not bright (except for heartburn, there are no other clinical signs).

The photo shows endoscopic diagnostics erosions of the stomach

The classic manifestation of gastric erosion is reduced to a complex of phenomena:

1. Pain in the stomach - main feature pathology. The nature of the pain has no specificity: the intensity may increase, then temporarily fade away, a slight pain may appear (the patient takes a drug like No-shpa) or pain tolerance becomes impossible. Severe pain indicates acute erosion. More dangerous than pain medium and low intensity, when their relief with analgesics contributes to the rapid growth of the focus of the disease.
2. Bleeding is a warning sign m requiring urgent medical intervention. Without surgical intervention can be dispensed with if blood impurities are found in the patient's vomit or feces. In the event that the vomit becomes dark brown in color and there are obvious signs of internal bleeding, it is not always possible to maintain the integrity of the stomach; to save the patient, they sometimes resort to ectomy of the affected part of the stomach.
3. Nausea and vomiting, in the absence of other signs, are not specific signs of erosive processes. Nausea and vomiting should not be excluded from the signs of erosion if their frequency becomes regular or the symptom is accompanied by other manifestations of the disease.
4. For signs of brittle nails and hair, as well as dryness of the skin, erosion of the stomach is judged on the basis of the physiological justification for the pattern of anemia due to internal bleeding. Low hemoglobin causes blue skin, thinning and unhealthy color of nails and hair.

Classification

Kinds

Primary

In medicine, it is customary to consider primary erosion of the stomach as a pathology that occurs in the stomach itself. Sometimes a pathology with an unclear etiology is taken for primary erosion.

Secondary

Secondary erosion of the stomach is a pathological process that is the consequences of disruptions in the work of other organs and functional systems(liver, heart and circulatory system).

Malignant

Erosive processes occur when oncological diseases organs of the gastrointestinal intestinal tract, as well as lymphogranulomatous inflammatory processes with fragmentary erosive lesions of areas of the gastric mucosa (Crohn's disease).

Forms

Acute

Regardless of the systematic variety of gastric erosion, 2 forms of this disease are distinguished, one of which is acute. Localization acute form erosion of the organ - the body of the stomach or its bottom.

With proper treatment and a successful set of circumstances, the disease can be eliminated in 6-7 days, in more severe cases treatment takes several weeks.

Chronic

The chronic form of gastric erosion usually shifts the localization of the pathology to the pyloric (antral) part of the organ. The chronic form is characterized by a longer treatment, sometimes taking up to 5 years.

Types

Hemorrhagic

In the hemorrhagic form, erosion is accompanied by the release of blood into the vomit and feces.

Often, the disease does not manifest itself with pronounced symptoms, but signs of anemia, confirmed by laboratory diagnostics, become pronounced on the face.

In this case, the patient's hemoglobin is reduced. The hemorrhagic form of the disease is characteristic of an acute course. When researching pathological formation surrounded by a ring of small dots cherry color. It is usually the edges of the hyperemic ring that bleed.

Surface flat

Erosion ulceration looks the same as in the hemorrhagic form, but the ring surrounding the affected area has a whitish color, without signs of hyperemia. Flat defects during erosion have slightly convex edges, distinguishable by color due to slight hyperemia of adjacent tissues.

Hyperplastic inflammatory or complete

At endoscopic examination complete erosion of the stomach is observed in the pyloric region. Bulges are visible under the mucosa of the organ, resembling erupting large molars: a crater-shaped shape with a depression in the center with signs of ulceration.

In some cases, the formations are not sufficiently visible due to hyperemic areas of the mucosa covering convex pathologies.

What is dangerous erosion of the stomach?

Untimely or illiterate treatment of gastric erosion increases the severity of the pathology and can develop according to one of the options:

1. Ulcerative condition. With an ulcer, damage to the stomach is localized not only in the internal membrane (mucosa), but also affects deeper layers (submucosa, muscular membrane). For the course of an ulcer, exacerbations and relapses of the disease are characteristic. An ulcer is a more dangerous form of stomach pathology, as it reveals the patient's weight loss, nausea and vomiting after any meal. Healing of erosion of the stomach is not accompanied by the formation of scars, with an ulcer, a section of the mucous membrane and a deeper layer is replaced by a connective scar tissue with a loss of functionality.
2. With hemorrhagic form internal bleeding causes a state of anemia. Kidney failure can be one of the options for the development of anemia. With vomiting, internal bleeding is recognized by the color and consistency of the coffee grounds.
3. Ulcerative-erosive conditions of the stomach have unpleasant possible consequences that worsen the quality of life for a long time: resection of a part of the stomach, a strict diet prior to surgery and during a long recovery period. Operations often take place in a state of ulcer, although in rare cases erosive phenomena require surgical intervention.
4. Polyps in the stomach- one of the more severe reactions in response to mucosal irritation. occurs infrequently due to infrequent occurrence. The prognosis after resection of polyps is favorable.
5. Most dangerous development erosion is a malignant neoplasm. The relationship between the two pathologies is bilateral: after the onset of gastric cancer, the pathologies are covered with erosive spots, and cancer can form at the site of erosion.

Diagnostics

Endoscopic examination is one of the few methods for detecting erosion. The procedure is unpleasant painful sensations for a patient who vomits, however more informative method about the state of the gastric mucosa in modern times does not exist.

An endoscope is a telescopic tube that is inserted into the mouth and then through the esophagus into the stomach. necessary to study the histological section of the gastric mucosa.

The scheme of treatment of erosion of the stomach

Medicines

Upon detection pathogenic bacterium Helicobacter pylori requires antibiotics.

In other cases, treatment does without antibacterial agents according to the scheme of using drugs - cytoprotectors (gastroprotector in the form of colloidal bismuth on a substrate or De-Nol tablets), inhibitors proton pump, synthetic prostaglandins and H2 blockers (Kvamatel). In secondary etiology, preference is given to prostaglandins and cytoprotectors.

Diet: menu for the week

Successful treatment of gastric erosion requires adherence to dietary nutrition by the patient as part of the treatment regimen. The nature of nutrition during treatment should have the direction of the absence of irritation and stimulation of the mucosa.

In this regard, rough foods rich in fiber, an excess of spices, spicy, salty and smoked dishes are excluded. Fatty foods, coffee, vegetables with bitterness (radishes), fruits with high content organic acids.

When choosing products, you should choose those that create an enveloping of the mucous membrane with a large amount of mucus (milk, low-fat sour cream, eggs, butter, milk porridge from oatmeal and semolina, low-fat hard cheeses, kissel).

The number of meals should be at least 6. At each meal, you should not eat a lot. You need to take only warm food, waiting for it to cool, but do not eat cold food.

Folk remedies at home

Healing is faster if the patient takes sea buckthorn oil 20-30 minutes before breakfast. For achievement therapeutic effect sea ​​buckthorn oil is consumed three times a day before meals.

You can enhance the effect of the oil with linseed oil, for which both oils are mixed in half a spoon. Honey also has healing properties in relation to gastric erosion, but it is better to take it dissolved in warm water or milk.

Of herbal teas, infusions and decoctions used both in mixtures and as a separate one have healing properties in relation to the gastric mucosa. healing remedy. The main plant used in the treatment of erosion is the great celandine. In the mixture, it can be used with common cudweed, highlander bird, St. John's wort, chemist's chamomile.

A glass of boiled hot water a mixture of herbs is poured and after half an hour the product is ready for use. Three times a day, use 100 grams of this drink.

When pain occurs, bee propolis is used.

Erosion of the stomach is a defect (lesion) of the surface layer of the mucous membrane that does not reach the muscle plate of the stomach, capable of healing without the formation of a connective tissue scar.

The disease with the development of erosion is called erosive gastritis.

Outwardly, erosion looks like an ulcer 0.3-15 mm. diameter, rounded or irregular in shape, can be localized in any part of the stomach. Some doctors consider erosion a pre-ulcer disease, others - an independent nosological form.

In fact, erosive defects can be combined with ulcers, especially when localized in the duodenum.

Epidemiology

Erosion is diagnosed in 15% of patients with gastroenterological diseases, mainly in people over 30 years of age. Among elderly patients, the incidence of gastric erosions is 2 times higher than in young patients. In children, the appearance of such defects is a rare occurrence.

Pathogenesis

The mechanism of the development of the disease is not well understood. Presumably, the cells of the gastric mucosa, as various factors experiencing oxygen starvation. As a result, ischemia of some parts of the stomach wall develops, which provokes a violation of the permeability of cell membranes.

Striving to the pathological focus of particles of the immune system and leukocytes, increased production of hydrochloric acid, pepsin, genetic predisposition to high sensitization of the body in combination lead to the development of autoimmune processes with the formation of defective cells and chronicity of phenomena.

Causes of erosion

According to one theory, the main cause of erosions is the vital activity of Helicobacter pylori bacteria in the stomach. This is proved by the presence of antibodies to the infection in the blood in more than 90% of the identified patients.

Erosive gastritis can develop with the participation of factors such as:

• Burns of the gastric mucosa, intoxication, vapor poisoning chemical substances.
• Operations on the organs of the gastrointestinal tract, heart, organ transplantation, any abdominal interventions.
• Shock conditions, severe shocks, prolonged stress and depression.
• Long-term use of NSAIDs, corticosteroids, antiarrhythmic drugs.
• Reception of coarse, insufficiently chewed, spicy, excessively hot food.
• Alcoholism, smoking.
• Reflux of bile into the stomach.
• Increased acidity of gastric juice with a simultaneous decrease in mucosal resistance.

Sometimes erosive defects in the stomach appear simultaneously with benign and malignant tumors, inflammatory diseases intestines, liver, lungs, in diseases of the blood and heart.

Diseases such as thrombosis or stagnation of blood in the portal vein are often accompanied by erosive gastritis. Hernia esophageal opening diaphragm can also be complicated by hemorrhagic erosions localized near it.

Types of disease

Erosion of the gastric mucosa can exist in the following forms:

• Acute erosion. Most often localized at the bottom or body of the stomach. It is characterized by the absence of an epithelial layer, weakly infiltrated by lymphocytes, and has small deposits of fibrin at the bottom.
• chronic erosion. In most cases, it is represented by erosion of the antrum of the stomach, consists of granulation tissue. At the bottom of such a defect, capillaries expand, dystrophy of the gastric glands is observed, and along the edges there is a layering of hyperplastic epithelium.

Depending on the amount of erosion of the walls of the stomach, there may be:

• single (total number -1-3, located in different departments stomach);
• multiple (more than 3 in one department).

According to pathomorphological features, the following types of gastric erosions are distinguished:

• Hemorrhagic. They can be deep and superficial, covered with a bloody coating on top, around they have a pale edematous membrane.
• Flat (surface). Erosions have a clean or white-lined bottom, low edges, hyperemic mucosa around the defect in the form of an edematous rim.
• Hyperplastic inflammatory, or complete erosion. Outwardly, they resemble polyps, are localized at the top of the folds of the stomach, moderately edematous.

Symptoms and signs of erosion

The location of erosions in the stomach is varied, so their clinic often differs in the type and area of ​​localization of pain and other sensations.

Erosion of the antrum leads to discomfort in the center of the abdomen, defects in the body of the stomach - to pain in the left hypochondrium.

The symptom complex of the disease includes hemorrhagic and ulcer-like signs.

Ulcer-like symptoms of erosion appear at any stage of defect development:

• pain after eating;
• sometimes - pain on an "empty stomach";
• frequent heartburn;
• nausea, belching of air.

Hemorrhagic symptoms (occur in 1/5 of patients suffering from gastric erosions):

• dark stools due to bleeding from the defect;
• rarely - vomiting with blood;
• drop in hemoglobin, anemia;
• weakness, poor performance.

As a rule, the acute form of erosive gastritis ends with rapid (5-15 days) epithelialization of erosions. After healing, they do not leave any diagnosable traces on the gastric mucosa.

Hyperplastic erosions often turn into a chronic course and can exist for several years, and then disappear. Some erosions of this type exist for a very long time, recurring as they are affected. annoying factors, often escalating and living.

Consequences and complications for a person

The main danger of erosion- asymptomatic (hidden) bleeding, which gradually "undermine" human health due to a decrease in hemoglobin in the blood and the development of anemia.

Large hemorrhagic erosions can lead to severe bleeding, which is manifested by an acute condition - brown vomiting, diarrhea with blood. Such a deterioration in a person's well-being requires an immediate call to an ambulance!

The risk of erosions turning into malignant tumors is debatable. As the practice of observations shows, malignancy of ulcers or erosions is quite rare; in most cases, the detection of a cancerous tumor of the stomach indicates a primary malignant process. On the contrary, the visualization of long-term non-epithelializing erosive defects, especially in the elderly, is a reason for a thorough examination of the large intestine, pancreas and liver due to the secondary nature of some ulcers, “supplementing” them with the clinic of the underlying disease.

Hyperplastic inflammatory erosions with prolonged development, they can become a trigger for the growth of polyps that require surgical removal. Another unpleasant “property” of erosions is their frequent combination with reflux esophagitis, gastric hernias, atrophic gastritis, and also, with the aggravation of the condition of the mucosa - the transition to an ulcer.

Diagnostics

The main method for detecting erosions, determining their variety and localization, as well as excluding the malignancy of the process is gastrophagoduodenoscopy with targeted biopsy. Often this type of study is preceded by a fecal analysis for occult blood, detection of anemia in general clinical analyzes, while there are no visible deformities or tumors on x-ray examination of the stomach.

In elderly patients, as well as with a long non-healing of benign erosion, an increase in its size, a colonoscopy of the colon, ultrasound or MRI of the abdominal organs is mandatory.

Differential Diagnosis put with a stomach ulcer, cancerous neoplasms, lymphomatosis, hyperplastic polyps of the mucous membrane.

Which doctor should I contact for help?

For pain in the stomach, abdomen, heartburn, belching, you should go for a consultation with a gastroenterologist.

Medical treatment

The therapy of erosive gastritis is similar to the treatment of gastric ulcers, is complex and is aimed at preventing bleeding, the fastest healing of erosion, reducing pain syndrome at the patient. Sample drug treatment program:

• Antacids(almagel, calcium carbonate, magnesium oxide, gaviscon, maalox).
• Enveloping drugs(preparations of aluminum hydroxide, white clay, bismuth, as well as flax seed).
• Preparations for the healing of erosions and histamine blockers (omeprazole, gastrozole, omez, metronidazole, gastrozepine, cimetidine, ranitidine).
• anticholinergic tablets(antiulcer drugs) - atropine, scopolamine.
• Long-term - gastroprotectors (cytotec, gelusil, simaldrate).

In the presence of diagnosed bleeding, the patient is hospitalized, the stomach is washed ice water. Further treatment is carried out in the surgical department. Blood or plasma is administered as needed. Intravenous injections of hemostatic agents (fibrinogen, aminocaproic acid), intramuscular injections of vikasol, dinocin or other hemostatic drugs are performed. After the bleeding stops, drugs are prescribed: kvamatel, pepsidin.

Modern methods of therapy for hemorrhagic and bleeding erosions, as well as hyperplastic erosions with the risk of polyp formation, are their laser coagulation, radio wave cauterization or electrocoagulation.

In severe cases, endoscopic or even abdominal surgery may be needed to remove part of the stomach.

The criteria for recovery are the absence of symptoms of erosive defects, improvement in a person's condition, as well as visualized epithelialization, reduction of edema and hyperemia (with control FGDS every 1-1.5 months).

Therapeutic nutrition and lifestyle

Continuing to smoke and take alcohol, it will be much more difficult to cure erosive gastritis. Healthy lifestyle, good sleep and limiting influence negative emotions is the key to success and quick release from illness.

Proper nutrition, as well as a special diet in the treatment of gastric erosions, occupy a central place. In many cases medications are not as important as following all the recommendations for a gentle cooking and eating regimen.

First of all, the menu excludes:

• all coarse food;
• vegetables with hard, fibrous fiber;
• alcohol, strong tea, coffee, soda;
• black bread;
• citrus fruits, juices from them;
• fatty meat, milk, cheese;
• any fried foods;
• hot spices, smoked food, vinegar.

All other food is allowed to be consumed. Especially useful are vitamin vegetables, fruits, whole grain cereals, dairy products, fish. In no case should you eat hot or icy food, or swallow it without chewing it well. It is advisable to eat at the same time of day, at least 4-5 times daily.

With exacerbation of erosion, only enveloping food is consumed , mashed (boiled, steam) or liquid (soups with slimy cereals, mashed potatoes, steam meatballs, kissels, non-sour fermented baked milk, kefir, etc.).

Alternative treatment

Apart from conservative treatment there are effective folk methods erosion therapy. However, interchangeability traditional means unconventional is not allowed: to avoid complications folk recipes used in parallel with the main treatment:

• Every morning before meals you need to eat 1 spoon of honey. This method helps erosion quickly epithelialize and disappear forever.
• From phytopreparations it is useful to drink infusions of chamomile flowers, calendula, immortelle herbs - individually or mixed as a collection. The rate of preparation - 1 spoon of raw materials - 200 ml. boiling water.
• One of the most effective remedies against stomach erosions is sea buckthorn oil. It is taken within 30 minutes. before meals 1 spoon. It is recommended to buy only natural oil of the first cold pressing, and not an infusion of sea buckthorn berries on other vegetable oils.
• Such a remedy has an enveloping, anti-inflammatory and healing effect: pour boiling water (400 ml.) 2 tablespoons of plantain herb, leave for 30 minutes. Then pour 1 tablespoon of flax seed into the infusion, let stand for another 1 hour. Drink during the day, dividing into several doses.
• Another effective folk remedy is propolis. It perfectly heals erosion, wounds and ulcers on the gastric mucosa. Pharmacy is used for treatment alcohol tincture propolis (10%). Half an hour before breakfast and dinner, you need to drip 30 drops of tincture into a glass of milk, drink. The course of therapy is 21 days.

Prevention

Prevention measures are similar to those for any gastroenterological disease: healthy lifestyle life without smoking and drinking alcohol, proper nutrition, treatment of infectious, inflammatory and any chronic diseases, if possible - reduction pernicious influence stress (self-control, taking special drugs, sedative herbs, relaxation, good sleep).

The most important point of prevention- exclusion of the harmful effects of drugs on the gastrointestinal tract ( simultaneous reception gastroprotectors, selection of sparing drugs).

IN AND. KASYANENKO, Doctor of Medical Sciences, Leading Researcher, Central Research Institute of Gastroenterology, Moscow

Symptomatic erosive ulcerative lesions stomach and duodenum - a fairly common group of diseases, united by a common feature (changes in the mucous membrane in response to various ulcerogenic factors), aggravating the underlying disease, leading to severe complications and requiring the appointment of additional medication.

The term "symptomatic erosive and ulcerative lesions of the stomach and duodenum (SEYAPZhiDK)" means acute or chronic focal destruction of the mucous membrane (SO) of these organs, etiologically and pathogenetically different from peptic ulcer (PU). Symptomatic erosions and ulcers are among the local manifestations pathological condition organism that occurs in severe patients against the background of burns, severe injuries, sepsis, polysystemic organ failure, hemorrhagic shock and other critical conditions.

ESAIDs are described in the literature under various names: erosive or hemorrhagic gastritis, medicinal ulcers, stress ulcers, symptomatic ulcers (SA), stress-related mucosal damage, stress-related mucosal damage, etc. .

The question of in what cases gastroduodenal ulcerative lesions in diseases internal organs should be attributed to SA, remains sufficiently debatable. It must be remembered that the presented conditions can not only cause the formation of acute stress ulcers, but also contribute to the exacerbation of a pre-existing ulcer. The characteristic features of the SEYAPZhiDK are:

Pathogenetic dependence of occurrence on background disease,
atypical clinical picture (erased pain syndrome, lack of seasonality, etc.),
enough fast healing and remission as the underlying disease improves.
For the course of gastric ulcer and duodenal ulcer (DC), in contrast to EIAPzhiDK, it is natural:
an indication in the anamnesis of the presence of gastroduodenal ulcers,
the presence of signs of PU (etiological factors, typical clinical picture, seasonal exacerbation, etc.),
development of the disease regardless of the underlying disease.

Based on the etiopathogenetic mechanisms, the EEAPZHiDK include:

1. AEs that have arisen against the background of chronic diseases of internal organs (digestion, lungs, of cardio-vascular system, kidneys, etc.).
2. Medicinal (when taking non-steroidal anti-inflammatory drugs (NSAIDs), corticosteroids, indole derivatives, histamine, etc.).
3. Endocrine (with hyperparathyroidism, ulcerogenic tumor of the pancreas (Zollinger-Ellison syndrome)) and others.
4. Stress (with myocardial infarction, burn disease, stroke, in the postoperative period, etc.).

SEYAPZhIDK, as well as PUD, can be complicated by bleeding, perforation, penetration.

AE arising against the background of chronic diseases of internal organs

A wide range of chronic diseases can be accompanied by erosive and ulcerative lesions of the gastric mucosa and DC. In gastroenterological practice, AEs detected in patients with chronic diseases liver (more often cirrhosis, less often chronic hepatitis), are called hepatogenic ulcers. The mechanism for the occurrence of these ulcers may be an increase in the content of histamine and gastrin in the blood due to a decrease in the inactivation of these compounds in the liver, a violation of blood flow in the portal system, followed by the occurrence of hypoxia of the gastroduodenal zone, and a disorder of gastric mucus formation. The causes of pancreatogenic ulcers occurring in patients with chronic pancreatitis are a decrease in the active secretion of bicarbonates by the pancreas due to inflammatory changes organ, as well as alcohol abuse, duodenogastric bile reflux, increased release of kinins, etc.

Lesions of the mucosa of the upper gastrointestinal tract, which developed with long-term lung diseases, are associated with prolonged hypoxia leading to a decrease in resistance, disruption of microcirculation, including in the CO of the gastroduodenal zone. ESAPZhIDK with widespread atherosclerosis, especially with lesions of the abdominal aorta, are trophic in nature and are caused by SO ischemia. SA of atherosclerotic origin are close to the so-called. senile gastric ulcers that occur in elderly and senile patients. Hypergastrinemia by reducing the destruction of gastrin in the kidneys, uremic intoxication, as well as the action of drugs (primarily steroid hormones used in large doses after transplant).

Medicinal SEYAPZhIDK

SA developed against the background rheumatoid arthritis, are due, perhaps, not so much to the underlying disease as to the use in its NSAID treatment, contributing, on the one hand, to cause acute ulcers, and on the other hand, to provoke an exacerbation of a pre-existing ulcer.

Among the drugs that cause AEAPZHiDK, one of the first places is occupied by NSAIDs, which are widely used in the treatment of many diseases manifested by inflammatory reactions and pain (arthritis, arthralgia, neuritis, neuralgia, collagenoses, etc.). To prevent thrombosis and thromboembolism in various situations (IHD, thrombophlebitis, etc.), acetylsalicylic acid preparations are widely used. When prescribing glucocorticosteroids, it is necessary to take into account their effect on CO. These drugs have a direct toxic effect on the gastroduodenal mucosa and often gastrointestinal tract, and also inhibit the activity of cyclooxygenase, prostaglandins (PGE2).

Endocrine AEDs

SEIAPZhIDK of endocrine genesis (with an ulcerogenic tumor of the pancreas - Zollinger-Ellison syndrome, hyperparathyroidism, etc.) have a peculiar clinical picture, and the acid-peptic factor plays a decisive role in their formation due to an increase in gastrin production.

Stress ulcers are usually acute, more often superficial and multiple ulcerative lesions of the stomach and DC that occur with certain extreme conditions.

The first description of stress ulcers belongs, apparently, to J. Swan (1823), who discovered ulcers in the gastric mucosa of children who died from common burns (“spots and stripes, like scabs, very deep and completely black”), and connected them origin with skin burn. Later B. Curling (1842) cited 12 cases of gastroduodenal ulcers in patients with extensive burns. Since that time, these ulcerative lesions of the stomach and DC have become known as Curling's ulcers. In 1867, T. Billroth described a new type of stress ulcers that developed acutely after thyroidectomy. He also suggested for the first time the existence of a relationship between sepsis and the subsequent development of gastric ulcers. In 1932, H. Cushing, describing the possibility of ulceration in the stomach in patients with cerebral hemorrhage, thereby discovered a new type of gastroduodenal stress ulcers that occur after traumatic brain injuries, neurosurgical operations, with brain tumors and received the name Cushing's ulcers in the literature .

In addition to the mentioned Curling and Cushing's ulcers, gastroduodenal ulcerative lesions that developed after extensive operations (especially those associated with organ transplantation), severe injuries, multiple injuries, on the background of sepsis and other serious diseases.

Symptomatic, especially stressful, EPUFIDs can be a source of bleeding in 20-60% of all bleedings from upper division gastrointestinal tract. From the 70s. worldwide there is an increase in the frequency of stress ulcers, which is explained by: an increase in severe injuries; the development of operative techniques and anesthesiology, which made it possible to carry out extensive, previously unfeasible operations; improvement of resuscitation and intensive treatment of patients in critical conditions; improved diagnosis of gastroduodenal ulcers as a result of wide application modern endoscopes.

Pathogenetic aspects of development

The main pathogenetic mechanisms for the development of erosive and ulcerative lesions of the mucous membrane is a violation of the interaction of factors of aggression and protection of the mucous membrane of the stomach and DC. Factors of aggression begin to prevail over the factors of protection. Stress, operational benefits provoke the release of stress hormones glucocorticosteroids and catecholamines into the blood. On the one hand, there is a stimulated secretion of hydrochloric acid as a damaging aggressive agent, on the other hand, a decrease in protective factors against the background of CO ischemia due to hypoperfusion, leading to an imbalance of oxidative processes. The activity of gastric mucus production as a protective mechanism also sharply decreases. Moreover, restoration of blood circulation after prolonged hypoperfusion leads to non-occlusive impairment of mesenteric circulation, which further exacerbates SO damage. The microcirculation system is a factor that determines the degree of compensation or decompensation of metabolic processes in SO. The result of ischemia is a decrease in the ability to neutralize hydrogen ions, which induces massive cell death and causes ulceration. .

Research has shown that education blood clot in the cavity of the stomach is more efficient, and its dissolution by proteolytic enzymes slows down under conditions high values pH. In the development of gastroduodenal ulcerative bleeding (GDYAK) is of great importance total time, during which the pH inside the stomach is less than 4; with an increase in this interval, the frequency of such changes decreases. For the prevention of HDYAK and in complex intensive care, there is experience in the use of drugs that are used in the treatment of PU, i.e. antacids, histamine H2-receptor blockers, inhibitors proton pump(IPP).

Prevention and treatment

The main principles of prevention of the development of erosive and ulcerative lesions of SO are:

1) maintenance of gastric Ph > 4 (in this case, the proteolytic activity of gastric juice decreases due to inhibition of the conversion of inactive pepsinogen to active pepsin);
2) normalization of blood supply and CO oxygenation;
3) support for CO protection systems.

Since the main goal of the prevention and therapy of EIFA, regardless of etiology, is to reduce the factors of aggression on the gastric mucosa, the therapy is based on adequate suppression of acid production. The leading place here belongs to drugs that block the production of hydrochloric acid by the parietal cells of the gastric mucosa. This action is inherent in blockers of histamine H2 receptors and PPIs (H + / K + -adenosine triphosphatase - ATPase). However, when choosing drugs, the following points must be considered:

1. Widely used in the 70s. antacids (reduce acidity by chemical interaction with hydrochloric acid in the stomach) do not affect the secretion of hydrochloric acid, they must be taken frequently to achieve optimal pH (almost 1-2 hours) and only inside, due to their consistency, they can cause occlusion of the nasogastric tube, lead to disruption of the water and electrolyte balance, the development of diarrhea, affect the absorption of a significant amount of drugs that are needed in crisis situations (ACE inhibitors, antiepileptic drugs, indirect anticoagulants, NSAIDs, cardiac glycosides, etc.). On the other hand, the oral administration of drugs in a patient in critical condition (artificial ventilation of the lungs, condition after operations on the gastroduodenal zone, paresis of the gastrointestinal tract) is technically very problematic. The release of carbon dioxide during the interaction of hydrochloric acid and carbonates can lead to distension of the stomach and regurgitation of gastric contents into the trachea and bronchi (Mendelssohn's syndrome, aspiration pneumonia).

2. Prior to the active introduction of PPIs into clinical practice, representatives of the group of histamine H2 receptor blockers were the most effective in suppressing acid production. And although it is possible to use drugs intravenously (an advantage over antacids), the tachyphylaxis caused by them (a rapid decrease in the therapeutic effect with repeated use) makes it difficult to maintain a gastric pH above 4. H2-blockers do not inhibit the secretion of hydrochloric acid caused by an increase in vagal tone, which makes them less effective in patients with cerebral disorders, interact with a wide range of drugs (hypnotics, antipsychotics, antiarrhythmics, opioid analgesics, etc.). Often, when they are used, headache, diarrhea, intestinal dyspepsia occur, and since the drugs are excreted by the kidneys, their dose should be adjusted in patients with reduced creatinine clearance.

Most effective drugs to suppress the formation of hydrochloric acid are currently proton pump inhibitors (PPIs). Among all antisecretory PPI drugs that are currently available (omeprazole, rabeprazole, esomeprazole, lansoprazole, pantoprazole), the most effective suppress basal and stimulated production of hydrochloric acid by inhibiting H + / K + -ATPase - the proton pump of the parietal cell.
For the prevention and treatment of EIID and PPIs, PPIs should have the following properties:

Have a spectrum dosage forms(intravenous, oral, or through a nasogastric tube),
increase intragastric pH (above 4) long time,
interact slightly with other drugs,
have a favorable safety profile, allowing use in patients with multiple organ failure.

All PPIs are taken orally, intravenous exist for omeprazole, pantoprazole, esomeprazole, lansoprazole.

According to the study, pantoprazole (Controloc), unlike omeprazole and esomeprazole, does not accumulate in the body after repeated doses. The pharmacokinetics of pantoprazole in serum / plasma is linear and does not depend on the route of administration when using 20, 40 and 80 mg; the pH level in the stomach increases in proportion to the dose of the drug. The linearity of the values ​​of the pharmacokinetics of pantoprazole is maintained even with intravenous administration at a dose of 240 mg. These pharmacokinetic properties differ significantly from those identified with intravenous administration of omeprazole. With an increase in the dose of the latter in the same range, the AUC indicator changes disproportionately, and the half-life increases already after a single dose. intravenous administration. During the first 3 days of treatment with pantoprazole (40 mg), a more rapid onset of action and a more pronounced decrease in gastric acid secretion (up to 46 hours) were noted than with treatment with omeprazole 20 mg (28 hours), esomeprazole (28 hours), as well as stable first dose and when re-appointed.

When conducting a randomized double-blind study, it was proved that in patients with OHD during endoscopic hemostasis (injections of 1:10,000 adrenaline 8–15 mg) with additional administration of the drug Controloc (80 mg intravenously as a bolus, then as a drip infusion of 8 mg/hour) for for 3 days, compared with the introduction of the same dose of omeprazole, the risk of recurrent hysterocytosis is reduced by 3 times, by 4 times the need for surgical intervention, 2 times - mortality and duration of hospitalization .

All PPIs are metabolized in the liver with the participation of cytochrome P450, its isoenzymes - CYP2C19, CYP3A4. The interaction of individual representatives of the PPI group with other drugs differs significantly at the first dose and at repeated appointment.

Compared to other PPIs, pantoprazole weakly inhibits the cytochrome P450 system, which clearly reduces the possibility of its effect on the metabolic elimination of concomitant drugs compared to omeprazole or lansoprazole. In particular, it does not enter into clinically significant interactions with drugs used in intensive care, such as caffeine, metoprolol, theophylline, metronidazole, amoxicillin, clarithromycin, diclofenac, naproxen, diazepam, carbamazepine, digoxin, nifedepine, warfarin, cyclosporine, etc. At the same time, there are restrictions when taking omeprazole.

In patients with severe kidney failure, including patients on hemodialysis (creatinine clearance 0.48-14.7 ml / min), there is no need to reduce the dose of pantoprazole, its daily dose should not exceed 40 mg / day.

In patients with cirrhosis of the liver, the half-life of pantoprazole slightly increases, but dosage adjustment is not required. In severe hepatic impairment, the dose may be reduced to 40 mg once every 2 days. In such patients, it is necessary to monitor the level of liver enzymes. In the elderly, dose adjustment is not required. daily dose Omeprazole (20 mg) should not be exceeded in patients with impaired renal or hepatic function, or in elderly patients.
Pantoprazole (Controloc) is the only PPI that has the characteristic properties that facilitate the management of AES, creating convenience not only for patients, but also for doctors. These properties include fast, effective control of acid secretion (which promotes faster healing and immediate relief of symptoms), ease of use and translation from intravenous treatment on taking pills, good patient tolerance and safety, stability and predictability of the effect, the absence of potential drug interactions and a positive attitude of patients to the chosen treatment strategy.

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Numerous diseases of the gastrointestinal tract are now quite common. As a result of malnutrition, experienced stress and other factors, there are various violations work of the stomach. Erosive and ulcerative gastritis is one of these serious illnesses that are difficult to treat. If possible, it is necessary to identify it as soon as possible in order to avoid even more trouble.

Features of the disease

This disease is a complex variety of gastritis, which is characterized by a severe course and can lead to much more serious consequences. Treatment of the disease, due to its specificity, can take a long period.

With any form of gastritis in humans, there is a violation of the activity of the mucous layer of the stomach. Erosive and peptic ulcer disease is characterized by the fact that the hydrochloric acid contained in digestive enzyme, penetrates into the mucous membrane of the walls of the stomach and corrodes them. This disease is characterized by increased secretion of gastric acid, with an increase in acidity.

A distinctive feature of erosive gastritis is that its acute form develops very quickly, within a few hours. On the epithelial, or surface layer of the walls, multiple lesions (erosion) are formed that can bleed. In the future, ulcers of various sizes appear in their place. If gastritis is not treated, the process progresses and becomes chronic, the treatment of which requires a more serious approach.

With timely and proper treatment, erosive formations pass without consequences. The epithelium is restored, mucosal defects heal without leaving scars.

Symptoms of the disease

Erosive gastritis, unlike other types, has a bright severe symptoms, which can determine the presence of a serious indigestion. If you find yourself with several of the symptoms described, you should immediately contact a specialist.

This disease can occur in two forms: acute and chronic. If the disease occurs for the first time, it takes an acute form and has more pronounced symptoms. Pain in the abdomen is sharp and bright, while they can be of a different nature.

The pains are cramping when they fade and reappear, or there is a constant sharp pain that does not give rest. If the disease is advanced and has become chronic, the pain may not be so pronounced and appear from time to time.

In addition to painful manifestations in the abdomen, an erosive and ulcerative disease may have the following symptoms:

• nausea, heartburn, sour eructation, vomiting with spotting;
• lack of appetite, general weakness body, dizziness;
• discomfort in the abdomen, pain on palpation;
• pain in the stomach occurs at a time when a person is hungry. During the meal, the pain may subside, but after eating it appears again;
• disruption of the intestinal tract: bloating, constipation, diarrhea;
• elevated temperature.

Causes

There are many reasons that can provoke the appearance of erosive-ulcerative gastritis. This may be the wrong way of life, a careless attitude to one's own health, as well as factors beyond the control of a person. Irritation of the mucous layer of the stomach can also cause harmful effects of the environment.

This disease may be due to long-term use medical preparations. In particular, this occurs after undergoing treatment for any infection. Violation of the stomach also occurs due to intoxication of the body, when working with industrial poisons and various chemicals.

Irritation of the mucosa can occur as a result of ingestion poor quality food, spoiled or with the addition of chemicals. This may also lead to malnutrition, constant consumption of fatty, spicy, too hot or cold food.

Often, the cause of erosive disease is alcoholism and constant smoking. In this case, regular poisoning of the body occurs. toxic substances. The development of the disease, in this case, is rather slow. First, the mucous layer of the stomach is irritated, then its microflora is destroyed and harmful elements corrode the inner surface. digestive organ.

Very negative effect on the body strong feelings and stress. Nervous disorders, lasting for a long time, can provoke the appearance of erosive gastritis. Also, the disease can appear due to disturbances in the immune system of the body and against the background of hormonal changes.

The presence in the body of a bacterium called Helicobacter pylori causes inflammation of the gastric mucosa and the development of erosions. This is considered a common cause of many types of gastritis and peptic ulcers.

Types of erosive gastritis

Depending on the duration of the course, the method of occurrence and localization, erosive type gastritis can be divided into several types. They may have various symptoms and complications.

Acute ulcerative gastritis occurs due to abdominal trauma, chemical burns, the beginning of the pathology of the inner part of the stomach, which leads to bleeding. In this case, the person exhibits symptoms such as fever, severe pain in the abdomen, dark-colored vomiting, with blood and mucus.

erosive disease chronic type may occur against the background of an acute form of gastritis. If the erosions bleed, the gastritis is called hemorrhagic. In the chronic course of the disease, a cyclical change in the phases of the disease regularly occurs in the human body. Periodically, the symptoms disappear, after which an exacerbation occurs.

Ulcerative gastritis of the antrum is a common disease in which the Bottom part organ that passes into the duodenum. The cause of this type of gastritis, doctors believe the bacterium Helicobacter.

Erosive reflux gastritis is considered a rather severe form of such diseases. In this case, the duodenum and the mucous layer of the stomach are affected by erosive and ulcerative formations different sizes.

Diagnosis and treatment

Modern diagnostic methods allow you to accurately determine the type of disease and the degree of damage to the gastric mucosa. In order to initial stage to identify the presence of peptic ulcer, the examination of the patient is carried out in several stages.

An analysis of the patient's feces, urine, as well as a general and chemical blood test is performed. According to the results, the acidity index and the presence of infection in the body are determined.

Gastroscopy allows visual inspection inner surface stomach through the use of a special probe. In this case, a flexible hose is inserted through the patient's oral cavity. Epithelial cells of the inner surface of the digestive organ can be taken to detect the presence of bacteria there.

A study using ultrasound radiation is prescribed for the diagnosis of internal organs (liver, kidneys, etc.) in order to exclude concomitant diseases.

Based on the results of the examination, the doctor prescribes medication and diet. Drug treatment is carried out by several types of drugs in order to comprehensively affect the inflammatory process:

• For elimination pain the patient is prescribed analgesic drugs: Analgin, Paracetamol, No-shpa, etc.
• In the event that Helicobacter pylori is present in the body, antibiotics are used. Antibiotics effectively destroy this bacterium and significantly reduce the possibility of new inflammation.
• Enzymes are used to restore the normal functioning of the digestive organs. These can be drugs such as Mezim, Pancreatin, etc.
• At peptic ulcers with high acidity, it is necessary to lower its level and bring the indicator back to normal. For this, Almagel, Maalox, Sanpraz, etc. are prescribed.
• It is recommended to take vitamins and other means that improve the general condition of a person. If necessary, immunomodulators are prescribed.

Diet for erosive gastritis

Diet for diseases of the gastrointestinal tract is an integral part of the treatment. If the patient does not comply with the special diet food, this can lead to exacerbations of erosive and peptic ulcer disease. It is necessary to eat regularly, every 5-6 hours, taking into account the recommendations of the doctor. Make sure the food is normal temperature, not hot and not cold, this can adversely affect the treatment process.

At the time of treatment, it is necessary to abandon junk food, which includes carbonated drinks, any canned food, fried, smoked and spicy foods. It is necessary to reduce salt intake to a minimum and exclude coffee, alcoholic beverages, strong tea from the diet.

It is recommended to eat dishes such as soups, cereals, vegetable and fruit purees. Raw vegetables and fruits are contraindicated, they must be steamed or boiled before use. You can drink green tea, purified non-carbonated water, fruit drinks, compotes.

Folk remedies

Gastrointestinal diseases such as ulcerative gastritis can be treated and folk remedies, as additional measure. Decoctions of medicinal injuries have an anti-inflammatory and restorative effect on the body.

The honey-olive mixture is an excellent restorative remedy. To prepare the medicine, you need to mix a glass of liquid honey and 0.5 liters of fresh olive oil. Add lemon juice from one fruit there. Mix the ingredients well until a homogeneous consistency is obtained. You need to take the composition half an hour before meals, one tablespoon.

Egg white has an enveloping effect and protects the lining of the stomach from damage. Take two fresh chicken eggs, break into a cup and carefully separate the whites from the yolks. Protein should be drunk two hours before meals, in the morning and in the evening.

Plantain tincture has antibacterial properties and accelerates the recovery of the mucosa. Take 200-250g of young leaves of the plant. Rinse well with water and grind. Fill the grass with 0.5 liters of alcohol. Then, let the composition brew for about a day. Take one teaspoon three times daily, before meals.

If there are signs of a serious violation of the gastrointestinal tract, consult a doctor to diagnose the disease. Remember that early detection erosive disease and its treatment will help to avoid serious problems with health.