What diseases are there associated with the gastrointestinal tract?

Diseases of the digestive system: esophagitis, gastritis, peptic ulcer of the stomach and duodenum, duodenitis, enteritis, colitis, digestive disorders and others

The human digestive system performs various functions - processing food, extracting useful substances from it, ensuring their absorption into the bloodstream. Interruptions in the functioning of even one of the digestive organs can cause serious problems for the entire system. The causes of such disorders are modern ecology, new products and medications, stress, untimely nutrition, bad habits, and hereditary factors.

Digestive diseases affect people of all ages. Among the most common pathologies are esophagitis, gastritis, peptic ulcer of the stomach and duodenum, duodenitis, enteritis, colitis.

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Esophagitis

Esophagitis

– damage to the mucous membrane of the esophagus, which can cause serious complications such as peptic ulcers, stenosis, Barrett’s disease. The main symptoms of esophagitis are impaired swallowing reflex, heartburn, and chest pain. Diagnosis of the disease includes x-rays of the organ, endoscopic biopsy, and laboratory blood tests. Treatment is prescribed strictly individually, taking into account the etiology of esophagitis and consists of drug therapy and a special diet. In severe cases, surgical intervention is possible.

Gastritis

Gastritis

– one of the most common diseases occurring in acute or chronic form in adults and children. These are inflammations of the gastric mucosa of different origins, which are characterized by pain in the epigastric region, heartburn, nausea, dyspepsia, bad taste and bad breath. An important condition for the treatment of gastritis is maintaining proper nutrition and diet, as well as taking medications and traditional medicine - infusions of chamomile, mint and other herbs. Patients are strictly prohibited from drinking alcohol!

Peptic ulcer of the stomach and duodenum

Stomach ulcer

and
duodenum
- a chronic disease, which is characterized by the appearance of pathological foci on the mucous membrane of the organs. The causes of its occurrence are considered to be infection of the stomach and duodenum by bacteria, as well as irregular nutrition, stress, prolonged use of medications, hypersecretion of gastric juice, and smoking. The main symptoms of the disease are frequent pain in the upper abdomen, especially on an “empty” stomach. Peptic ulcers of the stomach and duodenum are dangerous due to their complications - internal bleeding, perforation of the intestinal walls with penetration of its contents into the abdominal cavity and the development of peritonitis, as well as stenosis (intestinal obstruction). Treatment is carried out under the supervision of a gastroenterologist. Self-medication is prohibited! To suppress infection, antibacterial drugs are used, as well as antacids and gastroprotective agents. Throughout the course, you should adhere to a diet, stop smoking and drinking alcoholic beverages.

Diseases of the gastrointestinal tract (GIT)

Diseases of the gastrointestinal tract (GIT): how to recognize the enemy in time?

Digestion involves a dozen organs that break down food, absorb nutrients and remove excess waste from the body. This is a “full cycle” system - from the absorption of food products and their processing to the removal of undigested residues. It is extremely important that each of its elements works smoothly and does not fail.

How does the human gastrointestinal tract work?

The digestion process is somewhat reminiscent of going down a slide in a water park. The beginning of the journey is the oral cavity , where food is chewed, crushed, mixed with saliva and turned into a soft food bolus.

This is interesting

The mucous membrane of the oral cavity has receptors that help recognize the taste, temperature and consistency of food. These sensors transmit signals to the brain, which activates the salivary, fundic and pancreatic glands.

Next comes the pharynx , a funnel-shaped canal in which the digestive and respiratory tracts intersect.

The journey of food continues in the esophagus - a cylindrical muscular tube 22–25 cm long. The upper and lower esophageal sphincters at the ends serve as valves that prevent food from returning back into the oral cavity.

The stomach is a pouch-shaped muscular organ that connects the esophagus to the duodenum (duodenum). It is like a cauldron in which food is accumulated, mixed into a paste and digested by gastric juices. Stomach juice consists of enzymes and hydrochloric acid, due to which it has pronounced acidity (about 1.5–2.0 pH). Gastric juice breaks down proteins and other chemical compounds, after which they are transported to the small intestine for final digestion and absorption.

The length of the small intestine , consisting of the duodenum, jejunum and ileum and occupying most of the abdominal cavity, is about 4.5 m. The small intestine contains glands that produce intestinal juice for the main digestion of food and absorption of nutrients into the blood.

The large intestine is the lower part of the intestine where water, electrolytes, fiber are absorbed and unusable food residues are formed into feces. The large intestine is 1.5 m long and is divided into the cecum, colon and rectum. The rectum, the final section of the digestive tract, ends in an opening (anus). Serves for the accumulation of feces and bowel movements. This is where the “unprecedented journey” ends - processed food remains leave the body.

Digestion also involves the pancreas, kidneys, adrenal glands, gallbladder and liver.

The pancreas is located in close proximity to the stomach and duodenum. It secretes pancreatic juice, which promotes complete digestion of food and metabolic processes.

The liver takes part in the metabolism of lipids, vitamins, proteins and carbohydrates, synthesizes blood proteins: globulins, albumins and fibrinogen. The organ participates in immunological reactions.

The function of the gallbladder is to store and supply, as needed, concentrated bile, which is constantly produced by liver cells. Bile is directly involved in human digestion and acts as a kind of antibacterial agent.

It is worth mentioning the role of the kidneys and adrenal glands , which belong to the urinary system, in digestion. They process the water coming from the colon, filtering it into what is suitable for the body's needs and into urine, which contains unnecessary impurities and must be excreted.

At each stage of the passage of food through the gastrointestinal tract, failures are possible, leading to incomplete absorption of food, problems with the removal of waste material and threatening the development of gastrointestinal pathologies.

Among the causes of problems with the digestive system, the leading one is poor nutrition, which comes in various forms. This is overeating and eating heavy food, malnutrition and starvation, irregular meals, quick snacks, scarcity and unbalanced diet. The gastrointestinal tract is negatively affected by poorly purified water and harmful food additives.

Other factors: poor environment, stress, harmful working conditions, addictions, congenital predisposition, autoimmune diseases and disruptions in the endocrine system, side effects of drugs (antibiotics, anti-inflammatory, painkillers, hormonal drugs), violation of sanitary standards when preparing and eating food, which can cause infectious diseases and parasites.

Failures in the digestive system negatively affect the entire body, reduce immunity, disrupt metabolism, and lead to deterioration in the appearance of the skin, brittle hair and nails. They are fraught with numbness of the limbs, pain in muscles and bones, and sleep disturbances.

Possible complications for the cardiovascular system: hypertension, arrhythmia, angina pectoris, risk of stroke and heart attack. Against the background of gastrointestinal diseases, anular stomatitis, glossitis, bleeding gums, eczema, and neurodermatitis can develop. In advanced forms of gastrointestinal diseases, damage to the pituitary gland, adrenal glands, gonads, and thyroid gland is possible.

Gastrointestinal diseases: what the statistics say

Diseases of the gastrointestinal tract are among the most common pathologies in the world.

Medical statistics Mortality from gastroenterological causes in Russia ranks third after cardiovascular diseases and cancer and is about 0.08% (80 cases per 100,000 people). An average increase of 0.003% in deaths is recorded annually.

Men are 38% more likely to become victims of gastrointestinal diseases, which is associated with both uncontrolled alcohol consumption and late seeking medical help.

Among deadly gastroenterological diseases, over 45% are liver diseases caused by alcohol. Twice as many men die as women (16:7 ratio). Acute pancreatitis and other diseases of the pancreas are the cause of death in 17% of gastroenterologist patients. Death from peritonitis due to gallbladder rupture is less than 1%.

Lethal intestinal diseases are caused by advanced forms of inflammation and perforations (violation of integrity, formation of holes) in the walls of the small and large intestines. In particular, appendicitis (inflammation of the cecum) is responsible for up to 4% of all deaths associated with the gastrointestinal tract. The same amount is due to infarction (necrosis, necrosis) of the intestine.

Despite its widespread prevalence, gastric and duodenal ulcers are the cause of death in no more than 10% of the gastrointestinal group.

Chronic gastritis . It affects up to 80–90% of patients in the world, which is facilitated by the pathogenic bacterium Helicobacter pylori, which causes inflammation of the gastric mucosa. In developing countries, Helicobacter infection in people over 40 years of age reaches 95%.

In Russia, the presence of Helicobacter pylori in the stomach is noted, according to various sources, in 62–94% of adult patients.

The consequence of gastritis - a stomach ulcer is found in every 15th inhabitant of the Earth. In our country, the statistics are more optimistic - only 1 in 40 Russians is sick. Men get ulcers 2–4 times more often than women.

The prevalence of gastroesophageal reflux disease (GERD) reaches 50% among the adult population. Symptoms of the disease occur equally often in both men and women.

Duodenitis is a common disease of the duodenum, affecting 5–10% of patients. In men, it is diagnosed twice as often due to alcohol abuse and poor lifestyle choices.

Colitis , is also relatively common . The cause of the disease is pathogenic microbes (streptococci, staphylococci, E. coli).

Appendicitis (inflammation of the cecum) occurs in 30% of Russians.

Every tenth man and every fourth woman who complains of abdominal pain is diagnosed with chronic cholecystitis (cholelithiasis).

Dysbiosis is common among children and adults - an imbalance of intestinal microflora, leading to disruption of the digestive system.

Symptoms of the most common gastrointestinal diseases

Typical signs of gastrointestinal pathologies: heartburn (burning sensation from the reflux of stomach contents into the esophagus), flatulence and intestinal stenosis (bloating caused by the accumulation of gases in the intestines), belching (gases escaping from the stomach or esophagus), nausea and vomiting, problems with stool (constipation or diarrhea), bad breath, plaque on the tongue.

Less common: dysphagia (impaired swallowing, accompanied by pain and a feeling of stopping the food bolus), impurities in the stool (blood, mucus, undigested food residues), swelling of the tongue, bitterness in the mouth, itchy skin and other allergic reactions. Diseases of a common pathogenesis have both general and specific symptoms.

Stomach diseases

Pain in the epigastric region and dyspeptic syndrome (sour belching, heartburn, vomiting and nausea) may indicate a number of diseases of the stomach, esophagus and DCP.

With a peptic ulcer , which is a wound in the wall of the duodenum or stomach, there are sharp periodic pains in the left hypochondrium, weakness, diarrhea, vomiting, and bloody impurities in the stool.

Inflammatory processes of the stomach ( gastritis ) and duodenum ( duodenitis ) manifest themselves in a similar way. The diseases are accompanied by acute, aching or nagging pain in the upper abdomen, nausea, vomiting, and problems with bowel movements. Patients experience a feeling of a full stomach and heaviness in the abdomen, even with little food consumption.

A hiatal hernia also causes pain in the epigastric region when changing positions and after eating. It is also possible to experience back pain and girdling pain. 20% of patients (mostly over 60 years of age) experience pain in the heart area due to concomitant cardiac diseases.

The intestines often suffer from inflammatory processes and infectious lesions. Inflammation of the large and small intestines ( enteritis and colitis ) is accompanied by stool upset (up to 15 times a day). During defecation and immediately after it, the patient experiences severe weakness, dizziness, nausea, and a drop in blood pressure. There is bloating, cold sweat, trembling of the limbs, tachycardia, as well as loud rumbling, splashing noise and pain on palpation.

Signs of paraproctitis, or abscess (purulent inflammation) of the rectum are severe pain in the rectum or perineum. As the abscess increases in size, the pain intensifies, the urge to defecate becomes painful, the temperature rises, and chills are possible.

Dysbacteriosis is manifested by abnormal stool, bloating, cramping pain, dyspeptic disorders and allergic reactions (itching and skin rashes).

Hemorrhoids (varicose veins of the rectum) are characterized by bleeding or smearing with blood after defecation, prolapse of hemorrhoids through the anus and pain during bowel movements, which continues for some time (when walking, sitting and lying down).

The symptoms of appendicitis are determined by the patient’s age, the location of the appendix in the abdominal cavity, and the presence of complications. Characterized by a dull pain in the right side, weakness and headache, which may be accompanied by pain in the legs, nausea combined with single vomiting, frequent loose stools, temperature within 38 degrees.

One should not lose sight of one of the most common and yet mysterious pathologies - irritable bowel syndrome (IBS) , accompanied by abdominal cramps, stool problems, and painful bloating. IBS has a negative impact on the entire body: the patient complains of headache, insomnia, increased fatigue, and rapid heartbeat even at complete rest. According to most experts, IBS is of a psychosomatic nature and appears as a result of stress and severe emotional overload. However, to get rid of the problem, it is important not only to achieve peace of mind, but also to apply comprehensive drug treatment. One solution may be to take bismuth preparations, which simultaneously have a bactericidal, anti-inflammatory and protective effect.

Liver diseases

Acute hepatitis C (inflammatory viral damage to the liver) is marked by a whole range of symptoms. Among them: weakness, decreased appetite and performance, sleep disturbance, aversion to food, a feeling of heaviness in the abdomen, pain in large joints, the appearance of a rash, increased body temperature, darkening of urine, yellowing of the skin (hence the popular name for the disease - jaundice).

The first signs of liver cirrhosis are: a feeling of fullness in the abdomen, decreased performance, pain in the right hypochondrium, a feeling of fullness in the stomach, bleeding gums and nosebleeds, fever, flatulence, nausea, vomiting.

Diseases of the gallbladder and biliary tract

Signs of cholecystitis (inflamed gallbladder) are acute pain in the right hypochondrium, bloating, attacks of nausea and vomiting. The pain intensifies with a deep breath while palpating the gallbladder area. Many patients report a slight increase in temperature.

Pancreatic diseases

Patients with pancreatitis often complain of acute abdominal pain, which is accompanied by nausea and vomiting with gastric juice, mucus, bile, etc. There is also bloating, dry mouth, and belching. Blue spots often appear on the left side and in the navel area.

Most common and life-threatening diseases of the gastrointestinal tract are caused by inflammatory processes against the background of a bacterial or viral infection. Digestion is a single interconnected system and diseases of its organs can sequentially develop according to the domino principle. The source of an avalanche of problems is often in the stomach, which we put to the test of strength every day. Therefore, in the treatment of gastrointestinal pathologies, an integrated approach using gastroprotective (protective) and antiseptic gastrointestinal drugs is effective.

Duodenitis

Duodenitis

– inflammation of the mucous membrane of the duodenum, affecting its upper and/or lower sections. The main symptoms are general weakness, pain in the stomach, heartburn, nausea, belching. If you follow a gentle diet, acute manifestations usually end after a few days. The chronic form of duodenitis is characterized by frequent relapses. With untimely medical care and proper treatment, complications such as intestinal bleeding, perforation of the intestinal wall, and pancreatitis may occur.

Precautions for stomach upset

Gastrointestinal discomfort may be the first manifestation of a serious organic disease.

There are a number of so-called “alarming symptoms” in which you should not buy pills for intestinal upset, but rather consult a doctor without delay to rule out tumor diseases.

"Warning signs" include1:

1. constant abdominal discomfort;
2. rapidly progressing dyspepsia (development within 6 months);
3. pain when swallowing, a feeling of difficulty passing food through the pharynx and esophagus;
4. frequent vomiting, especially with blood in the vomit;
5. weight loss due to normal diet and lifestyle.

Doctors are especially wary of the appearance of these symptoms in people over 45 years of age and with a family history of cancer1. In such cases, urgent endoscopic examination is mandatory1.

Attention! Symptoms of dyspepsia, such as epigastric pain, may be the first manifestation of myocardial infarction1 and acute intestinal circulatory disorders - diseases requiring emergency medical attention1. In these cases, the question “how to treat stomach and intestinal upset” should not arise at all.

The need for emergency medical care is indicated by the following signs:

• sudden symptoms of dyspepsia that are not related to food and are accompanied by shortness of breath, sweating, and increased heart rate;
• if symptoms of dyspepsia occur every time during physical activity and go away at rest;
• when the symptoms of dyspepsia appear acutely, accompanied by severe abdominal pain.

Enteritis

Enteritis

– a set of inflammatory processes that occur in the small intestine and are accompanied by disruption of its function. The main symptoms are upset stool, bloating, pain in the navel, general weakness, pale skin. The causes of the disease are intestinal infections, poisoning with toxic substances, overeating spicy or fatty foods, and a tendency to allergies. Enteritis may be a consequence of other diseases of the gastrointestinal tract. The diagnosis is made on the basis of bacteriological examination of stool, biochemical blood test, and X-ray examination of the intestines. Acute enteritis is treated in a hospital. The patient is prescribed bed rest, dietary nutrition, enzyme preparations, as well as decoctions of chamomile, mint, and blueberries.

Diagnostics

Survey. Often, stomach diseases are chronic, develop gradually, and begin with minor symptoms. The patient is subjected to detailed questioning; first of all, the doctor seeks to find out what the patient’s diet is. Thus, the survey allows not only to correctly establish a diagnosis, but also to identify the cause of stomach disease.

Inspection and feeling (palpation). During examination, the doctor may note a protrusion of the epigastric region due to excessive filling of the stomach or significant swelling. The main physical method of examining the stomach is palpation. Percussion and auscultation, as a rule, do not have diagnostic value in this case, due to the fact that the stomach and intestines usually produce the same tympanic sound.

Study of the secretory function of the stomach. In diseases of the stomach, there are cases of changes in its secretory function. There is increased secretion (acidity), normal, decreased, lack of acidity or absolute absence of gastric juice.

X-ray examination. X-ray scanning of the stomach (as well as the intestines and esophagus) with an X-ray machine allows one to obtain a large amount of information. The patient takes a contrast mass (barium salts), it fills the stomach, allowing you to determine its shape and evaluate peristalsis.

Colitis

Colitis

– pathological changes in the mucous membrane of the colon due to infectious, toxic, drug damage. The main symptoms are severe pain, diarrhea, constipation, flatulence. To make a correct diagnosis and prescribe medications, stool examinations for the presence of helminths and protozoa, colonoscopy, biopsy, and laboratory blood tests are performed. Treatment is prescribed taking into account the results obtained and includes taking antibacterial drugs, enzymes, probiotics, as well as herbal medicine and dietary nutrition.

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GUT INFECTIONS

ACUTE DIARRHEA

Etiology and pathogenesis

The following physiological mechanisms for the development of diarrhea are known:

• increased secretion of electrolytes by the intestinal epithelium, causing massive fluid loss;
• decreased absorption of electrolytes and nutrients from the intestinal lumen, which develops as a result of damage to the brush border of the epithelium of the large or small intestine;
• increased osmolarity of intestinal contents due to deficiency of saccharolytic enzymes and lactose intolerance;
• disturbance of intestinal motility.

The first two mechanisms of diarrhea are based on infection. The etiological agents of diarrhea can be bacteria, viruses and protozoa. The etiology, pathogenesis and clinical and laboratory picture of diarrhea are largely interconnected, which makes it possible with a significant degree of probability to justify empirical therapy before identifying the etiology by microbiological methods. Based on clinical and laboratory data, several forms of intestinal infections are distinguished (Table 2).

Table 2. Clinical and laboratory characteristics and etiology of intestinal infections

"Waty" diarrhea

.

Direct cause of diarrhea caused by V.cholerae

, enterotoxigenic and enteropathogenic
E.coli
, as well as some salmonella, are the production of enterotoxins by microorganisms that cause the release of electrolytes and fluid into the intestinal lumen. The listed microorganisms are capable of adhesion to the intestinal epithelium, proliferation and toxin formation in the intestine, but invasion and cytotoxic effects on the intestinal epithelium are not typical for them.

B.cereus, C.perfringens

and
S.aureus
cause diarrhea as a result of the production of toxins of varying properties. Toxin formation occurs during the proliferation of microorganisms in contaminated foods, while the proliferation of microorganisms in the intestines is not significant.

Viruses and G.lamblia

affect the proximal parts of the small intestine without causing significant local inflammation.

"Bloody" diarrhea (dysentery-like syndrome)

.

The causative agents of diarrhea, accompanied by damage to the mucous membrane of the large and distal small intestine, are Shigella

spp.
enteroinvasive E.coli, V.parahaemolyticus
and some salmonella (usually
S.enteritidis
). The cause of the development of pathological changes in the intestine is the production of cytotoxic Shiga toxin and similar toxins, as well as the ability of microorganisms to invade epithelial cells.

E.coli deserve special mention

(serotype O157:H7, less often than other serotypes), producing a toxin similar to Shiga toxin and causing, in addition to hemorrhagic colitis, hemolytic-uremic syndrome.

Intestinal lesions caused by Y. enterocolitica

and
C.jejuni
are associated mainly with the invasive properties of these microorganisms.

C.difficile

causes diseases of varying severity from relatively mild antibiotic-associated diarrhea to life-threatening pseudomembranous colitis. Pseudomembranous colitis is caused by strains of the microorganism that produce cytotoxins.

Of the protozoa, the most common causative agent of diarrhea with severe signs of inflammation is E. histolytica

(amebic dysentery).

Systemic manifestations of intestinal infections

. Intestinal pathogens, whose main virulence factor is invasiveness, are able to penetrate the intestinal lymphoid tissue and proliferate in these loci. In some cases, microorganisms leave the lymphoid tissue and develop bacteremia with a corresponding clinical picture. As a rare complication, the formation of extraintestinal foci of infection of various locations is possible.

The ability to generalize to the greatest extent is characteristic of Salmonella of the typhoparatyphoid group.

"Traveler's Diarrhea"

.

“Traveler's diarrhea” refers to three or more cases of loose stool per day when changing place of permanent residence. Travelers' diarrhea can be caused by all known intestinal pathogens, depending on their prevalence in specific geographic regions. For example, people who have visited Russia often describe mild watery diarrhea caused by C. parvum.

Choice of antimicrobials

The feasibility of antimicrobial therapy and its nature completely depend on the etiology of diarrhea and, accordingly, on the characteristics of the diarrheal syndrome. An initial examination of the patient and a visual examination of feces (assessment of the presence of blood and mucus) make it possible with a significant degree of probability to judge the possible etiology of diarrhea before obtaining the results of a bacteriological examination. Simple microscopy of feces stained with methylene blue (magnification x 400) can provide important additional information to assess the presence of leukocytes.

For “watery” diarrhea caused by bacteria that produce enterotoxins, as well as viruses and protozoa, antibacterial therapy is not indicated. In this case, the basis of treatment is pathogenetic therapy aimed at maintaining water and electrolyte balance (oral or parenteral rehydration). AMPs are indicated only for cholera in order to shorten the period of bacterial excretion and prevent the spread of the pathogen in the environment.

Diarrhea with pronounced signs of inflammation (the presence of blood, pus, mucus and leukocytes in the feces), accompanied by fever, is most likely caused by pathogens (Table 2), for which the administration of etiotropic drugs can provide a clinical and bacteriological effect. In vitro activity

and have proven clinical effectiveness in dysentery-like syndrome: fluoroquinolones; co-trimoxazole; ampicillin; tetracyclines; nalidixic acid.

However, on the territory of Russia, among the main pathogens of acute diarrhea, primarily Shigella

spp.,
Salmonella
spp., enteroinvasive
E. coli
, there is a high incidence of acquired resistance to co-trimoxazole, ampicillin and tetracyclines. It is also necessary to keep in mind that salmonella can cause both “watery” diarrhea and diarrhea with severe signs of inflammation, as well as generalized processes. The drugs of choice for the treatment of diarrhea of ​​known etiology are given in Table. 3.

Table 3. Drugs of choice for the treatment of diarrhea of ​​known etiology

In areas with a high incidence of Campylobacter

spp., combination empirical therapy with co-trimoxazole and erythromycin is recommended (40 mg/kg/day every 6 hours for 5 days).

Based on data on the effectiveness of antimicrobial agents for acute diarrhea caused by various pathogens, it is possible to substantiate the indications and regimens for empirical therapy. In adults, fluoroquinolones are the drugs of choice; in children, despite the spread of resistance, it is advisable to use co-trimoxazole. Indications for empirical treatment of acute diarrhea and antimicrobial regimens are summarized in Table. 4.

Where can you get examined, prevented and treated for diseases of the digestive system in Moscow?

In a multidisciplinary medical center you can always undergo examination, prevention and treatment of diseases of the digestive system

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Literature

1. E. A. Lyalyukova, V. N. Drozdov. “Unspecified dyspepsia”: differential diagnosis, tactics for patient management at the outpatient stage. Attending doctor. No. 8, 2021.
2. E. I. Vovk. Functional and organic dyspepsia: “crossover” of diagnostic and treatment strategies in general practice. Attending physician. No. 9, 2012.
3. Instructions for use of the drug IMODIUM® Express
4. Register of medicines in Russia. Active ingredients. Loperamide. https://www.rlsnet.ru/mnn_index_id_637.htm.
5. A study by Ameri et al. "A multicenter, double-blind study: a comparison of the effectiveness of loperamide in acute diarrhea with two popular antidiarrheal agents and placebo," 1975.