Protocol for diagnosis and treatment of patients with chronic gastritis in the Republic of Belarus

Chronic gastritis is a chronic inflammatory process of the gastric mucosa, characterized by a violation of its physiological regeneration, a decrease in the number of glandular cells, and, with progression, atrophy of the glandular epithelium with the development of intestinal metaplasia, and subsequently dysplasia. Chronic gastritis is usually caused by the microorganism Hp.

According to ICD-10, chronic gastritis is classified as:

• K29.3 chronic superficial gastritis;
• K29.4 chronic atrophic gastritis;
• K29.5 chronic gastritis, unspecified: chronic antral gastritis; chronic fundic gastritis;
• K29.6 other gastritis: hypertrophic giant gastritis; granulomatous gastritis; Ménétrier's disease;
• K29.7 gastritis, unspecified;
• K29.8 duodenitis;
• K29.9 gastroduodenitis, unspecified.

Clinical criteria for chronic gastritis are:

• B12 deficiency anemia (a manifestation of autoimmune gastritis);
• iron deficiency anemia, resistant to standard oral therapy with iron supplements (may be a manifestation of chronic Helicobacter gastritis, chronic autoimmune gastritis).

Acute gastritis

An acute form of inflammation of the stomach occurs a short period of time after exposure to negative factors on the mucous membrane of the organ.
Severe symptoms, including abdominal pain and indigestion, also occur quickly. Kinds:

• Fibrinous gastritis is an inflammation of the mucous membrane that occurs against the background of acid poisoning or a severe infectious disease.
• Catarrhal gastritis is an inflammation that occurs due to poor nutrition. It manifests itself as damage to the cells of the mucous membrane and migration of leukocytes to the site of inflammation.
• Necrotizing gastritis is a severe form of inflammation that occurs when various chemicals enter the organ. The disease is characterized by destruction of the mucous membrane and deeper tissues of the stomach walls.

With timely treatment, the acute form of the disease is characterized by a favorable prognosis.

Chronic gastritis

The chronic form of the pathology can occur independently or against the background of acute gastritis. Symptoms of the disease are not always pronounced, so inflammation can develop over many years. The most common cause of chronic gastritis is Helicobacter pylori infection.

Types of chronic gastritis:

• Autoimmune. Inflammation of the stomach occurs due to disruption of the body's defense systems.
• Reflux form, which occurs when the contents of the small intestine are constantly refluxed into the stomach.
• Bacterial form. Long-term invasion of Helicobacter pylori leads to dystrophic changes in the inner lining of the organ.

Doctors also distinguish other forms of chronic gastritis, including radiation and eosinophilic. To accurately determine the etiology of the disease, the results of instrumental and laboratory examinations are necessary.

Causes

Gastritis is a polyetiological disease. In 90% of cases, inflammation of the stomach occurs against the background of Helicobacter pylori invasion into the mucous membrane of the organ. The activity of the bacterium leads to the gradual destruction of the protective film of the stomach, as a result of which hydrochloric acid begins to damage the epithelium and other tissues. The bacterium is found in the stomach of almost every second person, but not all people's carriage causes damage to the organ.

Other reasons:

• An acute bacterial infection that occurs when E. coli, staphylococcus or streptococcus penetrate an organ.
• Other types of infectious diseases, including tuberculosis and candidiasis.
• Reflux disease of the gastrointestinal tract, characterized by the reflux of the contents of the duodenum into the stomach. Bile acids and other substances can damage the walls of the organ.
• Poisoning with acids, alkalis, heavy metals, salts and other chemicals that damage the tissues of the gastrointestinal tract.
• Inflammatory and autoimmune processes in other parts of the digestive system, including chronic duodenitis and Crohn's disease.
• Adverse effects of drugs. Damage to the gastric mucosa can occur while taking non-steroidal anti-inflammatory drugs, glycosides, corticosteroids and some antibiotics.
• Bad habits. Alcohol and substances contained in tobacco smoke irritate the mucous membranes of organs.
• An allergic reaction in which the body attacks the lining cells of the stomach.

The factors listed above cause the development of the disease in most cases.

Cause of the disease

Let's try to understand the reasons for CG. Let us divide the causal factors into external (exogenous) and internal (endogenous):

External ones include:

• eating disorder: the majority of the working population sins by eating according to the principle “either empty, then thick”, without having full meals all day, and after a working day - “breaking off completely”, thereby disrupting all digestive processes, including those that are carried out in the stomach. The body “endures” for a certain period of time (depending on the initial safety margin), and then “takes revenge.” HCG is one of the manifestations of this “revenge” for an incorrect attitude to nutrition;
• smoking and alcohol abuse (it has been proven that contact exposure to cigarette smoke can lead to superficial gastritis);
• prolonged neuropsychic overload;
• occupational hazards (metal and cotton dust, vapors of alkalis and acids, etc.);
• Helicobacter pylori. I would like to stop at this point, because... Recently, pharmaceutical companies have been actively using this microorganism to lead to increased sales of certain drugs. But I would like to remind you that Helicobacter pylori belongs to the saprophytic flora, i.e. to opportunistic, which only under certain conditions acquires pathogenicity properties (in combination with erosive and ulcerative lesions of the gastric and duodenal mucosa). And all other things being equal, this microorganism can be found in the gastrointestinal tract of 80-90% of the population and not cause any harm to health.

External factors include:

• chronic infections (oral cavity and nasopharynx, nonspecific and specific diseases of the respiratory system, including gastrointestinal tuberculosis);
• diseases of the endocrine system (autoimmune thyroiditis with hypothyroidism, thyroid disease with hyperthyroidism, Itsenko-Cushing's disease, type 1 diabetes mellitus);
• diseases associated with metabolic disorders (obesity, gout, etc.)
• diseases leading to tissue hypoxia (heart failure, respiratory failure), i.e. the so-called ischemic mechanism of damage to the gastric mucosa;
• autointoxication (uremia, etc.);
• food allergies, etc.

Risk factors

In addition to the above reasons for the formation of gastritis, it is worth paying attention to the risk factors for the disease. These are conditions associated with lifestyle, heredity and the patient’s individual history.

Main risk factors:

• Poor nutrition. Excessive consumption of fatty, spicy or salty foods increases the risk of developing gastritis. In addition, carbonated drinks, crackers, chips and other types of fast food are harmful to the gastrointestinal tract.
• Prolonged stress. A psychological state can affect the organ by affecting the secretion of gastric juice. With chronic stress, acid is constantly released in the stomach.
• Elderly age. The pathology is most often diagnosed in men and women over 60 years of age.
• Diseases that negatively affect the immune system. First of all, these are HIV infection and congenital immunodeficiencies.
• Unfavorable heredity. Predisposition to the disease can be transmitted to the patient from parents.

Taking risk factors into account allows for effective preventive measures.

Symptoms

Manifestations of the disease depend on the form of inflammation. Symptoms of acute gastritis occur suddenly against the background of exposure to negative factors on the stomach. Patients complain of pain in the upper abdomen, nausea and vomiting. Pain is also characterized by chronic gastritis with increased secretory activity of the organ, since with this disease an excess amount of hydrochloric acid is formed. Inflammation with a decrease in the secretory activity of the stomach most often manifests itself as mild symptoms.

Additional symptoms:

• pain in the chest and neck area (heartburn);
• constant belching;
• loss of appetite;
• frequent urge to defecate;
• decreased performance;
• insomnia;
• bloody vomiting;
• black stool (melena);
• white coating on the tongue;
• bloating;
• worsening mood.

If any of the above symptoms appear, you must make an appointment with a gastroenterologist.

Chronic gastritis with normal and increased secretory function of the stomach

Description

Chronic gastritis with normal and increased secretory function of the stomach is Gastritis, usually superficial or with damage to the gastric glands without atrophy, which occurs more often at a young age, mainly in men. Symptoms Characterized by pain, often ulcer-like, heartburn, sour belching, a feeling of heaviness in the epigastric region after eating, and sometimes constipation. Gastric secretion: basal up to 10 mmol/h, stimulated (after maximum histamine stimulation) - up to 35 mmol/h. Often there is abundant gastric secretion at night. Differential diagnosis Gastritis with preserved and increased gastric secretion, antral gastritis, often manifested by pain, should be differentiated from peptic ulcer; with gastritis, there is no seasonality of exacerbation; at the height of exacerbation, ulceration of the gastric mucosa is not detected. Treatment Nutritional therapy is of key importance. In case of chronic gastritis with normal and increased secretion, during the period of exacerbation, diet N 1a is prescribed, after 7–10 days they move to table N 16, after the next 7–10 days - to diet N 1. During the period of exacerbation, the diet should be complete, limited only table salt, carbohydrates and extractives, especially with increased acidity of gastric juice.

Complications

Without treatment, acute or chronic gastritis can cause a variety of complications. Some negative consequences of the pathology can threaten the patient's life.

Possible complications of gastritis:

• Ulcerative lesions of the stomach and small intestine.
• Gastrointestinal bleeding. Symptoms of this complication include pale skin, weakness, sweating, dizziness and low blood pressure.
• Perforation of the organ wall with the risk of extensive inflammation.
• Megaloblastic anemia, manifested by weakness, constant fatigue and dizziness.
• Malignant neoplasm of the stomach.

Dangerous negative consequences of acute inflammation can occur within several days.

Diagnostics

In most cases, detecting gastritis is not difficult. To undergo a comprehensive examination, you must make an appointment with a gastroenterologist. The doctor will ask the patient about complaints and examine medical history. A general examination sometimes reveals external manifestations of the disease. The diagnosis is made after analyzing the results of instrumental and laboratory examinations. If acute abdominal pain occurs due to a gastrointestinal disorder, a doctor can be called to your home.

Examination methods used:

• Esophagogastroduodenoscopy is a standard examination method for suspected gastritis or gastric ulcer. The doctor asks the patient to lie on his side and open his mouth wide. The root of the tongue is treated with lidocaine, after which a flexible tube equipped with a camera and a light source is inserted into the gastrointestinal tract. During the examination, the doctor can examine the condition of the mucous membrane of the stomach and intestines by looking at the monitor. This is the most informative type of diagnosis.
• A biopsy of the gastric mucosa is the collection of a small number of organ cells for subsequent histological examination and determination of the cause of the disease. A painless biopsy is usually performed during an esophagogastroduodenoscopy.
• X-ray of the organ. A contrast agent is first injected into the stomach. The resulting image helps to detect indirect signs of inflammation.
• Study of the acid-base state of the stomach contents (pH-metry). This study helps determine the type of gastritis and evaluate the effectiveness of therapeutic treatment of the disease.
• Breath test to detect bacterial gastritis. Using a special device, the concentration of carbon in exhaled air is assessed. An excess of this substance indicates Helicobacter pylori infection.

If necessary, your doctor may need additional tests, including blood tests and an ultrasound examination of the digestive system. The use of several diagnostic methods allows a specialist to prescribe more effective and safe treatment.

Chronic gastritis with secretory insufficiency

This form of gastritis occurs more often in old age. Usually, patients simultaneously experience a pathological process in other digestive organs, which has a significant impact on the general condition.

The method of suction biopsy of the gastric mucosa allows us to trace the development of gastritis, which goes from a superficial chronic process with damage to the glands without atrophy to an atrophic process.

Secretory function in superficial gastritis with damage to the glands without atrophy can remain normal due to increased function of the main glands. With atrophic gastritis, secretory insufficiency is usually determined.

There is a correlation between disturbances in the secretory activity of the stomach and pathohistological changes, but complete parallelism is not observed. With atrophic gastritis, the activity of gastric juice in relation to plasma proteins decreases. Globulins are almost not digested by gastric juice at all, and the digestion of albumins is impaired. The amount of gastromucoprotein is reduced in approximately half of the cases, which indicates better preservation of the functional activity of accessory cells compared to the main and parietal cells.

Clinical symptomatology consists of signs of damage to the gastric mucosa, its secretory insufficiency, as well as disorders of motor-evacuation and excretory functions. Some patients complain of decreased appetite, but more often it is preserved. Others note an unpleasant taste in the mouth, increased salivation, belching of air or food, sometimes with a rotten egg smell, which indicates a disturbance in the intestines. Belching is apparently associated with the occurrence of putrefactive processes in the upper intestine and the penetration of rotting products into the stomach. Often these patients complain of a feeling of heaviness and pressure in the abdomen after eating, bloating, rumbling in the abdomen and nausea. With exacerbation of gastritis, vomiting often occurs. Heaviness and pressure in the epigastric region are explained by a decrease in muscle tone and an increased reaction of the pathologically sensitive interoceptive apparatus of the stomach. Intense pain in the upper abdomen is rare. Typically, pain is caused by the spread of the pathological process to the small intestine or bile ducts. Intestinal damage is observed in almost half of patients. In the presence of hypoglycemia, patients report pain. Sharp pain of a constant nature in the epigastric region indicates ganglionitis, which can accompany chronic gastritis. Chronic gastritis with secretory insufficiency is characterized by a combination of the listed symptoms, their occurrence soon after eating, dependence on the physical properties of food (temperature, grinding), and not on its chemical composition.

Chronic gastritis with secretory insufficiency is a progressive process, the pace of development and manifestations of which are different. If the atrophic process is localized predominantly in the fundus, pernicious anemia may develop.

Disorders of the liver and biliary tract occur in approximately 20% of patients. These disorders can occur reflexively, as well as due to the influence of bacteria and their metabolic products entering the portal vein system, or through the bile ducts due to a violation of the integrity of the sphincter of Oddi. Damage to the pancreas is observed in 10-15% of patients.

The absorption of food in patients with gastritis with secretory insufficiency can proceed normally or with minor deviations. The often observed weight loss is usually explained by long-term use of a “gentle” diet with excessive restrictions.

Many patients complain of weakness, lethargy, emotional instability, poor sleep, neuromuscular pain, neuralgia and paresthesia. These patients are irritable, self-centered, and often withdraw into themselves, withdrawing into a circle of painful symptoms and experiences. Among mental disorders, cancer phobia occupies a special place.

The severity of the disease is not always determined by the acidity of gastric juice. A mild course can occur in individuals with histamine-refractory achylia and, conversely, a severe course in patients with a subacid state. Often, during a quiet course of the disease, the morphological condition of the gastric mucosa progressively worsens. In 30-40% of patients, the disease proceeds without dyspepsia or pain. The asymptomatic course is explained by compensation from other digestive organs and restructuring of the secretory and motor functions of the small intestine.

Against the background of gastritis with secretory insufficiency, rigid gastritis can develop, occurring with deformation of the antrum of the stomach, thickening of the affected part of its mucous membrane, sclerotic compaction of the wall of the antrum, the outlet part of which turns into a narrow tube-like canal. The clinical picture of rigid gastritis is characterized by polymorphism: severe pain, lack of appetite, belching, a feeling of heaviness in the epigastric region and nausea, and sometimes progressive weight loss. Vomiting is rare.

Due to the anacid state, the development of polypous gastritis is also possible (in 8-10% of patients), which is considered to be a precancerous disease. However, chronic gastritis itself with secretory deficiency is not a precancerous condition. Even with a long course of the disease, stomach cancer develops only in a small proportion of patients.

Treatment. In the treatment of patients with gastritis with secretory insufficiency, nutritional therapy aims to improve the compensatory mechanisms of other digestive organs, normalize the motor-evacuation activity of the gastrointestinal tract and increase the enzymatic activity of the pancreas.

Therapeutic nutrition in these cases is based on three principles: 1) mechanical sparing of the gastric mucosa, 2) stimulation of its glandular apparatus with chemical food irritants, and 3) suppression of the inflammatory process in the mucous membrane. The idea of ​​inflammatory damage to the mucous membrane and the possibility of restoring its secretory function formed the basis of diet No. 2, developed in 1923 at the Clinical Nutrition Clinic. However, clinical observations have shown that many patients suffering from anacid or subacid gastritis are reluctant to eat pureed food. With damage to the liver and bile ducts, patients also do not tolerate this diet well, as it is rich in extractive substances. Its administration is also inappropriate for patients with symptoms of atherosclerosis and hypertension. A significant group of such patients suffers from constipation, and prescribing them mechanically gentle diets aggravates this condition. Observations carried out at the Medical Nutrition Clinic showed that the majority of those examined had a total or subtotal irreversible atrophic process of the glandular apparatus of the stomach. Consequently, measures aimed at restoring secretory function are not justified. In some patients, there were no signs of inflammation in the gastric mucosa. Thus, in all cases of chronic gastritis with secretory insufficiency, it is not advisable to prescribe mechanically gentle diets aimed at eliminating the inflammatory process.

Diet No. 2 should be prescribed in cases where secretory insufficiency is caused by an inflammatory state of the gastric mucosa or suppression of secretory function is caused by reflex influences from other organs.

Sometimes patients with chronic gastritis with secretory insufficiency do not tolerate milk well, which causes flatulence, diarrhea and belching. In such cases, you should not immediately cancel it. Milk is a highly valuable product, and human adaptation capabilities are great. If you start drinking milk with tea and gradually increase its amount, your body can adapt to milk. It should not be prescribed only during exacerbation of enterocolitis. Milk satisfies the body's need for proteins, fats, calcium, riboflavin and vitamin A. The milk regime has a dehydrating effect and helps reduce inflammatory reactions. If you are intolerant to milk, it is useful to give it along with cocoa or coffee, and for diarrhea, it is recommended to add 1-2 tablespoons of lime water to a glass of milk.

Most patients with chronic gastritis with secretory insufficiency tolerate diet No. 1 (see below), which includes dairy products in their natural form and all dishes are prepared without mechanical sparing. Flatulence observed at first usually goes away after 7-10 days. Satisfactory tolerance of the diet and digestibility of nutrients is confirmed by the absence of creato- and steatorrhea and sufficient weight gain. Diarrhea, often observed in these patients, usually stops with intestinal-loading diets (No. 1 and No. 15, see p. 131). All this indicates the advisability of expanding the diet for patients with gastritis with secretory insufficiency. The exception is patients with an active inflammatory process in the gastric mucosa, accompanied by dyspeptic symptoms, the presence of inflammatory elements in the gastric contents, pain and spread of the pathological process to the intestines.

The presented data made it possible to recommend the construction of differentiated therapeutic nutrition for patients with gastritis with secretory insufficiency, depending on the characteristics of the course (Table 37).
Table 37. Therapeutic nutrition for gastritis with secretory insufficiency

For patients with gastritis with secretory insufficiency, in whom an inflammatory state of the gastric mucosa is established or the secretory function is suppressed as a result of reflex effects from other organs, diet No. 2 is recommended, from which fatty lamb, pork, goose and duck, spices, fruits, and herbs are excluded. smoked foods, and if intolerant - whole milk.

Special purpose

. Help normalize the motor function of the stomach and intestines, stimulate gastric secretion and help reduce fermentation processes.

Indications for diet No. 2

. Chronic gastritis with secretory insufficiency, mostly secondary.

general characteristics

. The diet is physiologically complete, coarse plant fiber, spicy foods, raw vegetables and fruits are limited, and in case of intolerance, whole milk is excluded.

Cooking

. Food is prepared mainly in pureed or crushed form. When frying, the formation of a rough crust is not allowed.

Calorie content and diet composition

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Proteins 120-130 g, fats 100-110 g, carbohydrates 300-350 g, calories 3200, vitamins: C - 100 mg, B1 - 4 mg, riboflavin - 4 mg, A - 2 mg, nicotinic acid 30 mg; calcium 0.8 g, magnesium 0.5 g, phosphorus 1.6 g, iron 15 g. Table 38. Sample menu for one day (diet No. 2, 3320 kcal)

The total amount of free liquid is 1.5 liters. Number of meals 5 times a day.

A sample menu is shown in table.
38, and recommended dishes are in table. 39. Table 39. List of recommended dishes for diet No. 2

As can be seen from table. 39, diet No. 2 includes foods that strongly stimulate gastric secretion, but does not contain coarse fiber, connective tissue, fatty and stringy meat and therefore is mechanically gentle. In this kind of patients, the peptic function of the stomach is absent or reduced, and the digestion of connective tissue of animal and plant origin is impaired. Therefore, food must be well boiled, which reduces mechanical irritation and increases contact with the gastric mucosa, which increases the intensity of enzymatic digestion. In order to relieve the digestive organs, frequent and split meals are used (4-5 times a day).

In case of severe inflammatory condition of the stomach, an anti-inflammatory diet is recommended, prescribed for 2-3 days (Table 40). This diet is based on the principle of sharply restricting sodium chloride and carbohydrates in food, which promotes dehydration of the body and reduces the tendency to an inflammatory reaction. A decrease in sodium causes the phenomenon of transmineralization in the body and leads to the fixation of potassium salts in the tissues. It is useful to limit the caloric content of the diet mainly due to fats and carbohydrates.

Chemical composition of the diet: proteins 100 g, fats 60 g, carbohydrates 300 g, calories 2270. Amount of liquid 1450 ml.

Diet No. 15

Patients with gastric hypotension, combined with general trophic disorders and decreased nutrition, are prescribed a complete fractional diet - diet No. 15, reducing the single amount of food and increasing the amount of protein in the daily diet to 140-150 g, and the total calorie content of the diet to 3000-3200.

Indications for diet No. 15

. The diet is prescribed as a transition to a balanced diet during the period of convalescence and as a test for the digestibility and tolerance of food in certain gastrointestinal diseases, in particular in chronic gastritis with secretory insufficiency.

Special purpose

. Provide nutrition to the patient in a medical facility when a special therapeutic diet is not required. Check the functional capacity of the gastrointestinal tract in terms of digestibility and tolerance of food.

general characteristics

.
A physiologically complete diet for a person who does not engage in physical labor, with a normal quantitative ratio of proteins, fats, carbohydrates, salts, but with double the normal content of vitamins and the exclusion of difficult-to-digest fatty foods (goose, duck, fatty pork, beef and lamb, beef, pork and lamb lard). Coarse plant fiber is excluded. Culinary processing is varied. Table 40. Sample menu for one day of an anti-inflammatory diet for exacerbation of chronic gastritis (2600 kcal)

Calorie content and diet composition

.
Protein 120-130 g, including animal 65 g, fat 100 g (animal 65-70 g), carbohydrates 400-450 g (including sugar 100 g), table salt 10-12 g, calories 3000-3200, vitamins : A - 2 mg, C - 100 mg, B1 - 4 mg, B2 - 4 mg, PP - 30 mg, calcium 0.8 g, phosphorus 1.6 g, magnesium 0.5 mg, iron 15 mg. The weight of the diet is about 3 kg. The total amount of free liquid is 1.5 liters. The number of meals is 4-5 times a day (Table 41). Table 41. Sample diet menu No. 15 (3900 kcal)

(Notes: For patients with a height of more than 175 cm without excess weight and with a height of 165-170 cm, but with a reduced nutritional status, and for patients who were engaged in physical labor and physical education before entering a medical institution, the calorie content of the diet increases by 15% with a corresponding uniform increase in content in the diet of proteins, fats and carbohydrates. For patients with a height of 150 cm and below with normal weight, as well as for patients who are overly well-fed or with a tendency towards obesity, the diet indicators are correspondingly reduced by 10%.

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It is useful to use yeast and dry hematogen in diet No. 15 as additional sources of protein.

In the treatment of patients with chronic gastritis with secretory insufficiency, vitamins play a special role.

Vitamins influence the motor and secretory functions of the stomach, the course of metabolic processes, tissue metabolism and the general condition of the body. The dosage of vitamins should exceed the physiological need by approximately 2 times. The use of B vitamins is of particular importance. Vitamin B6 is prescribed mainly due to its stimulating effect on the acid-forming function of the stomach and its regulatory effect on the nervous system. Vitamin B12 is prescribed to patients who have undergone gastrectomy, as well as to prevent pernicious anemia.

The use of nicotinic acid (vitamin PP) is based on its stimulating effect on the glandular apparatus of the stomach. Given the vasodilating effect of nicotinic acid, it is best to administer it after meals. Nicotinic acid preparations can be used subcutaneously, intramuscularly and intravenously.

If you are prone to diarrhea, vitamin C is best administered intravenously. When taken orally, it is recommended to dilute ascorbic acid in lemon juice to increase its resorption.

For patients with chronic gastritis with secretory deficiency, the use of vitamin A is especially indicated, since it has the ability to influence the state of epithelial tissue and its physiological function, and increases the function of the mucous membranes as a protective barrier. Vitamin A is prescribed orally in tablets (1-2 mg) or in the form of an oil solution (100,000-200,000 IU).

Patients with chronic gastritis with secretory insufficiency often have to be prescribed natural gastric juice or pepsin in tablets of 0.5 g 3-4 times a day together with gray.

The use of abomin containing a sum of enzyme preparations is also indicated. Abomin is taken orally with meals, 1 tablet 3 times a day (course of treatment up to 2 months).

Chronic gastritis, complicated by intestinal damage, in some cases does not respond to the therapy used. A common cause of treatment-tolerant intestinal disorders is parasitic infestation, for which specific drug therapy is effective. Persistent diarrhea may be a consequence of infectious colitis. In these cases, the use of sulfonamide drugs, especially in combination with antibiotics, gives a good effect.

The diet of such patients should meet the principles of sparing the intestinal mucosa (diet No. 4, p. 194) and contain an increased amount of protein (140-150 g) while limiting carbohydrates.

In some cases, the use of hydrochloric acid and gastric juice is recommended. It is better to combine hydrochloric acid with pepsin. Hydrochloric acid does not replace gastric juice, but is a physiological regulator of the pyloric function and the causative agent of pancreatic secretion. As a result of its use, the evacuation of food from the stomach and digestion in the intestines can be normalized. Taking hydrochloric acid is recommended together with pancreatin.

Patients whose chronic gastritis is combined with damage to the liver and biliary tract are treated on the background of diet No. 5 (see page 256). Foods rich in extractive substances, fried foods are excluded from the diet, foods rich in cholesterol, fatty meats, lard, etc. are limited; Diet No. 5 contains a normal amount of protein, carbohydrates and is rich in lipotropic factors. If the liver is enlarged, an anti-inflammatory diet and fasting days (sugar, compote, etc.) are indicated.

(The rice-compote day is carried out as follows: the patient is given a glass of sweet compote 6 times a day, 2 times with sweet rice porridge boiled in water. In total, the patient receives 1-2 kg per day. fresh or 240 g dried fruit, 50 g rice, 120 g sugar (1.5 l compote). When prescribing a sugar day, give a glass of hot tea with 30-40 g of sugar every 3 hours (5 times a day).

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Along with therapeutic nutrition, medications are also used: insulin, glucose, liver drugs, lipocaine and pancreatin. Duodenal intubation in combination with injections of penicillin and streptomycin gives a good effect in inflammatory changes in the gallbladder and biliary tract.

Patients with chronic gastritis complicated by hypochromic anemia are prescribed iron supplements and hydrochloric acid. The use of iron ascorbate or reduced iron is indicated; if reduced iron is poorly tolerated, carbon dioxide or lactic acid ferrous iron is prescribed. Iron supplements are prescribed 3-4 times a day after meals along with hydrochloric or ascorbic acid. Parenteral administration of iron preparations (fercoven) is most effective. Hemostimulin, folic acid and vitamin B12 are prescribed.

For the treatment of patients with chronic gastritis with hyperchromic anemia, the liver or its drugs - antianemin, kamiolon - are used. The use of vitamin B12 has a particularly good effect. It is necessary to ensure sufficient levels of animal proteins, vitamins and mineral salts in the diet. Increased amounts of thiamine, riboflavin, pyridoxine, ascorbic and folic acids, and vitamin A are introduced.

The main task of treating patients with gastritis with secretory insufficiency is to establish compensatory mechanisms by improving the functioning of the unaffected digestive organs and reducing the inflammatory process in the gastric mucosa. The duration of the therapeutic effect depends on the patient’s discipline, adherence to nutrition and diet. Patients require nutritional therapy even after treatment. The diet should be gradually expanded, bringing it closer to a rational common table. Often the compensation is so good that patients can easily tolerate general nutrition. The therapeutic effect in patients with gastritis with secretory insufficiency after hospital treatment remains very stable: after 5 years, almost 60% of patients remain in good health; after 10 years, approximately 40% of patients cannot detect clinical signs of the disease.

When tested after 5-20 years, gastric secretion returned to normal in only 3% of cases. This confirms that even a significant improvement in the health of such patients is not due to the restoration of the secretory function of the stomach, but to the phenomena of adaptation and compensation of the organs of the digestive system.

Treatment

The treatment regimen is selected by the doctor after determining the factor that caused the inflammatory process and clarifying the form of the disease. You can read more about modern methods of treating gastritis in the article:. Without fail, along with drug therapy, the patient is prescribed a therapeutic diet. Strict cessation of smoking, alcoholic beverages, certain medications and junk food is required. The recommended diet for gastritis also depends on the form of inflammation.

Prescribed medications:

• Antibiotics necessary to eliminate Helicobacter pylori infection. It is possible to prescribe several antibiotics simultaneously along with proton pump inhibitors and bismuth-based drugs. Other types of stomach infections are treated with anti-inflammatory or antifungal medications.
• Protective drugs that protect the gastric mucosa from adverse effects. Enveloping agents help prevent acid from attacking the walls of the organ. Doctors usually prescribe acid-neutralizing antacids to patients. These drugs cannot be used on an ongoing basis, so the course must be limited.
• Medicines that affect the secretory function of the organ. First of all, these are proton pump inhibitors and H2-histamine receptor blockers, which are required for excess gastric acidity. These medications normalize the condition of the organ within 24 hours. Pepsin supplementation is required when gastric secretory activity is insufficient.

Additional medications used for other forms of gastritis include corticosteroids, sorbents and antidotes. In severe cases, the patient may require infusion therapy and surgical treatment. It is important to remember that the main method of preventing the disease is a healthy diet.

Chronic gastritis with secretory insufficiency

Description

Chronic gastritis with secretory insufficiency is Gastritis, characterized by atrophic changes in the gastric mucosa and its secretory insufficiency, expressed to varying degrees. It develops mainly in mature and elderly people. Symptoms Gastric and intestinal dyspepsia are noted (unpleasant taste in the mouth, loss of appetite, nausea, especially in the morning, belching of air, rumbling and transfusion in the abdomen, constipation or diarrhea); with a long course - weight loss, hypoproteinemia, symptoms of polyhypovitaminosis, mild hypocortisolism, insufficiency of other endocrine glands (general weakness, impotence, etc.), normochromic or iron deficiency anemia. Concomitant enteritis often occurs; intestinal dysbiosis, pancreatitis, cholecystitis leave their mark on the clinical picture of the disease. Treatment is carried out on an outpatient basis; in case of exacerbations, hospitalization is advisable. Medical nutrition is of key importance. During the period of exacerbation of the disease, meals should be divided, 5 - 6 times a day (diet N 2). During the period of exacerbation, the diet should be complete, only table salt, carbohydrates and extractive substances are limited. In chronic gastritis with secretory insufficiency and pain, ganglion-blocking drugs are prescribed (quateron, gangleron, which, while causing a pronounced antispasmodic effect, have relatively little effect on the secretory function of the stomach), as well as plantain juice, plantaglucide, which cause a slight increase in secretion, enhance the motor function of the stomach and have anti-inflammatory and antispasmodic effect. Astringent and enveloping agents are indicated. In order to influence the secretory function of the stomach, vitamins PP, C, B6 are prescribed. Outside of exacerbation, when there are signs of decompensation of gastritis (flatulence, Achilles diarrhea), replacement therapy with gastric juice, abomin, betacid, pancreatin, etc. is used. For the treatment of chronic gastritis with secretory insufficiency, in the development of which autoimmune processes play a significant role, in some cases the prescription of glucocorticosteroid hormones is justified . Physical methods of treatment: heating pads, mud therapy, diathermy, electro- and hydrotherapy, etc.