Violation of the secretory function of the stomach. Achlorhydria: the role of hydrochloric acid in the stomach, how to treat its absence

In all classifications of nosological forms adopted by WHO, functional diseases of the stomach (including digestive tract) are missing. Symptoms and treatment of functional gastric diseases are included as nonspecific manifestations in vegetative (neurovegetative) dystonia, which, in turn, reflects polymorphic disorders central regulation of visceral functions, which are universal for any psychosomatic pathology. These changes determine functional diseases of the stomach in general and the stomach in particular. As is known, vegetative dystonia syndrome is characteristic of any neurosis. The digestive system is one of the most reactogenic systems in relation to exogenous influences, which has been repeatedly proven by the work of the school of I. P. Pavlov, who studied functional diseases of the stomach.

Types of functional diseases of the stomach

Even in ancient times, a close relationship was established between gastrointestinal and depressive-hypochondriacal disorders. Functional diseases of the stomach: dyskinesia and secretory disorders of the hollow organs of the abdominal cavity, including the stomach, painful sensations in the abdomen that are not amenable to conventional therapeutic interventions, persistent anorexia with progressive emaciation, up to cachexia, turns out to be a unique way of expressing emotions, a natural consequence of hypochondriacal syndrome , the object of Koluporu becomes digestive system(masked or larved depression).

A clear dependence of violations of the latter on emotional state individual determines the great variability of clinical manifestations of functional diseases of the stomach.

From the point of view of an internist, functional diseases of the stomach occupy an intermediate position between health and disease; they are borderline conditions, pre-diseases.

A. P. Peleshchuk et al. (1985) classify functional diseases of the stomach as follows:

Types of functional diseases of the stomach by type of origin

Primary functional diseases of the stomach:

psycho-emotional disorders (neurotic and neurosis-like);
based on mental illness(schizophrenia, manic-depressive syndrome, etc.);
due to damage to the central and peripheral nervous system (encephalitis, solaritis, etc.):
reflex disorders (visceral-visceral reflexes):
functional diseases of the stomach also occur due to disorders of the endocrine system and humoral regulation:
due to metabolic disorders (hypovitaminosis, enzyme pathies, drug effects);
for allergic reactions.

Secondary functional diseases of the stomach (with organic diseases of the digestive system).

Types of functional diseases of the stomach according to the principle of localization of the disease

According to the predominant localization and clinical manifestations, functional diseases of the stomach are distinguished:

disorders of the esophagus and stomach (dysphagia, achalasia, irritable stomach syndrome, etc.);

bowel disorders (irritable bowel syndrome);

violations by biliary tract, pancreas, liver.

Symptoms of functional gastric diseases

In foreign literature, functional diseases of the stomach are often called “non-ulcer (functional) dyspepsia” - a collective concept that unites various symptoms, related to the upper parts of the digestive tract. The diagnosis of functional diseases of the stomach is rare in everyday practice and is most often established by the method of consistent exclusion of organic pathology.

Important Features Any functional sensations are characterized by their unusual brightness, often bizarre descriptions, and a sharp subconscious hyperbolization of complaints. This feature is fully manifested in functional diseases of the stomach. Some authors point to peculiar symptoms of functional stomach diseases:

heartburn,
aerophagia,
belching,
flatulence,
rumbling in patients with non-ulcer dyspepsia.

There are 2 types of functional diseases of the stomach: dyspeptic syndrome, some of whom have delayed gastric emptying (functional stasis), and with ulcer-like clinical picture.

Mostly in young people (especially girls), psychogenic nausea and vomiting is by no means a rare phenomenon. A painful sensation of nausea (or slight nausea) is most often localized in the upper part chest, "at the throat"; it is especially painful in the morning, on an empty stomach, and intensifies with excitement or sudden changes in meteorological conditions.

Emotive (often habitual) vomiting also often occurs in the morning or during meals, sometimes immediately after the first sips, is not related to the nature of the food, and does not bring relief. Patients with functional diseases of the stomach, characterized by psychogenic nausea and vomiting in functional diseases of the stomach, often have a fairly pronounced, albeit short-term, depressive reaction with a hint of acute rejection of reality.

Many functional diseases of the stomach have a psychosomatic origin such as neurovegetative dystonia or masked depression. At the same time, we cannot exclude the dependence of some forms functional disorders(for example, irritable stomach syndrome) from shifts in the hormonal regulation of secretion and motility of this organ.

Treatment of functional gastric diseases

The emerging therapeutic tasks mainly boil down to the following:

impact on changes in the neuropsychic sphere;

alignment of secretory and motor disorders of the stomach.

Modern psychotherapeutic treatment of functional diseases of the stomach is difficult to carry out, and its presentation is beyond the scope of this book. Relevant information can be found in the monograph by V. D. Topolyansky and M. V. Strukovskaya “ Psychosomatic disorders"(M., Medicine, 1986).

Treatment of functional diseases of the stomach with psychotropic drugs

Although the treatment of functional diseases of the stomach is the prerogative of psychoneurologists, the therapist and gastroenterologist need to be sufficiently familiar with the method of using psychotropic drugs. Initially, they are usually prescribed in small doses, which, in accordance with the effect, are gradually increased. In this case, the criterion is to achieve favorable changes in the neuropsychic status, without developing weakness, lethargy, and drowsiness, indicating excessive dosage.

The duration of treatment for functional diseases of the stomach is determined by the clinical dynamics of the disease, averaging about 6 weeks. In this case, you should not abruptly stop treatment, but gradually reduce the dosage over 1.5-2 weeks. If during the process of its reduction there is a deterioration, then they switch to maintenance treatment of functional diseases of the stomach. At the same time, it is necessary to remember about the possibility of developing psychological drug dependence. To avoid this, it may be advisable to change the psychotropic agent used to another with a different chemical structure.

Regarding the use of individual psychotropic agents and their selection from an extensive list of representatives, we note the following.

For irritable weakness syndrome, they most often resort to benzodiazepine derivatives (Chlozepid, Sibazon, Nozepam, Mezapam). They are prescribed from /2 to 2 tablets 2-3 times a day, and in case of poor sleep - at night. In more severe cases use thiazine derivatives (Etaperazine, Melleril or Sonapax, Frenolon) in small or medium doses.

Treatment of functional diseases of the stomach is carried out with antidepressants. (Amitriptyline, Melipramine, Petilil, Gerfonal, Azafen, Pyrazidol) are used when fear, anxiety, melancholy, or insufficiently motivated fears predominate in the picture of the disease. Initially, small doses are prescribed (2 tablets of Amitriptyline after dinner), followed by an increase in the number of doses and daily dosage, up to providing healing effect, usually up to 3 tablets per day.

Treatment of functional gastric diseases with antacids and myotropic agents

Another direction in therapy is pharmacological interventions in its impaired functions. They are carried out depending on the nature of secretory and motor disorders. For hyperchlorhydria, especially when combined with gastric restlessness, along with antacids, both non-selective and selective anticholinergic drugs and myotropic agents are used.

From ready-made dosage forms functional diseases of the stomach with gastric hypersecretion are treated with belladonna alkaloids. This includes Bellasthesin, Bellalgin, Becarbon, as well as a solution Atropine and containing in pure form this alkaloid tablet "Kellathrina." Bellalgin is taken after meals, and all others - 20-30 minutes before it, 3 times, take them increased sensitivity, requiring caution in dosage.

Other anticholinergics (Platifillin, Legations) inferior to atropine in antisecretory activity, but better tolerated and have an antispasmodic effect. Platiphylline and Metacin are prescribed orally in a dose of 0.004-0.005 g. The first of them is part of such ready-made forms, like “Tepafillin”, “Palufin”.

Since hyperchlorhydria and gastric hyperkinesia are often combined, and anticholinergics and myotropic antispasmodics complement each other, when treating functional diseases of the stomach, a combination of these drugs is advisable. The complex preparations we offer meet this goal. "Belpap" And "Belmet" which are convenient especially in outpatient practice. Here is the copybook "Belpapa":

Rp.:Extr. Belladonnae

Phenobarbitali aa 0.015 Papaverini hydrochloridi 0.08-0.1 Natrii hydrocarbonatis Magnesii oxydi Bismuthi subnitratis aa 0.25 M. 1.puiv. S. 1 powder 3-4 times a day

"Belmet" has the following writing:

Rp.: Methacini 0.005

Extr. Belladonnae 0.01

Phenobarbitali 0.015

Sodium hydrocarbonatis

Magnesii oxydi_

Basmuthi subnitratis aa 0.25

S. 1 powder 3-4 times a day

In case of severe hyperchlorhydria (occurring, for example, in irritable stomach syndrome), treatment of functional diseases of the stomach is carried out by prescribing Cimetidine(0.4 g after breakfast and at night) or Gastrocepin(0.05 g per z hour before breakfast and dinner). It is quite justified to combine the first of them with non-selective anticholinergics, and the second with myotropic antispasmodics.

Treatment of functional diseases of the stomach with stimulants of gastric secretion

As for stimulants of gastric secretion, drugs in this group are endowed with only very hypothetical activity. The above applies to propolis, bitters, plantaglucide, the ability of which to enhance gastric secretion is more declared than strictly proven. More effective in this regard may be psychotropic drugs, eliminating centrogenic torpor of the gastric glands.

Functional diseases of the stomach can occur with a weakening of its motility and a change in its propulsive direction, which leads to disruption of the evacuation activity of the organ and gastroesophageal reflux. In such pathological situations, it is justified to prescribe Tserukala(0.01 g 3 times a day 2 hours before meals and at night). Abroad for a similar purpose functional gastric diseases are treated with the drug Domperidone, which is accepted according to the same scheme.

Unfortunately, mainly due to central side effects, Cerucal is not tolerated by approximately 15% of patients. They are deprived of another dopamine antagonist - Domperidone, which does not penetrate the blood-brain barrier and has only a peripheral effect. In terms of its main pharmacological effect, it is close to Cerucal, surpassing it in its ability to stimulate propulsive peristalsis of the esophageal-gastro-duodenal section. However, if it is used to treat functional diseases of the stomach, this drug can cause side effects: itchy skin, sweating.

In conclusion, we note that functional diseases of the stomach are a source of not only subjective painful sensations. Especially those forms that are characterized by hyperchlorhydria can act as a precursor to duodenal or prepyloric ulcers, which gives them additional clinical significance. Accordingly, rational pharmacotherapy of irritable stomach syndrome and related forms can be regarded as meeting the task of primary prevention of peptic ulcer disease.

Not many people know how to eat properly. While eating, our thoughts are busy with how to get back to business or work as quickly as possible. All this can soon lead to problems with the gastrointestinal tract. Just indigestion is one of the possible problems. When indigestion occurs, intestinal functions are disrupted, discomfort, heartburn appears, and weight loss occurs.

Symptoms

We roughly understand what indigestion is; the symptoms of this disease can be completely unrelated directly to food or physical activity, and appear unexpectedly:

periodic stomach discomfort or even pain;
feeling full almost immediately after eating;
heartburn;
belching;
infrequent nausea;
bloating.

Discomfort with indigestion can be completely different; an unpleasant feeling of heaviness, fullness, heat, and bloating appears in the stomach. Often, indigestion occurs against the background of other diseases.

Symptoms can be quite for a long time do not make themselves felt, and only over time, when other diseases appear against the background of indigestion, digestive disorders begin to manifest themselves openly.

Causes

All these digestive problems appear due to:

eating in a hurry;
frequent overeating;
taking any certain foods that may have a negative effect on correct work intestines;
drinking certain types of drinks. Drinks containing a lot of sugar are associated with bloating. Alcohol and caffeine actively increase acidity and can severely irritate inflamed areas of internal organs;
sports and any other physical activity a short time after finishing breakfast or lunch;
stress;
long-term use of anti-inflammatory drugs or antibiotics.

In about 5% of patients, indigestion is directly related to other diseases, such as peptic ulcers.

What should you remember to reduce your risk of indigestion?

If you have just played sports or some other physical activity, then it is better to start eating at least half an hour later.

Also avoid strenuous activity for about an hour after eating. The way you eat food is very important: it needs to be chewed slowly and thoroughly. If we eat quickly, then the food is digested worse, because digestive juices do not have time to be released in the required quantity. It is better to put off sweets or fruits for an hour or two if you have eaten something fatty before.

You need to be careful when drinking drinks, add less sugar to tea, eliminate coffee and alcohol completely or drink it extremely rarely.
At frequent stress Before meals, it is useful to drink an infusion of parsley, a decoction of peppermint and chamomile helps, an infusion of burdock and dandelion is excellent.

And after eating, you can chew cardamom or cumin seeds, all this improves metabolism and affects the proper functioning of the gastrointestinal tract. If you still feel signs of indigestion after eating, chamomile tea will help.

To normalize digestion, season your food with rosemary, parsley or dill; they help secrete digestive juice, which, in turn, is responsible for the quality of food digestion.

During treatment, the diet will change radically, some doctors advise switching to separate meals, portions should be small but frequent, about 6 times a day, food taken must be warm, not hot or cold.

Any stress negatively affects the functioning of the intestines, since the hormones released during this redistribute the blood flow: more blood flows to the muscles, less to the vessels. After a stressful situation, while eating, a person swallows large volumes of air, and this causes bloating. Smoking before meals is bad for digestive processes. Give up this bad habit.

It is important not to forget when starting treatment that indigestion is necessarily associated with other diseases. All processes in the body are interconnected, and when treating one ailment, it is necessary to treat another.

First aid for indigestion

If indigestion occurs with bloating and abnormal gas formation, then you can take a drug suitable for this case, for example Espumisan. It will work quickly, but the effect will not last long.

There is an old, good method that our great-grandmothers used - coal. It has been taken for all kinds of disorders and diarrhea, but we need to remember that charcoal will only work properly in cases of acute indigestion. If it is mild or the symptoms began quite recently, then a solution of potassium permanganate, warm tea, jelly or cold water will help.

You can try a light massage in the abdominal area, and then put on a warm heating pad. Another interesting method- foot massage: left foot massage right hand, then do the same with the right leg, then switch to massage between the second and third toes right leg closer to the foot. Oddly enough, these points affect the proper functioning of the intestines and alleviate the condition.

No matter how quickly the treatment helps, it is still necessary to consult a doctor, since symptoms of indigestion can also be symptoms of other diseases.

Causes, symptoms and treatment of gastric stenosis

Gastric stenosis is a complication of peptic ulcer disease, in which the normal lumen in the pyloric area narrows, which connects the stomach and intestines. Because of this, food simply cannot move normally through the digestive tract, which causes a whole host of side painful syndromes of the gastrointestinal tract, ranging from gastritis to relapse of ulcers (due to the prolonged presence of food in the stomach cavity). This often leads to a total disruption of hemostasis.

Symptoms

The symptoms of stenosis are quite vague and are described by a dozen painful sensations and discomfort in the stomach area. To simplify the diagnosis, doctors divided the symptoms into 3 stages, which differ in the degree of narrowing of the lumen for the passage of food.

Stage 1 - slight narrowing. The patient mostly complains of frequent belching, acidic taste in the mouth. Even after eating a small amount of food, he feels full in his stomach.
Stage 2 - medium narrowing. The patient feels constant stomach fullness. After eating, he vomits, after which the discomfort decreases. Often all this is accompanied by painful sensations, as during ordinary gastritis.
Stage 3 - severe narrowing. The disease progresses rapidly, and inducing vomiting does not help improve the patient’s well-being. Vomit has a strong stench because it contains food that has remained in the stomach for many days. Severe dehydration and weight loss are diagnosed.

Stenosis of the pylorus of the stomach can lead to hypertrophy of the organ, its stretching, and the appearance of esophageal hernias with compression of the diaphragm. The tissue around the pylorus becomes inflamed, pathogenic microflora develops there, which can provoke a recurrent ulcer.

There is also such a thing as congenital gastric stenosis, which develops specifically in newborns. Statistics indicate that pathology is much more common in boys than in girls. Accompanied by very rapid weight loss, vomiting, constant worry baby, lack of stool and urination. Extremely dangerous disease. If not installed in a timely manner accurate diagnosis, then the probability fatal outcome will be extremely high.

In the most severe cases stenosis leads to bleeding in the stomach, disruption of the outflow of bile and liver function. If food does not enter the intestines within a few days after eating it, the natural process of rotting begins, releasing large amounts of gas. It is because of this that a distinct and sharp “aroma” of acetone, one of the decomposition products, is felt from the patient’s mouth.

Causes

There are two main causes of pyloric stenosis:

a previous stomach or duodenal ulcer;
congenital pathology.

Does stenosis occur in those who have not previously been diagnosed with an ulcer? This phenomenon also occurs, but is extremely rare (with the exception of newborns, of course). The reasons for its appearance: chronic gastritis, constant irritation of the gastric mucosa, as well as dysfunction of the sphincter, which separates the duodenum and the esophageal cavity. The disease also occurs in obese people with too much body weight. But in them the cause of stenosis is pressure on the esophagus and the pyloric area by fatty masses.

Another reason is the preference for fast food and the complete lack of a normal diet. At the same time, the mucous membrane and the walls of the stomach themselves due to excessive load from indigestible food they atrophy and become inflamed. The free cavity of the esophagus decreases, hernias appear. As a consequence, there is a decrease in the natural gap of the pylorus, which turns into the most common barrier for food.

Treatment

If stenosis is diagnosed at the first, “mild” stage of its development, then treatment includes taking medications that help relieve inflammation and optimize the functioning of the entire gastrointestinal tract. Naturally, the patient will have to adhere to a strict diet for some time, which includes mainly foods plant origin(vegetables, fruits, cereals). Meat, eggs, milk are strictly contraindicated. In this situation, the likelihood of self-healing of the stomach, if the doctor’s recommendations are followed, is high.

If stenosis is detected already in the chronic stage, then the only correct radical treatment method is surgical intervention and removal of the damaged section of the esophagus (pylorus).

Often the operation involves drainage - the removal of slag masses that literally clog the passage into the duodenum. This disorder is more common among lovers of too spicy food and those who abuse strong alcoholic beverages.

Signs of improvement in the patient’s well-being occur immediately after the operation. The risk of relapse remains quite high. After eliminating the cause of the disease, the patient will need long-term restorative therapy and diet aimed at regenerating the beneficial microflora of the digestive tract. Doctors also recommend that during this period you cleanse your body of toxins and stop eating meat for a while (with the exception of fish and poultry).

Danger surgical treatment stenosis - very high. It is mostly associated with possible complications due to violation mineral salt balance in the blood (due to severe dehydration). It is because of this that the surgeon may require artificially introducing nutritional serums into the patient’s body for several days, and only after that he will undertake the operation.

IT IS IMPORTANT TO KNOW!

Chronic pancreatitis: causes, symptoms, treatment

When certain diseases of the digestive system are present in the body, they can cause chronic pancreatitis, treatment of which will be prescribed after the symptoms of this pathology appear. Middle-aged and elderly people often suffer from the disease.

What is chronic pancreatitis

In the presence of an inflammatory-destructive lesion of the pancreas, as a result of which its functions are disrupted, chronic pancreatitis is diagnosed. The disease is characterized by a long, relapsing course. As the pathology develops, the cellular structure of the gland changes, and functional failure occurs.

Wikipedia says that chronic pancreatitis is a very common disease in which the patient suffers from pain, as well as manifestations of insufficiency - exocrine and endocrine. Sometimes there are few signs of pathology or it is mistaken for another disease.

Food is normally processed and absorbed thanks to the coordinated work of many organs. Any of them can cause pancreatic failure. People with chronic pancreatitis know that this damage to the gland is often not so easy to determine at the initial stage. The pathology can be mistaken, for example, for gastritis, cholecystitis or biliary dyskinesia.

It may take 10-15 years before the signs of chronic pancreatitis become so obvious that there will be no doubt about the diagnosis. The disease may occur due to:

Cholecystitis, gastritis or duodenitis chronic form.
Ulcers of the stomach or duodenum.
Infectious lesions - mumps, abdominal or typhus, viral hepatitis.
Excessive drinking.
Unregulated diet.
Atherosclerotic disease.
Penetration of worms into the body.
Intoxication with harmful substances - arsenic, phosphorus, mercury, lead.

People who regularly experience stress are at risk. When the nervous system is unstable, problems with the gastrointestinal tract cannot be ruled out during this period; in particular, blood circulation in the abdominal organs is impaired due to spasmodic phenomena. Chronic pancreatitis is inevitable with systematic spasms of pancreatic vessels.

Processes in the gland during chronic pancreatitis

When digestive juice is delayed from the pancreas, premature activation of the enzymes trypsin and lipase occurs. If the digestive process is functioning normally, the work of enzymes begins in the lumen of the duodenum.

When the excretory duct spasms, stagnation of the secretion containing enzymes occurs, thus the parenchyma of the organ is targeted. The connective tissue grows, the gland becomes sclerotic. The process is evolving long years. The formation of persistent pancreatic insufficiency indicates chronic pancreatitis.

If the pathology is present for too long, secondary development of pancreatic cancer is possible against its background.

In some cases, microorganisms can penetrate the gland. The reason is that the motility of the digestive tract is impaired. As a result, along with pancreatitis, infectious inflammation of the gland is present.

The resulting stagnation in the ducts can provoke the formation of stones.

What you should know about chronic pancreatitis is that it is a disease that has different mechanism development. Accordingly, the disease is distinguished:

hydropic;
parenchymal;
sclerosing;
calculous.

Symptoms of chronic pancreatitis

As practice shows, initially pathological changes in the gland, in most cases, occur secretly. Or the symptoms of chronic pancreatitis are mild and nonspecific. When any sign becomes clearly visible, problems in the organ will be very serious.

Chronic pancreatitis is a condition accompanied by:

Painful discomfort, and the degree of intensity may vary. Localization location – epigastric region and left hypochondrium. The pain is either constant or appears intermittently. After the patient eats something, the symptom gets worse.
Dyspeptic disorders - nausea, urge to vomit, feeling of heaviness in the abdomen, unpleasant taste in the oral cavity, flatulence. The patient may develop an aversion to fatty foods, and sometimes lose appetite.
Weakening of the lower esophageal sphincter, causing stomach contents to regularly leak into the esophagus. The patient suffers from heartburn, cough, and sour taste.
Diarrhea. At the beginning of the disease, no bowel disorders are observed, but then diarrhea occurs, which alternates with constipation. With pancreatic diarrhea, a lot of feces are released. It contains leftover food that has not been digested. The feces themselves have a disgusting smell and leave greasy marks on the toilet.
The patient's weight loss and problems with weight gain.
Formation of small angiomas on the skin.
The appearance of diabetes mellitus (in some cases).

Characteristics of pain syndrome in chronic pancreatitis

Damage to the pancreas can be recognized by one of the main signs – pain. Typically, the patient complains of discomfort on the left side, which can affect the entire left side.

When chronic pancreatitis worsens, the symptoms are not as severe as with acute pancreatitis. In addition, the patient experiences pain after breaking his diet or drinking alcohol.

The patient suffers from discomfort most often after eating fried or fatty foods or 3-4 hours after eating. The pain can also be bothersome on an empty stomach. If the patient fasts, the pain subsides, so many refuse to eat, and, accordingly, lose weight.

Symptoms increase in the evening. In the morning hours it practically does not occur or is weakly expressed.

Nature of pain:

pressing;
burning;
drilling.

If the patient is lying down, the discomfort at this time can be quite severe. Changing position helps. The sensations decrease in a sitting position, while the torso must be tilted forward.

With chronic pancreatitis, pain occurs as a result of:

problems with the outflow of pancreatic juice;
increasing the volume of gland secretion;
pancreatic ischemia;
inflammation of the surrounding fiber;
changes in nerve endings;
compression of nearby organs.

Possible complications of chronic pancreatitis

Because the chronic process It can be more protracted than the acute form; complications arise after a certain period. Chronic pancreatitis can result in the development of:

obstructive jaundice (due to the fact that the head of the gland is enlarged);
duodenal stenosis (the changed size of the head of the pancreas compresses the duodenum);
pancreatogenic abscess of the abdominal cavity (provoked purulent inflammation, as well as the melting of gland tissue and nearby organs);
inflammatory processes, the location of which is the greater and lesser omentum, the gallbladder duct;
cysts and pseudocysts;
blood loss in the gastrointestinal tract (the result of a ruptured cyst or varicose veins of the stomach and esophagus);
gland fistulas – post-traumatic and post-necrotic.

Features of diagnostic examination for chronic pancreatitis

To confirm the diagnosis, the patient is sent for testing general analysis blood, urine and feces. There is also a need for other laboratory tests that can be used to diagnose acute form, and in instrumental studies. The last option involves using:

computed tomography;
radiography.

The patient is also prescribed radioisotope scanning affected organ.

Each study has its own characteristics:

Lab tests. The doctor will learn about the development of pathology from the results of a blood test. They will show the presence of leukocytosis with a shift of the formula to the left.

If present in urine increased level alpha-amylase, which means that the disease has worsened, and a reduced level indicates a sclerosing form.

Also required bacteriological examination In addition, duodenal contents are analyzed and a coprogram is performed (analysis feces).

Radiography. An accessible and widespread method, during which the examined part of the patient’s body is scanned with X-rays. The negative point is ionizing radiation.
Retrograde cholangiopancreatography. A more informative procedure that is prescribed to a patient with chronic pancreatitis if symptoms such as abdominal pain are present. However, not all patients are indicated this examination. Diagnostics is prohibited if:

severe kidney and liver damage;
thyroid diseases;
pregnancy;
general serious condition.

Preparation includes taking a laxative the day before the examination. Then an enema must be given. To relax the smooth muscles, special drugs are administered. Most patients react negatively to the procedure, so they are prescribed sedatives.

Ultrasonography. If the doctor suspects the presence of chronic pancreatitis, ultrasound is a mandatory method. It helps with making an accurate diagnosis.
CT scan. The method is expensive, so it is not used so often. Ultrasound data is often sufficient. Tomography is appropriate when the doctor suspects the development of:

pancreatic carcinoma;
tumors;
cystic form of the disease.

Radioisotope scanning. A diagnostic method that uses radioactive isotopes. During the procedure, the patient is injected with a radioisotope drug. A special scanner helps collect the necessary information by recording the level of radiation of the drug.

Thanks to scanning, chronic pancreatitis can be detected at an early stage. All patients are allowed to undergo the procedure.

How to treat chronic pancreatitis?

If the patient does not delay treatment, any serious complications can be avoided. It is important to remember that pancreatitis is a rather serious disease, because it causes a malfunction of other organs. Thus, when chronic pancreatitis is detected and its symptoms intensify, treatment should be carried out immediately.

To get rid of the disease, you will need:

Follow a strict diet, especially for patients suffering from an exacerbation.
Eliminate pain discomfort.
Restore the digestive process.
Replenish enzyme levels.
Remove inflammation.
Restore damaged pancreatic tissue.
Engage in prevention.

Treatment of chronic Pancreatitis involves the use of antibiotics if an infection is detected. The course lasts approximately a week.

When the ducts intended to drain bile become inflamed, the drug Amoxicillin is prescribed. The medicine does not give inflammatory process develop further. Amoxicillin is prescribed for pancreatitis to prevent relapse, as well as when there is a risk of complications.

You can relieve pain with the help of non-steroidal anti-inflammatory drugs (Nimesulide, Diclofenac, Paracetamol). Only the doctor prescribes the required dosage and adjusts it if necessary.

If the pain is too severe, medications are used with a narcotic effect. This could be, for example, Promedol or Tramadol. “No-shpa” and “Drotaverin” will cope with spasmodic phenomena. These drugs can be used orally or by injection.

Chronic pancreatitis is accompanied by digestive disorders, so treatment involves preparing a dietary diet. In addition, there is a need for enzyme preparations (“Creon”, “Pancreatin”, “Trienzyme”).

Complex therapy includes the use of medications that reduce acidity levels. That is, treatment of chronic pancreatitis can be carried out with the help of Almagel and Maalox.

Intoxication is eliminated by intravenous administration of Ringer's solution, the drug "Hemodez" and saline solution.

Since chronic pancreatitis has symptoms in the form of increased production of pancreatic secretions, treatment will be aimed at the use of drugs (Octreotide, Sandostatin) that will help solve the problem. The drugs are administered subcutaneously.

If necessary, the patient is prepared for surgery.

Indications for surgery for chronic pancreatitis

If the patient's condition is too severe, the doctor may prescribe surgery. Surgical treatment is used to eliminate:

purulent complications;
obstruction of ducts (bile and pancreatic);
sphincter of Oddi stenosis;
pronounced severe changes in pancreatic tissues;
cysts and pseudocysts;
severe course of the disease, in which conservative therapy turned out to be powerless.

As practice shows, patients with pancreatitis, which has an alcoholic etiology, are often operated on. During the procedure, doctors try to reduce the intensity of pain in the abdomen or lower back, but the anatomical and functional changes pancreas does not occur.

Chronic pancreatitis: treatment with folk remedies

Self-treatment is allowed under normal conditions, that is, at home, but first you should definitely consult a doctor. Recipes must be selected carefully. With help certain herbs pancreatic function is normalized, and complications will not arise.

Traditional medicine in combination with medicines helps the patient cope with the symptoms of chronic pancreatitis.

To improve bile excretion, you need to:

Mix immortelle, dandelion roots, tansy, chamomile, knotweed. Each ingredient is taken in a tablespoon.
The mixture is poured with a liter of boiling water and left for 2 hours.
The decoction should be drunk half an hour after eating, one glass at a time.

Relieve inflammation:

Juice is squeezed out of plantain.
For a month, you should take a teaspoon of the product before meals.
At the end of the course, a break of 2-3 months is taken, after which the course must be repeated.

Recipe for pain relief:

Herbs are mixed: zopnik, agrimony, dandelion, plantain, motherwort, chamomile, cucumber, yarrow.
The ingredients are crushed.
The mixture (2 tbsp. L) is poured with boiling water (0.5 L) and left for 8 hours.
The medicine is taken before bedtime.

Doctors advise drinking alkaline mineral water because it is excellent at combating painful discomfort.

Diet as a way to improve the condition of the pancreas

Diet therapy is prescribed to patients not only as a therapeutic method. It makes it possible to avoid exacerbation and further progression of pancreatitis.

During an exacerbation, it is better not to eat food for the first two to three days. Nutrition is provided using intravenous administration glucose. Also introduced isotonic solution sodium chloride. To relieve the patient from thirst, he is given a 1% soda solution. With the onset of the fourth day, the diet is replenished with food.

It is necessary to sit down at the table often - 7-8 times throughout the day, and the portions should be small. Allowed use:

fruit juices;
Sahara;
honey;
jam;
decoction of rose hips and currants;
cranberry juice.

Fifth day: the patient can take food that contains small quantity protein – vegetable and milk. Days six to seven: there may be more proteins and carbohydrates, and fats are also introduced. Food must be pureed.

You should not use products that have a stimulating effect on gastric secretion and pancreatic function. For example, you should refrain from meat, fish broths, carbonated and alcoholic drinks, coffee, strong tea, smoked meats, chocolate, sausages, sour juices and so on.

The exacerbation period is the time when the patient is prohibited from foods that contain a lot of fiber and connective tissue, as well as cold dishes.

Preventive measures for pancreatitis

Patients should never forget about prevention, which will prevent exacerbations of the disease. To do this you need:

limit the consumption of alcoholic beverages to a minimum;
eat rationally;
avoid overeating;
reduce the amount of fatty foods and foods with carbohydrates;
stop smoking;
drink enough water (at least 1.5 liters per day);
take care of the availability of products containing vitamins and microelements in sufficient quantities;
consult a doctor on time and follow his instructions.

Patients must be examined twice a year. A special recommendation is sanatorium-resort treatment.

If the patient takes preventive measures seriously, the course of pancreatitis will be mild. But violating the diet, drinking alcohol, smoking and lack of treatment will result in the progression of dystrophic processes in the pancreas and the appearance of complications. The patient risks more than just his health. The consequences can be fatal.

A patient who takes care of his body will be able to cope with the disease without any problems. The main thing is to notice negative manifestations in time so that you can start as early as possible. treatment course. A competent specialist will help you choose effective medications and also advise folk remedies. If the process does not start, the symptoms can be eliminated in as soon as possible. And thanks to prevention, you can keep your body in good condition.

- this is the lack of free of hydrochloric acid in the gastric cavity due to disruption of its production by parietal cells. It manifests itself as a feeling of fullness and heaviness in the stomach, epigastric pain, nausea, belching, and bloating. The diagnosis can be made by performing FEGDS with Congo staining, gastric biopsy and pH-metry; A test is required to check for the presence of Helicobacter pylori and antibodies to the lining cells of the stomach. Specific treatment has not been sufficiently developed; exogenous hydrochloric acid and symptomatic treatment and physiotherapy are mainly used.

ICD-10

K31.8 Other specified diseases of the stomach and duodenum

General information

Achlorhydria is the process of reducing or completely stopping the production of hydrochloric acid in the stomach. According to studies of this pathology, the vast majority of patients encounter it in old age. Thus, about 20% of the subjects were aged 50-60 years, 70% were over 80 years old. It is believed that this is due to more frequent infection with Helicobacter pylori infection in older people and an increased incidence of stomach diseases in older people.

On initial stages When the underlying pathology is cured, secretion can be restored. In later stages, the prognosis is poor. The development of achlorhydria in elderly patients is often associated with gastric cancer. Despite the efforts made to study this pathology, effective treatment methods have not yet been identified. Today, it is possible to maintain gastric acidity at a sufficient level only by replacement therapy.

Causes of achlorhydria

According to research in the field of modern gastroenterology, the development of the disease can be caused by a variety of background diseases of the stomach and other organs. Most often, a decrease in stomach acidity is caused by atrophy of the mucous membrane as a result of severe and prolonged Helicobacter pylori infection, autoimmune gastritis - in this case antibodies affect own cells stomach, uremia in renal failure and age-related changes. Also, stress and endocrine diseases (autoimmune thyroiditis, diabetes mellitus, autoimmune polyglandular syndrome) can cause a decrease in the acid-forming function of the stomach.

Pathogenesis

At the onset of achlorhydria, decreased acid production may be due to functional reasons. Gastric acidity is determined by two mutually occurring processes: the production of HCl in the mucous membrane of the stomach body and the production of mucus with bicarbonates. These two substances balance each other, with a predominance of free hydrochloric acid usually noted. If according to various reasons The influence of mucus and bicarbonates begins to increase, the amount of free hydrochloric acid in the stomach cavity decreases, sometimes to zero, even with a slightly reduced production.

If the cause of the development of this pathology is eliminated before organic changes appear, the disease can be completely cured. At organic damage The gastric mucosa cells stop producing hydrochloric acid and completely atrophy; in this situation, even eliminating the cause will not lead to the restoration of gastric secretion.

Symptoms of achlorhydria

Even in the complete absence of hydrochloric acid in the stomach, the disease may not manifest itself with severe symptoms, and therefore the patient long time may not be aware of it. In this situation, it is possible that irreversible changes in the gastric mucosa may develop even before treatment begins. Sometimes significantly reduced acidity is accidentally discovered during examinations for another pathology. Fortunately, in most cases, achlorhydria is manifested by symptoms of gastric damage, which make it possible to diagnose and set correct diagnosis in the early stages of the disease.

Patients are usually bothered by a feeling of fullness and heaviness in the stomach after eating, and dull aching pain in the epigastrium. Nausea, belching and bloating may occur. These symptoms are caused by impaired digestion of food, especially protein, with a decrease in the amount of hydrochloric acid in the stomach.

Diagnostics

There are several research methods for detecting achlorhydria. The most accurate method is FEGDS (gastroscopy) with simultaneous pH-metry and endoscopic biopsy of the mucosa. Assessing the content of free hydrochloric acid in gastric juice will allow you to determine the acidity of the stomach. A biopsy examination will reveal mucosal atrophy or destruction of acid-producing cells. Also in the biopsy specimen you can find Helicobacter, which can cause severe chronic gastritis. During gastroscopy, it is possible to stain the mucous membrane using Congo-rot dye - this diagnostic method will allow you to evaluate the acid-forming function of stomach cells.

A blood test is taken to determine the content of specific hormones - pepsinogens and gastrin. With atrophy of the gastric mucosa, the amount of gastrin in the blood increases, and pepsinogens decreases. The presence of antibodies to stomach cells is also determined in the blood, and PCR diagnostics of Helicobacter pylori is performed.

Achlorhydria can be combined with various stomach diseases. Thus, with pernicious anemia, antibodies to the stomach’s own lining cells circulate in the blood, which can provoke the development of achlorhydria. If a significantly reduced amount of hydrochloric acid is detected in the stomach, the patient should exclude chronic gastritis (Helicobacter pylori, atrophic, autoimmune), as well as stomach cancer.

Treatment of achlorhydria

Treatment of pathology is usually carried out by a gastroenterologist in close collaboration with endoscopists, internists and physiotherapists. Unfortunately, on this moment methods have not yet been developed complete cure this condition. Typically, therapy comes down to replacing reduced gastric function and symptomatic treatment.

First of all, when reducing stomach acidity, it is prescribed special diet: food should be semi-liquid and warm, it should be taken often and in small portions. In the acute phase of the disease, table 1a is prescribed; when the condition improves, they switch to table 2, then to a full fortified diet. You should include in your diet foods that stimulate gastric secretion: sour juices (lemon, cranberry, cabbage, tomato), weak coffee, cocoa, herbs and vegetable decoctions. Decoctions of herbs will also be useful: wormwood, dandelion root, fennel, parsley, plantain.

Replacement therapy for achlorhydria involves taking natural gastric juice with meals. A tablespoon of juice is dissolved in half a glass of water; you should drink the solution in small sips during meals. Combined enzyme preparations. A drug based on large blood hemodialysate helps restore the gastric mucosa and its function well cattle, nandrolone decanoate, carnitine, sea buckthorn oil. For severe autoimmune gastritis, corticosteroid hormones may be used.

After completion of treatment in the gastroenterology department, sanatorium treatment using medicinal mineral waters is recommended. Hydrocarbonate and sodium chloride waters are used in the treatment and prevention of achlorhydria.

Prognosis and prevention

The prognosis for achlorhydria is favorable when timely diagnosis and the beginning of treatment. It is highly dependent on the underlying pathology that caused achlorhydria. Functional lesions are more treatable, and organic changes in the mucosa most often determine the irreversible nature of the disease. Prevention of achlorhydria lies in the timely identification of diseases that can lead to this pathology, since early start treatment of chronic gastritis and other conditions reduces the likelihood of irreversible damage to stomach cells.

ICD-10 code

Achlorhydria is a disease characterized by a complete lack of hydrochloric acid production in the stomach. The symptoms of the disease are vivid, significantly worsening the patient’s quality of life. To this day, no treatment has been found that could completely correct the situation. Basically, all activities come down to replacement therapy.

The role of hydrochloric acid

Gastric juice is secreted due to the work of the mucous membrane. Its composition is complex, but the main component is hydrochloric acid, which is highly concentrated. It is produced by the cells of the stomach glands.

Hydrochloric acid improves digestion, destroys bacteria, and eliminates putrefactive processes. She:

Leads to the destruction of the molecular structure of proteins.
Activates pepsinogen, which is needed for the breakdown of proteins.
Creates an acidic environment under which food is quickly digested.
Accelerates the process of evacuation of food into the duodenum.
Leads to the production of pancreatic juice.

When a food bolus enters the stomach, it is subjected not only to mechanical stress, but also to chemical stress for several hours.

For the latter to be effective, the concentration of hydrochloric acid is 0.3-0.5%. If the pH in the antrum of the stomach becomes less than 3.0, the secretion of gastric juice begins to be inhibited by acid.

Most modern scientists say that gastric juice always has the same concentration of hydrochloric acid: 160 meq/l. Fluctuations in the acidity of the contents and on an empty stomach are determined by the ratio of acidic and alkaline components.

Kinds

There are several types of achlorhydria.

In the absolute form, the release of hydrochloric acid completely stops. At relative we're talking about about the “imaginary” form. Its difference is the fact that the enzyme continues to be produced by the glands, but in insufficient quantities.

Hydrochloric acid becomes so small that it is neutralized by alkaline liquids. The process is so serious that it is impossible to detect the enzyme in gastric juice.

Depending on the cause of the development of pathology, there are:

Functional. The acidity of gastric juice depends on the release of HCI in the mucosa and the secretion of mucus, which contains bicarbonates. These two components balance each other. Under the influence of certain factors, the amount of bicarbonates in mucus increases. Therefore, the concentration of hydrochloric acid decreases sharply. This may occur under the influence of the endocrine system.
Organic. It appears due to changes in the glands of the gastrointestinal tract. A prerequisite for this may be gastritis. In the organic form, hydrochloric acid is not released even after injection of a solution of histamine hydrochloride.

Causes

There are a large number of reasons that can lead to achlorhydria. One of the common ones is a slowdown in normal metabolism due to decreased activity of the thyroid gland.

The reasons for the development of pathology include:

Pernicious anemia. It causes the body to produce antibodies in response to certain cells in the stomach.
Frequent use of antacids and medications aimed at reducing the production of gastric juice. The latter include proton pump inhibitors and P2 receptor antagonists.
Presence of grade 4 mucolipidosis. With this hereditary disease, diffuse, homogeneous clouding of the cornea occurs. Appears in the first months of a person’s life.
At infectious lesions stomach bacteria, which neutralize and reduce the production of gastric juice to ensure living conditions.
Presence of gastritis, inflammatory diseases stomach, especially in atrophic forms. They are characterized by changes in the mucous membrane and glands.
Tumors in the organ And . The latter is used to treat cancer, suppresses the activity of the necessary cells.

Sometimes the cause is a deficiency of chlorine, sodium, zinc and some other elements necessary to produce a sufficient amount of gastric juice.

According to statistics, older people are at risk. In 20% of cases, the disease develops between the ages of 50 and 60 years, in 70% - in citizens over 80 years of age. This is due to a decrease in the body’s protective properties and susceptibility to Helicobacter pylori infection.

Symptoms of gastric achlorhydria

The disease does not appear overnight, so symptoms appear gradually. The patient may experience severe or moderate pain in the stomach. There is a feeling of fullness in the stomach and bloating.

Sometimes a person does not realize that he has stopped producing hydrochloric acid, since there are no signs of illness. The danger is that irreversible changes begin. Such situations are rare; usually, at an appointment with a gastroenterologist after taking an anamnesis, a decrease in acidity is expected, and during diagnosis, achlorhydria is detected.

Some patients complain of an increase in the size of the abdomen and increased salivation. Symptoms increase as stomach tissue changes.

Consequences

Little is known about the complications of the disease. But gastroenterologists say that with such a pathology the risk of developing and increases.

With achylia, a violation of secretory function occurs when pepsin completely ceases to be produced.

The consequences include cryptogenic pernicious anemia. Some consequences appear in the early stages of the disease, others – against the background of the complete absence of hydrochloric acid.

The disease can lead to intestinal inflammation, hepatitis, and atrophy of the liver parenchyma. The disease itself cannot cause death, but progression of the disease can lead to an increase in risk.

Diagnostics

The study begins at the time of collecting the anamnesis. The gastroenterologist interviews the patient, studies the medical history, and conducts a physical examination. These measures will help determine the cause of the symptoms.

Laboratory diagnostics are required. It includes:

clinical blood test;
determination of the hormones pepsinogen and;
identification pathogenic bacteria.

Appointment possible microscopic analysis feces A general clinical examination of gastric contents is carried out. It allows you to assess the condition of the organ. The method includes research physical and chemical properties, microscopic diagnostics.

The main method is fractional probing using a test breakfast. The peculiarity is that the entire contents of the stomach are removed using a probe. Color, smell, volume of gastric juice, acidity are studied.

It is advisable to carry out it in a vertical and horizontal positions. Contrasting of the digestive canal is performed if there are additional indications.

Hardware diagnostic methods include and. The method allows you to see even minor violations in the work of the organ.

One of the most accurate methods is gastroscopy with simultaneous pH-metry and mucosal measurement. Additionally, a study of the biopsy specimen is prescribed; the method reveals atrophic processes and destruction of cells that produce acid.

Treatment

Since the exact treatment algorithm similar disease no, the main measures are aimed at getting rid of hydrochloric acid deficiency. Treatment includes:

diet,
medicines,
physiotherapy,
medicinal plants.

The diet is aimed at providing a gentle regime for the stomach. The diet should include components that are mild stimulants of gastric secretion. These include cabbage and tomato juices, weak coffee, rosehip infusions, fish soup and vegetable soups. Diet can be supplemented mineral waters, which are drunk warm.

At in serious condition Diet No. 1a is prescribed. As the condition improves, patients move to table No. 2 with a gradual return to normal nutrition.

Drug therapy is selected individually for each patient. It includes:

Gastric secretion stimulants. These are Etimizol, insulin, calcium preparations, Limontar.
Substitutes; 3% hydrochloric acid, Pepsidil, Abomin.
Polyenzymes for correcting the digestion process: Festal, Digestal.
Preparations for the restoration of mucous membranes: vitamins, Befungin, carnitine.

Replacement therapy is important. Taking natural gastric juice with meals may be prescribed. The solution should be drunk in small sips.

For autoimmune gastritis and high levels of antibodies, corticosteroids are indicated. Since the disease is often caused by a bacterium, eradication therapy aimed at eliminating Helicobacter pylori helps to cope with it.

To stop the rapid growth gastric microflora antibiotics are prescribed. If the disease develops due to long-term use of proton pump inhibitors, the dose of the main drug is adjusted or its use is completely discontinued.

The healing process can also be accelerated by using physiotherapeutic techniques. Peloid therapy involves the use of therapeutic mud. It is carried out using the application method. Apply mud to the epigastric region and segmentally.

A positive effect is also achieved when using electrophoresis or hyperbaric oxygen therapy. The first method allows the delivery of vitamins or drugs using currents of a certain purity. The second technique is aimed at enriching all cells of the body with oxygen. For this purpose, barometric devices are used.

Treatment includes the use various decoctions and infusions. They can be made from hops, parsley, plantain, and caraway seeds.

Prognosis and prevention

With timely treatment, the prognosis is favorable. Often depends on the underlying disease that led to achlorhydria.

Doctors note that it is easiest to cope with functional forms. In the organic form, changes in the mucosa can be irreversible.

TO preventative measures refers to the elimination of ailments that led to the development of pathology. To avoid stopping the production of hydrochloric acid, you need to regularly undergo medical examinations and visit sanatoriums, the main focus of which is the treatment and prevention of gastrointestinal disorders.

Violation of the secretory function of the stomach

Violation of the secretory function of the stomach includes changes in the amount of gastric juice, acidity, pepsin and mucus formation. Hydrochloric acid and pepsin are necessary for the chemical processing of food. The main stimulator of hydrochloric acid formation is gastrin, produced by G-cells of the gastrointestinal tract. Gastrin stimulates the release of HCl and gastric enzymes, increases blood circulation in the stomach (it is a trophic hormone), enhances motility of the antrum of the stomach, but inhibits gastric emptying, and stimulates the release of insulin. Gastrin secretion is increased by: irritation of the vagus, intake of protein foods, excess Ca ions, intake of caffeine, ethanol. Gastrin secretion is reduced by: hypersecretion of HCl, the action of somatostatin, secretin, glucagon.

The main stimulators of hydrochloric acid secretion in the stomach, in addition to gastrin, are histamine and acetylcholine. In response to irritation n. vagus, the concentration of gastrin produced by G-cells of the antrum of the stomach increases, which leads to an increase in the secretion of hydrochloric acid (a synthetic analogue of gastrin, pentagastrin, is used as a stimulator of HC1 secretion). Gastrin and acetylcholine activate specific receptors associated with the calcium/protein kinase C system. After activation of the corresponding mechanisms, hydrogen-potassium (H+/K+) ATPase channels are stimulated, leading to the production and release of hydrogen ions.

The stomach secretes up to 2 liters of fluid per day. Quantitative changes secretion of gastric juice is expressed in an increase (hypersecretion) and decrease (hyposecretion). This can be combined with changes in the production of hydrochloric acid by parietal cells and pepsinogen - the main cells located in the tubular glands mainly of the fundus and body of the stomach. Hydrochloric acid production may increase (hyperchlorhydria) or go down (hypochlorhydria). Combinations of hypersecretion with hyperchlorhydria and hyposecretion with hypo- and achlorhydria are possible.

Methods for studying the secretory function of the stomach include the method of fractional gastric intubation and pH-metry. Fractional gastric intubation method consists of obtaining gastric juice through a probe inserted into the stomach at

on an empty stomach 12 hours after eating. In this case, they receive: an “economy” portion - the contents of the stomach are sucked out 5 minutes after insertion of the probe, “basal” secretion - 4 portions every 15 minutes for one hour, “stimulated secretion” - 4 portions every 15 minutes for one hour. hours after stimulation with the stimulus. Submaximal stimulation with histamine (0.01%, 0.1 ml/10 kg body weight) and maximum stimulation with pentagastrin (6 μg/kg body weight, synthetic drug gastrin) or histalong (2 μg/kg). In each portion of juice, the following is determined: volume, acidity (free, protein-bound and total HC1), debit-HC1 - absolute acid production in 1 hour, pepsin content (based on the ability of gastric juice to digest proteins), separation coefficient (based on the ratio of liquid and dense layers) (Table 17-1).

Table 17-1. Normal gastric juice levels

It should be noted that the term “free HC1” is conditional (hydrogen ions are bound by protein molecules and bicarbonate ions, so hydrogen ions can be divided into bound and free). In this regard, the absence of free hydrochloric acid does not indicate achlorhydria, but only states a decrease in the concentration of hydrogen ions to pH 3.5 and below. It is necessary to judge the increased or decreased acid-forming function of the stomach by definition absolute production (flow rate) of hydrochloric acid(mmol/h), where the amount of secretion is taken into account

gastric juice in milliliters (ml) and the concentration of total hydrochloric acid in millimoles (mmol) in each portion of gastric juice in the phases of basal and stimulated secretion.

Violation of acid formation is judged taking into account age, gender (in women, acidity is 20% lower) and the weight of the patient (with increasing weight, acidity indicators increase). Considering the great variability in the indicators of the secretory function of the stomach, its violations are spoken of only when there are gross deviations from normal secretion indicators, taking into account the errors in the method for determining this function. The disadvantages of the method include: the need for continuous suction of gastric juice, research in vitro, determination of mainly only general NS1. In addition, when assessed by this method, the flow rate of hydrochloric acid depends on what is being titrated with (there may be impurities of mucus and bile, which have an alkaline pH).

A more accurate method for assessing the acid-forming function of the stomach is pH-metry - wall pH determination. It is carried out using special devices with pH probes, which are administered to the subject transnasally (through the nose). 3-hour pH measurements and 24-hour pH monitoring can be performed. The advantages of this method include: the ability to carry out pH measurements in each part of the stomach, functional tests of a stimulating and depressing nature and select the appropriate drug therapy, determine true achlorhydria, which has great importance in the diagnosis of precancerous conditions in atrophic gastritis.

Digestion with hypersecretion and hyperchlorhydria. With hypersecretion and hyperchlorhydria, the presence of acidic gastric juice of more than 50 ml with a hydrochloric acid concentration of up to 40 mmol is noted on an empty stomach.

Stimulation of the secretory function of the stomach is carried out

starring vagus nerve through gastrin, histamine, glucocorticoids, insulin, thyroxine, etc. In addition, some medications, spicy and hot foods, specific food components, such as peptides, amino acids, caffeine, alcohol, calcium, which stimulate the production of gastrin, can stimulate gastric secretion.

In the reflex phase, the secretion of gastric juice is enhanced by the sight, smell and taste of food, which occurs through the influence n. vagus. In the gastric phase of secretion, a mechanical dis-

tension of the stomach with food, perceived by stretch receptors in the wall of the stomach, which is realized through reflex arcs, including the vagus nerve.

Hyperchlorhydria in the stomach is observed with Zollinger-Ellison syndrome(gastrinoma), caused by a gastrin-forming tumor, which is located in the pancreas (65-75%) or in other organs (stomach, duodenum(duodenum), liver, testicles, mesentery, lymph nodes, abdominal fat). This is usually a multiple tumor. The release of gastrin by tumor cells causes persistent gastric hypersecretion, which is associated with the main manifestations of the disease: ulceration, indigestion and diarrhea. More than 90% of patients with gastrinomas develop ulcerative defects upper sections gastrointestinal tract. The ulcers are resistant to standard therapy, have a continuously relapsing course, and are prone to severe complications: perforation, penetration and bleeding. Even surgery for complications of ulcers does not stop the recurrence of the disease. In addition to peptic ulcers, common manifestations of Zollinger-Ellison syndrome are diarrhea and maldigestion syndrome(digestion disorder). The pathogenesis of diarrhea in this syndrome is complex and is mainly associated with hypersecretion of gastric juice, reaching several liters per day. In addition, the cause of diarrhea may be inactivation of pancreatic enzymes by gastric juice increased acidity, which leads to steatorrhea and maldigestion syndrome. Due to the decrease in pH in small intestine the mucous membrane is damaged with the development malabsorption syndrome(malabsorption). The development of “secretory” diarrhea is possible, since hypergastrinemia increases potassium secretion and reduces the absorption of sodium and water in the small intestine.

In addition to its stimulating effect on acid secretion, gastrin has a pronounced trophic effect on the tissues of the gastrointestinal tract. It enhances the synthesis of DNA and proteins in the cells of the gastric mucosa and in other tissues. Hypergastrinemia in Zollinger-Ellison syndrome causes two synergistic effects: hyperstimulation of gastric parietal cells and, as a consequence, a significant increase in acid secretion and the number of secreting parietal cells.

The main differential diagnostic feature of this syndrome is hypergastrinemia. Average gastrin level

healthy people and patients with peptic ulcer disease - less than 150 ng/ml, while the gastrin level in patients with Zollinger-Ellison syndrome is much higher - >1000 ng/ml. At the same time, it is necessary to know that hypergastrinemia can be not only primary, contributing to an increase in the level of hydrochloric acid (as is the case with Zollinger-Ellison syndrome), but also secondary due to hypo- and achlorhydria. The most common cause of hypergastrinemia is atrophy of the fundic mucosa of the stomach, since hydrochloric acid is the main inhibitor of gastrin release. The absence of hydrochloric acid leads to uninhibited secretion of gastrin, hyperplasia of cells in the antrum of the stomach, which often occurs with pernicious anemia. In this regard, the determination of gastric acid plays an important role in differential diagnosis hypergastrinemia syndrome.

Early detection and removal of the tumor are the basis for the treatment of Zollinger-Ellison syndrome.

With hypersecretion of hydrochloric acid, conditions arise for persistent pyloric spasm, since it takes a lot of time to neutralize the excessively acidic stomach contents in the duodenum. When the pylorus spasms, food remains in the stomach for a long time, the stomach is full, heartburn, sour belching, and sometimes vomiting may occur, pain occurs, and the evacuation function of the stomach decreases. More homogeneous food enters the intestines, intestinal motility decreases, a tendency to constipation and autointoxication appears.

Digestion during hyposecretion and hypochlorhydria. A decrease in the secretion of gastric juice develops with an increase in the tone of the sympathetic nervous system, the action of glucagon, secretin, cholecystokinin, enterogastron. Secretin, cholecystokinin, enterogastron belong to the duodenal inhibitory mechanism of gastric secretion. Somatostatin normally inhibits the release of gastrin and the secretion of hydrochloric acid in the stomach. A decrease in the secretion of gastric juice also develops with significant structural changes in the glandular layer of the stomach and a decrease in the number of cells producing gastric juice.

When acid formation decreases, pepsin is not active and proteins are not digested. Patients may complain of “rotten” belching, as the bactericidal effect of hydrochloric acid decreases and the processes of putrefaction and fermentation intensify. Decreased hydrochloric acid production leads to excess colonization

gastrointestinal tract bacteria. The evacuation of food chyme from the stomach is usually accelerated, since its neutralization in the duodenum occurs quickly. Conditions are created for the gatekeeper to gape. Large portions of gastric contents quickly entering the duodenum are less well saturated with duodenal juice. Duodenal digestion suffers due to a decrease in gastric secretion and the secretion of pancreatic juice, the secretion of which is stimulated by hydrochloric acid. Food coarse chyme, not prepared for absorption, enters the underlying parts of the intestine. Peristalsis increases, causing diarrhea, increasing maldigestion syndromes(mainly disturbance of cavity digestion) and malabsorption(malabsorption). An early sign of the latter is steatorrhea (after taking fatty foods food). Body weight decreases, hypovitaminosis, electrolyte metabolism disorders, dehydration, and significant metabolic disorders occur.

Achlorhydria may be associated with ahilia(lack of pepsin in gastric juice). There are functional and organic achylia. At functional achylia gastric activity and the activity of the main cells are preserved, but their function is inhibited. This is a reversible condition, the occurrence of which is possible with stressful situations, avitaminosis (scurvy, pellagra). The unstable nature of achylia is noted, varying depending on the secretion stimulus and the conditions of the study. Organic ahilia develops with severe atrophic gastritis. Functional disability, and then structural changes in the activity of the main cells develop later than in the parietal cells. Organic achylia is always associated with severe maldigestion syndrome and is often combined with pernicious (B 12 deficiency) anemia.