Hemorrhages in the stomach. Erosive hemorrhagic gastritis antral gastritis

Of all the variety of types of inflammation of the gastric mucosa, hemorrhagic gastritis is the most insidious and dangerous form of the disease. It stands out from the general picture due to the peculiarity of the mechanism of damage, the rate of progression and severe consequences in case of delay in medical treatment.

The insidiousness of this type of gastritis lies in the absence of characteristic signs. Tissue damage begins from the submucosal layer, in which, for one reason or another, blood microcirculation in the vessels and capillaries is disrupted. This entails the sweating of blood onto the surface of the mucosa, and the formation of hemorrhages, and with the formation of blood clots, bleeding erosions appear. As a result, inflammation develops leukocyte infiltration threatening internal bleeding.

Damage to the submucosal layer produces scanty, vague symptoms, regardless of the cause of the disease. At the early stage of the disease, a person periodically feels heartburn, weak and vague pain in the epigastric region, more like discomfort, and occasional nausea.

Such a picture of symptoms can mislead not only the patient himself, but also the diagnosing doctor. Quite often, these manifestations are associated with poor-quality food, exacerbation of the chronic process of an existing disease of the digestive system, or suggest other causes of illness. Moreover, the main lesion most often affects the antrum, the farthest section, since there is a cluster of main vessels there.

As a result, it is possible to determine the form of gastritis only with the onset of gastric bleeding, when the condition can threaten a person’s life.

The similarity of symptoms and the presence in some cases of erosions on the mucous membrane give reason to consider the hemorrhagic form to be identical to the erosive form. In many sources, the classification is called erosive-hemorrhagic gastritis. This is not an entirely correct formulation, since hemorrhagic gastritis can occur either with the formation of erosions or manifest itself only as hemorrhages. In turn, erosive gastritis is not always complicated by bleeding.

It would be more correct to call hemorrhagic gastritis morphological type changes during endoscopic examination, with minimal histological manifestations. The paradox is that the affected vessels become provocateurs of destruction epithelial tissue mucous membrane, causing inflammation and erosive manifestations, but cellular infiltration is minimal or completely absent. In the vast majority of cases, the antrum of the stomach suffers, in its own way anatomical location, which additionally promotes inflammatory processes due to stagnation of gastric juice.

This form of the disease, being one of the most severe damage to the gastric mucosa, still remains poorly understood. According to the World Health Organization, over the last decade alone, the number of cases of diagnosing hemorrhagic gastritis has increased tenfold. Of all patients admitted with bleeding upper sections digestive system, more than 5% are provoked by this particular form of the disease. And, approximately 2% of hemorrhagic gastritis, complicated by bleeding, are fatal. This picture forces scientists to redouble their efforts to study the causes of pathology that provoke the mechanisms of damage.

The pathology is polyetiological; the disorder can be provoked by completely different negative factors and causes.

In the first place is the addiction to alcoholic beverages. Almost half of alcoholics are diagnosed with hemorrhagic gastritis of varying severity during examination.

But, very rarely, symptoms of hemorrhagic gastritis appear only due to one provoking factor.

Usually the reasons combine several indicators at once, these include:

1. Pathological eating habits. This may be an excessive love of seasonings, consumption of smoked meats in large quantities, irregular meals, fasting, strict vegetarianism.
2. The very prescription and uncontrolled use of medications, for example:
   • 3rd generation analgesics;
   • glucocorticoids,
   • antibiotics;
   • NSAIDs.
3. Massive blood loss during surgery or injury.
4. Extensive burns covering more than 40% of the entire skin surface.
5. Insufficient functioning of such internal organs and systems like:
   • liver;
   • kidneys;
   • lungs;
   • heart,
   • vessels.
6. Severe stress can provoke hemorrhagic gastritis, against the background long stay in reanimation.
7. Placement of a nasogastric tube for a period exceeding 5 days.

Hemorrhagic gastritis, unlike other types, never occurs due to the development of Helicobacter pylori. Therefore, the bacterial test will always be negative.

Symptoms and signs

The development of hemorrhagic gastritis can occur in acute or chronic form, which differ in the degree of manifestation of symptoms and the size of tissue damage.

At acute form General symptoms of gastritis appear quickly and clearly. An acute attack progresses over several hours, but signs of bleeding may be delayed, especially if the lesion affects the antrum of the stomach.

Chronic course The disease is characterized by blurred symptoms. For a long time, the patient cannot understand the symptoms and has no idea about the pathology. During this time, increasingly deeper tissues are involved in the pathological process, forming extensive erosions, some of which can completely corrode the wall of the stomach, up to perforation. This threatens not only gastric bleeding, but also blood penetration into the abdominal cavity.

Both forms of the disease require taking emergency measures Therefore, treatment of hemorrhagic gastritis is carried out only in a hospital setting.

It is impossible not only to cure this form of gastritis with folk remedies or at home, but even to temporarily alleviate the condition. But it is quite possible to worsen the situation.

Symptoms such as:

• severe pain in the epigastric region, worsening after eating;
• symptoms of indigestion, for example: heaviness in the stomach, increased gas formation, general malaise;
• symptoms of dyspepsia: nausea, flatulence;
• symptoms of internal bleeding: weakness, rapid heartbeat, dizziness, attacks of vomiting with streaks of scarlet blood if the affected area is in the upper parts of the stomach, and with an admixture of digested blood (black spots) if the antrum of the stomach is affected.

Upon examination, the doctor sees such signs of hemorrhagic gastritis as:

• severe pallor of the skin;
• coating on the tongue of a whitish or grayish tint;
• severe pain in the peritoneum in the stomach area upon palpation;
• low blood pressure and severe tachycardia.

Hemorrhagic gastritis is confirmed using fibrogastroduadenoscopy, a study that allows the doctor to clearly determine the presence of hemorrhages, bleeding erosions and the absence or intensity of bleeding. Adequate treatment can be prescribed only after the location of the bleeding has been established, since the antrum has a different environment from the other part of the stomach, and requires special approach. During the course of the study, a sample is taken to determine the level of acidity of gastric juice and the presence of bacterial flora.

Appointed:

• clinical blood test to determine hemoglobin level;
• stool analysis occult blood;
• a general urine test to determine the level of kidney function.

Treatment methods

Treatment of a disease as complex as hemorrhagic gastritis requires rapid medicinal action that can comprehensively affect all links of the pathological chain.

Of primary importance is the elimination of bleeding, while simultaneously addressing the underlying causes vascular disorders. Gastric lavage or administration of medications through a gastric tube may be necessary.

A strict diet in combination with drug treatment and psychological rest gives a chance for complete recovery in acute forms and long-term remission in chronic gastritis.

The first day a fasting diet is prescribed. It is not recommended to even drink water while bleeding is being stopped. An ice pack is applied to the epigastric region of the abdomen. Coagulating drugs are prescribed intravenously in a stream or in droppers. Further treatment involves the introduction of inhibitors, regulators of gastric juice synthesis and correction of the enzyme composition. The antrum of the stomach reacts especially sharply to the composition of gastric juice and its acidity. In case of antral hemorrhagic gastritis

Taking any medications through the esophagus is strictly contraindicated, since it is necessary to allow the stomach to rest and stop hemorrhages and erosions.

Bleeding in the antrum of the stomach is most dangerous, since blood can accumulate in large quantities and remain there for several days. Which ultimately leads to the development of purulent processes. Treatment in this case involves removing accumulated blood through a tube, gastric lavage and fasting for several days.

Many medicinal plants have hemostatic properties, and can also gently regulate the production of stomach acids. But treatment with folk remedies on your own, when it is not known exactly what form of hemorrhagic gastritis, and how deep the tissue damage is, is simply dangerous.

If you do not consult a doctor in a timely manner and start treatment with folk remedies, you may waste precious time. Then it will be difficult even for surgeons to cope with the pathology.

There are many cases of severe complications developing after exposure to the stomach using folk remedies without prior consultation with a doctor.
The correct action is not treatment with folk remedies, but diet. More precisely complete failure from food during an attack, call a doctor, and strictly follow his instructions.

Prevention

Hemorrhagic gastritis is one of those types of pathology, the prevention of which depends entirely on the person himself. First of all, a diet that involves eating regularly and selecting healthy foods.

The various types included in the weight loss diet have a very harmful effect on the condition of the gastric mucosa. Mono-diet, starvation diet, dry diet, all of them can be the last straw in the development of hemorrhagic gastritis.

Treatment methods for chronic erosive gastritis

Erosive gastritis is a type of inflammatory lesion of the gastric mucosa. The disease can occur in an acute or chronic process, characterized by single or multiple erosions formed on the membrane of the organ.

If the localization of the inflammatory process is observed in the antrum of the stomach, antral chronic erosive gastritis is diagnosed. Many people consider this disease not serious, so they do not seek help from a specialist in a timely manner.

In reality, this form of gastritis does not pose a particular danger to human life, however, ignoring treatment increases the likelihood of developing a gastric ulcer, which can later develop into malignancy- cancer.

Features of erosive gastritis

Unlike ordinary gastritis, the erosive form is accompanied by numerous erosive areas on the gastric mucosa, formed against the background of an inflammatory process. In some cases, such pathology is observed on the entire surface of the digestive organ.

Acute erosive gastritis occurs suddenly and, as a rule, it is provoked by toxic compounds or poor-quality food entering the body. Helicobacter pylori infection can also trigger the development of this form of the disease. Unlike ordinary gastritis, erosive gastritis has a fairly long course and is difficult to treat.

With chronic gastritis of the erosive type, sudden internal bleeding of varying degrees of severity cannot be excluded. In some cases, this dangerous complication observed on the entire surface of the stomach, simultaneously.

Acute gastritis occurs due to direct contact of the mucous membrane with aggressive components. Chronic erosive gastritis is based on disorders of secretory processes that may be associated with internal failures in the functioning of the body, as well as due to poor quality nutrition.

Antral erosive gastritis can occur due to pathological changes vessels of the organ, in the presence of helminthic infestation, as well as after long-term use of certain medications. Nervous overstrain also contributes to the development of this disease. bad habits, the presence of infection in the body and autoimmune disorders.

Erosive gastritis can be diagnosed by characteristic symptoms, manifested in the patient during the period acute process. As a rule, the chronic form of the disease is practically not detected by symptoms or there are mild signs that can be ignored by the sick person.

Symptoms of acute and antral erosive gastritis

In acute erosive gastritis, the patient is bothered by paroxysmal pain in the abdominal area, which intensifies after eating. After eating, attacks of nausea may also occur, sometimes vomiting is detected, where mucus and gastric juice. This disease is also characterized by stool disturbances, and diarrhea is common.

If blood clots are visible in the stool, there is Great chance internal bleeding. With such symptoms, you cannot self-medicate and ignore the help of specialists. The right decision is to contact a gastroenterologist, who, based on individual characteristics sick patient will be able to prescribe effective drug treatment.

With antral gastritis, cramping pain in the abdomen is observed, often occurring during periods of hunger. In the epigastric region, the patient feels characteristic discomfort: heaviness, bloating, a feeling of oversaturation after eating food, even in small quantities.

Sometimes nausea, vomiting, belching, and painful heartburn appear. Also, a person is often bothered by diarrhea and bloating, and in some cases there is constipation. Antral gastritis radically disrupts the digestive process; in the patient’s oral cavity, bad taste and a characteristic smell.

Disturbances are also noticed in the level of stomach acidity. The disease can cause internal bleeding, which is especially likely in late stages progression.

These symptoms indicate the need adequate treatment, as prescribed by an experienced gastroenterologist. Ignoring the signs is fraught with serious consequences and the disease becoming chronic.

Erosive-hemorrhagic gastritis

The long course of chronic gastritis of the erosive form leads to serious complications, one of which is gastric bleeding from the mucous membrane of the organ. This manifestation of gastritis is called erosive-hemorrhagic. Its development is associated with the localization of erosive formations, as well as the depth and size of these pathologies.

The greatest danger is posed by multiple erosions that occur at great depths, especially if their location is in the area of ​​slight curvature. As is known, in this zone there are large vessels having high blood flow intensity. If the disease causes bleeding in this area, the consequences can be quite dangerous.

The degree of risk of transition from erosive gastritis to erosive-hemorrhagic is ambiguous for each patient. It depends on the individual characteristics of the branching small vessels, their structure and internal pressure.

Patients at risk include those who have poor clotting blood, as well as people diagnosed with arterial hypertension. Taking anticoagulant drugs, anti-inflammatory and non-steroidal painkillers also increases the likelihood of transforming erosive gastritis into erosive-hemorrhagic.

There are certain symptoms that indicate such a transformation:

• reduced pain intensity;
• a mandatory sign is vomiting, in the masses of which brown contents are observed, which confirms the presence of blood in the stomach area;
• decreased blood pressure;
• accelerated pulse;
• dizziness, general weakness;
• the skin becomes noticeably pale;
• feces acquire a dark color.

Treatment of erosive gastritis

Depending on the form of the disease, treatment is carried out in laboratory or in inpatient conditions, as prescribed by a doctor. IN complex therapy includes medication and diet. To eliminate excess secretion of gastric juice, antisecretory drugs are prescribed.

It is possible to eliminate stomach acidity and form a protective film over the organ mucosa and erosive formations with the help of antacid medications. also in compulsory course therapeutic treatment includes enzymes that significantly facilitate the digestion process.

If erosive-hemorrhagic gastritis is detected, the patient is prescribed hemostatic medications administered intravenously or intramuscularly. If the disease is caused by Helicobacter pylori infection, mandatory prescriptions include anti-Helicobacter drugs.

The effectiveness of treatment largely depends on adherence to diet, which plays a big role in the fight against this disease. A detailed diet plan is prescribed by the attending physician, focusing on the form of diagnosed gastritis.

Antrum gastritis is one of the most common forms of gastritis based on the localization of inflammatory processes in the mucous membrane, in which the progression of pathology can occur at a fairly rapid pace. Erosive antral gastritis is more late stage diseases when superficial inflammation of the epithelium develops into focal erosions - areas of damage to the upper layer of the mucosa. In the antrum of the stomach, located in the lower part of the organ, there are glands responsible for the secretion of mucus and enzymes that ensure alkalization of an overly acidic environment (since the antrum is adjacent to the duodenum, which is characterized by alkaline environment). If superficial gastritis is fairly easy to treat, then therapy for its erosive form is a rather complex and lengthy process, since erosion affects large areas of the mucosa and penetrates into deeper layers. Without treatment this pathology rapidly progresses, causing severe complications, from gastric ulcers to the development of malignant neoplasms.

Without treatment, the patient's condition worsens

The severity of inflammatory processes may be indicated by the symptoms of the disease, but you should not rely too much on these signs - they are characteristic of many gastrointestinal pathologies. The diagnosis can only be clarified through a thorough examination using laboratory and modern instrumental methods.

In the outdated medical classification, antrum gastritis is classified as “B” type (bacterial) gastritis; the Sydney classification, adopted in 1990, is more accurate and allows gastritis to be divided according to four criteria. In the acute course of the disease, its symptoms manifest themselves in a pronounced form, and in many cases such exacerbations become the cause of the development of a chronic form of the disease, in which erosions spread throughout the entire antrum. Note that in the early stages of the disease, healing of erosions is possible without replacing dead cells with fibrous connective tissue.

Reasons for the development of the disease

In approximately 90% of cases, when diagnosing erosive gastritis of the antrum of the stomach, increased content pathogenic bacteria in the lower part of the stomach Helicobacter pylori, for which the alkaline environment of the mucous membrane is an ideal habitat. However, this bacterium is the only one in the microflora digestive tract, for which an acidic environment with acidity in the region of 2 – 4 and even higher is not fatal. But the bacterium actively reproduces under more favorable conditions, so it is not surprising that its primary distribution area is the antrum.

Erosive gastritis of the antrum of the stomach is characterized either by the presence of one extensive lesion, or many small erosions, which subsequently still merge into a large area of ​​necrosis, causing internal stomach bleeding.

Alcohol is one of the factors that provoke gastritis

The following factors can cause the occurrence and spread of erosion foci:

• other chronic pathologies digestive tract, including chronic superficial gastritis localized in other parts of the stomach;
• long-term use of certain medications (hormonal, anti-inflammatory, cytostatics);
• bad habits (uncontrolled drinking of alcohol, smoking);
• abuse of fatty, spicy, salty, hot foods, fast food, irregular meals);
• stress and others psychoemotional disorders, which are the cause of the development of neuroses;
• vascular pathologies.

The cause of acute erosive gastritis can be conditions such as renal/liver failure, extensive blood loss, sepsis, and large-area burns.

Symptoms of the erosive form of antral gastritis

The problem with most types of gastritis is that their classic manifestations are not perceived by patients as pathology. Belching with a pronounced sour taste, bowel irregularities, bloating and short-term pain in the stomach are often simply ignored, in best case scenario painkillers or drugs that facilitate the digestion process are taken. And only with an exacerbation of the disease, when the erosive areas deepen at a rapid pace, this leads to a sharp deterioration in the patient’s condition, which forces him to seek qualified medical help. In any case, the symptoms and treatment of this form of gastritis should be monitored by the attending physician.

Symptoms of acute erosive antral gastritis:

• sharp abdominal pain of a constant or paroxysmal nature, which increases immediately or some time after eating;
• heartburn with nausea, which also appears after eating;
• attacks of vomiting with the presence of mucus, blood clots and gastric juice in the vomit;
• diarrhea, the presence of blood clots in the stool indicate the development of intragastric bleeding.

Symptoms of chronic erosive antral gastritis manifest themselves in more soft form: attacks of nausea, bloating, sensations of heaviness in the epigastric region, short-term stomach pains, unstable stools are possible. There are frequent cases when the chronic form of erosive gastritis long time is generally asymptomatic.

Features of treatment

Choosing a treatment regimen for antral gastritis erosive form depends on many factors: the patient’s medical history, the causes of the pathology, diagnostic results, and the presence of concomitant diseases.

Since in most cases this type of gastritis is accompanied by extensive Helicobacter pylori infection, antibacterial therapy is a mandatory component of treatment. In this case, a regimen is usually used using two or three different antibiotics (Metronidazole, Amoxicillin, Levofloxacin). It should be noted that while the full course of treatment for a chronic form of the disease can last up to a year, antibiotic therapy is used for no longer than two weeks.

This is interesting: The majority of the population is carriers of Helicobacter (according to some data, up to 80 - 90%), but not everyone has gastritis. The fact is that in the normal state of the stomach, Helicobacter pylori bacteria are not active, and only under favorable conditions, which include inflammatory processes in the mucous membrane, do they actively multiply.

Treatment of antral erosive gastritis involves the mandatory use of proton pump blockers and antacids - drugs whose therapeutic effect is to reduce the level of acidity of gastric juice, since this form of pathology is characterized by increased secretion of hydrochloric acid, which negatively affects the epithelial layer of the mucosa. These are the drugs Almagel, Maalox, Phosphalugel, Nizatidine. During exacerbations good effect observed when using Ranitidine, Famotidine.

A decrease in the acidity of gastric juice sometimes needs to be compensated with enzyme preparations that facilitate the digestion of food (Festal, Maalox). The pain syndrome is relieved by taking antispasmodics, the most popular of which are No-shpa, Papaverine.

Drug treatment of antral gastritis in the erosive form should be combined with a diet. Without following a proper diet drug therapy does not make any sense, since its positive effect is completely neutralized by the use of products that irritate the mucous membrane.

Diet for antral gastritis

If found reliable symptoms erosive antral gastritis, treatment of the pathology should be accompanied by careful adherence to a proper diet.

This means not only the composition of the menu, but also the volume of food consumed, and compliance with general recommendations:

• meals should be fractional (frequent, but in small portions): the number of meals should be increased to 5 - 6;
• You need to learn to chew food as carefully as possible: the preliminary action of enzymes contained in saliva will make it easier for the stomach to digest foods, reduce the load on its glands, and reduce irritation of the mucous membrane;
• The diet recommends eating food heated to human body temperature (too hot food further injures the epithelium, which does not contribute to the healing of inflamed areas, and cold foods take much longer to digest, since appropriate temperature conditions are required for the enzymes to work);
• Most products with a solid consistency should be crushed and consumed in a well-cooked state.

You should avoid fried, spicy, smoked foods and canned food (including homemade food). Spices, spices are also taboo, as are vegetables/fruits with high content fiber. It is not recommended to eat fresh bread made from rye flour, eat sweets, baked goods, strong tea/coffee and carbonated drinks.

First courses should be prepared with water/milk; the use of rich broths (meat/vegetables) is prohibited. Whole milk is also not included in the diet for the treatment of erosive antral gastritis, since it leads to increased gas formation. You should not eat sour berries/fruits, especially citrus fruits, or drinks made from them.

• light cereal soups (possibly including small pieces of lean meat);
• buckwheat porridge, oatmeal, rice, mashed potatoes, pasta made from premium flour;
• low-fat sour cream, kefir, yogurts;
• lean fish/meat, the preferred cooking method is steamed;
• Drinks allowed are weak tea, still mineral water, and dried fruit compotes.

Conclusion

Erosive antral gastritis is a disease that is accompanied by extensive dysfunction of the digestive tract. Without proper treatment, the prognosis is unfavorable - there is a high risk of developing peptic ulcers and stomach cancer. In the chronic form, the disease will have to be treated for about a year, but even during the period of remission you should adhere to the principles of light nutrition (diet No. 5).

Hemorrhagic gastritis is an inflammation in the mucous parts of the stomach, although first disturbances occur in the vessels located there. Erosive-hemorrhagic gastritis causes bleeding from the stomach in the presence of a strong inflammatory process and damage to the gastric mucosa by erosion. Erosive-hemorrhagic gastritis can be a consequence of the usual hemorrhagic “brother” or arise on an independent basis.

Both types of illnesses have acute and chronic forms. The symptoms of these diseases are almost the same, which often leads to confusion with terminology.

As a result of exposure to hemorrhagic gastritis, the gastric mucosa becomes saturated with blood, and bleeding may begin. Blood clots often form in the capillaries passing through this organ. This enhances inflammatory process, leads to erosion. In order to find out about gastritis, what it is, it is better to seek advice from the appropriate doctor.

• 1Causes of the disease
• 2Main symptoms
• 3Factors leading to the development of acute gastritis
• 4Diet food
• 5Conservative treatment

1Causes of the disease

The reasons why the hemorrhagic or erosive type of disease occurs are as follows:

1. Most often, the disease is caused by uncontrolled and improper use by people. various drugs, for example, anti-inflammatory medications, glucocorticoids, analgesics, etc.
2. The disease can develop when eating poor quality foods.
3. Infection of the stomach with salmonella, Helicobacter, and diphtheria bacilli often causes erosive gastritis.
4. Irregularity of nutrition, consumption of a variety of smoked meats, fatty and spicy foods leads to damage to the mucous structure of the gastrointestinal tract with the formation of various defects on it, which then causes erosive gastritis.
5. Too hot food can lead to internal burns, which can then trigger erosive gastritis.
6. The appearance of defects in the gastric mucosa can occur due to severe stress. This is especially common when the patient has chronic psychological trauma.

The development of bleeding is caused by microcirculatory disorders in the capillaries of the stomach, the penetration of blood particles and fragments of cellular structures into the lumen of the gastrointestinal tract.

2Main symptoms

The symptoms of the described type of gastritis are not specific in clinical manifestations. The main symptoms of this disease correspond to almost all types of gastritis or peptic ulcers in the gastrointestinal tract. But there are some differences from other similar diseases. Symptoms of hemorrhagic gastritis may look like this. The patient begins unpleasant pain in the projection of the stomach and epigastric zone, and the person complains of increased pain after finishing eating.

Gastric dyspepsia and nausea may develop. Many patients experience belching and heaviness in the gastrointestinal tract. Patients with this type of gastritis may begin to vomit the stagnant contents of bloody or Brown. Often people with gastritis begin to feel dizzy. The stool that comes out is black.

When examining a patient, doctors note his pallor skin. In the human tongue with gastritis it is formed specific plaque. When palpating the gastric region, the patient complains of severe pain. If the patient develops bleeding, it may cause strong fall blood pressure in the arteries. At the same time, an increase in heart rate is noted.

When diagnosing using fibrogastroduodenoscopy, reliable data are obtained about the places of multiple erosion of the mucous structures of the stomach against the background of their impregnation with blood plasma. The erosions themselves can also bleed. Patients are diagnosed with an increase or decrease in stomach acidity. Blood tests often show anemia, and the Helicobacter test is negative.

3Factors leading to the development of acute gastritis

Acute hemorrhagic gastritis can occur suddenly. If a person has already had it, then the reappearance of the disease takes on a lightning-fast character. This type of disease has brighter clinical manifestations due to a transient inflammatory process, but with it bleeding occurs much less frequently.

Usually, the appearance of this type of lesion is caused by poor quality food or food that has been spoiled due to long-term storage. But such an illness can also occur when food is poisoned with toxins.

Chemicals, heavy metal salts, and poison can provoke acute gastritis. This may result in strong chemical burn on the mucous membranes of the stomach, and this leads to the development of hemorrhagic or erosive gastritis. The same impact can have constant reception low-quality alcoholic drinks.

Often play a provoking role systemic diseases on connective tissues, which occur against the background of ailments that disrupt normal blood circulation in the gastrointestinal tract.

Gastritis can appear due to injuries to the abdomen, or when the stomach is bruised during a closed blunt trauma.

Under the influence of these factors, the development acute gastritis is not associated with the secretory activity of mechanisms in the gastrointestinal tract, and therefore it occurs in a relatively short time. Basically, this is influenced by external factors, which gives clear symptoms of this type of disease.

4Diet food

Diet is one of the main methods of combating the disease, so it is prescribed to all patients with gastritis. Simply following doctors' recommendations when selecting foods and dishes to feed a patient during gastritis in many cases allows him to be protected from repeated manifestations of the disease.

In acute forms of the disease, patients are prescribed diet table No. 1, and after passing crisis period transfer a person to food in the form of table No. 5. The measures taken include the following recommendations for food selection: complete exclusion from the diet of spices, coarse, fatty, spicy, canned, fried, smoked foods. Citrus fruits, sweet products and fresh bread are prohibited. You cannot eat tomatoes, peas, or other legumes.

Products allowed for consumption include: bran bread (you can also use a stale white loaf or crackers), various porridges (rice, oatmeal, buckwheat). The meat is selected without fat and only of dietary grade. It is best to use rabbit and chicken meat in your diet. It is recommended to eat omelet or soft-boiled eggs, various products fermented milk content (low-fat cottage cheese, yogurt, kefir). Boiled vegetable dishes, fruit and berry juices and compotes are required; you can also drink fruit drinks.

Liquid and semi-liquid dishes (broths, various soups, jelly, purees, etc.) should be eaten warm by the patient.

You should not give him hot or very cold food, as this may cause repeated attacks of the disease.

All dishes must be steamed or boiled. The patient should be given food in moderate portions 5-6 times a day. Meal times should be the same. The patient should not overeat, as this will only worsen his situation.

5Conservative treatment

To eliminate this disease, it is mainly used conservative techniques. After gastritis has been diagnosed, treatment of the disease begins with the use of various medications.

To eliminate the disease, drugs are used that reduce the secretion of gastric acid and juice. This creates opportunities to reduce inflammation. Doctors usually recommend drugs to patients such as Dalargin, Omeprazole, Nolpaza, Ranitidine, Kvamatel.

To protect the mucous structures of the gastrointestinal tract from acid in the stomach, medications such as Venter, Phosphalugel, Maalox, etc. can be used.

If bleeding is detected in the patient, it is recommended to drink Vikasol, aminocaproic acids, and Etamsylate.

To facilitate digestive processes, the patient must use medications such as Creon, Pancreatin, Mezim. This enzyme preparations, which eliminate stomach discomfort.

Various vitamin complexes and aloe-based tinctures can be used. Medicines such as Plazmol and Actovegin have proven themselves well.

All these medications should be used in parallel with the prescribed diet.

What is duodenal erosion: pathology clinic and effective treatment

Erosion duodenum- This is a local destruction of the surface epithelial layer of an organ without damage to deep tissues. Timely treatment pathology gives a favorable prognosis - erosive defects of the mucous membrane heal quickly and do not leave scars.

Provoking factors

In most cases, the pathology is characterized by a pronounced picture due to the presence hemorrhagic syndrome. Erosion often occurs in the gastroduodenal region, that is, along with the small intestine, the mucous layer of the stomach is damaged. In this case, the pathology is called erosive gastroduodenitis.

The causes of erosion have now been well studied. The main risk factor is damage to the duodenum by the bacterium Helicobacter pylori, which also colonizes the stomach wall. Typically, defects occur against the background of existing chronic inflammation of the intestine in the area of ​​the bulb or as a result of drug aggression.

Other causes of the disease:

• Acute infectious gastroenteritis, in which symptoms of intoxication of the body and disruption of the digestive system appear. Such a patient needs timely drug treatment, replenishing fluid deficiency, diet.
• Poor nutrition, addiction to spicy foods, hot foods, spices, and alcoholic beverages. Abuse of these products leads to disturbances in stomach acidity and dyspepsia.
• Chronic inflammatory lesion walls of the duodenum, not associated with Helicobacter pylori infection. A long-term inflammatory process leads to the appearance of shallow defects in the mucosa - erosions.
• Long-term treatment with anti-inflammatory drugs, including reserpine, antibiotics, NSAIDs (non-steroidal anti-inflammatory drugs), steroid hormones.

The psycho-emotional factor also contributes to the appearance of erosive areas on the inner wall of the intestine. The development of pathology may be preceded by severe stress, depressive disorder. Treatment is effective only with the use of psychotherapeutic techniques in combination with drug therapy.

Signs

The nature and intensity of symptoms of erosions in the duodenum depends on the severity of the hemorrhagic syndrome (defects in the mucosa are prone to bleeding), the number and size of the defects, and the degree of the inflammatory process.

Manifestations of the disease include:

• painful sensations in the projection area of ​​the duodenum (in the epigastric region);
• nausea, vomiting, sometimes streaked with blood;
• against the background of hidden chronic bleeding from the upper gastrointestinal tract, general malaise and pale skin appear;
• Acute massive bleeding occurs less frequently (sharp pallor, falling system pressure, fainting);
• decrease in hemoglobin level in the blood;

How to treat

Treatment begins with eliminating the causative factor. For this purpose, laboratory, instrumental diagnostics; the patient is examined by a surgeon, gastroenterologist and nutritionist (if necessary, by an infectious disease specialist or immunologist).

With intestinal erosion, there is a deterioration in appetite, since eating is accompanied by pain. Chronic hemorrhagic symptoms and persistent inflammation lead to the appearance of deficiency anemias, which are characterized by damage to the gastrointestinal tract, skin, and nervous system.

These patients can be treated by general practitioners, gastroenterologists, and, less commonly, by surgeons. Modern therapy is aimed at eliminating the root cause of the disease and inflammation of the mucous membrane of 12-PC, relieving dyspepsia. When diagnosing bleeding erosions, hemostatic treatment is carried out.

The most commonly used drugs are:

• antibiotics of the penicillin or macrolide series - for confirmed Helicobacter pylori infection;
• antacids and antisecretory agents (Omez, Phosphalugel, Ranitidine or Maalox) - they neutralize increased acidity, protect the wall of the duodenum and stomach from further damage;
• prokinetics (Cerucal, Domperidone) - medications restore normal motor function of the gastrointestinal tract, eliminate nausea and vomiting;
• injectable vitamins (C, B6, 9 and 12, PP) – strengthen the walls of blood vessels, fight the symptoms of anemia;
• angioprotectors (Etamzilat) – stops internal bleeding. May be injected or taken in tablet form.

The effectiveness of treatment is assessed according to the following criteria:

1. The symptoms of the disease subside (the pain goes away, the patient’s well-being improves significantly). During this period, supportive treatment is continued, a diet and restrictions on physical activity are prescribed.
2. Beginning of healing of superficial erosions; There are no hemorrhagic changes, swelling and redness disappear.
3. Epithelization of chronic affected areas, endoscopic control is carried out.

Complicated erosion

Patients with bleeding are admitted to surgery department. Gastric and duodenal lavage is performed cold water, after which hemostatic drugs and glucose-saline solutions are administered.

At massive blood loss(a rare occurrence for erosions) the patient is prescribed infusions with whole blood and plasma.

Nutrition

Nutritional therapy is extremely necessary for patients with diseases of the duodenum. The diet involves eliminating irritating foods, hot dishes, and alcohol.

The diet is based on the following principles:

• compliance temperature regime when cooking;
• fractional meals;
• preference for liquid and soft foods, soups, cereals and purees;
• all dishes are allowed boiled and steamed;
• excluded fried food, canned products, salted, smoked;
• a therapeutic diet allows you to drink a little milk or kefir, but only with normal bowel movements.

Foods that can provoke increased secretion of gastric juice are prohibited:

• meat and mushrooms, everything salted, fish broths, seasonings, pickled foods, spices;
• rye and fresh bread, baked goods with yeast;
• sorrel, onions, radishes, cabbage, corn;
• products that increase gas formation and provoke pain: carbonated drinks, strong coffee and tea.

Forecast

If a lesion of the duodenum is diagnosed, the patient always needs treatment and medical supervision. Since erosions are superficial defects, they are able to “heal” without leaving scars (the average duration of epithelium renewal in the gastrointestinal tract is 1 month).

If treatment is started in a timely manner and all recommendations are followed, the disease has a favorable outcome, and properly selected prevention will help avoid relapses.

Erosive gastritis is a type of inflammation of the stomach. It is characterized by damage to the mucous membrane with the formation of single or multiple erosions on it without damage to the muscle wall.

Types of erosive gastritis

There are exogenous and endogenous forms of erosive gastritis. Exogenous inflammation of the stomach develops as a result of exposure to external pathogenic factors. Endogenous gastritis occurs due to the influence internal reasons. Mixed inflammation also occurs.
According to the course, erosive gastritis can be acute and chronic. Acute erosions heal within 4-10 days, but with erosive chronic gastritis, mucosal defects can remain for many months. The disease can also be primary or secondary. Primary gastritis with erosions develops against the background of an unaffected stomach in almost healthy people. Secondary inflammation affects individuals with certain pathologies of the digestive tract.
Erosion may appear predominantly in the fundus, body or antrum of the stomach. Erosive antrum gastritis is most often observed, since the antrum is the most lower section organ. It is here that gastric juice can stagnate and corrode the mucous membrane.

Etiology of erosive gastritis

As noted above, erosive-ulcerative gastritis can be caused by external, internal and mixed factors.

External reasons

Exogenous factors include the following:

• various chemical substances(acids and alkalis), which can be taken accidentally or for suicidal purposes;
• some medications (glucocorticoid hormones, anti-inflammatory drugs);
• bacterial agents (diphtheria bacillus, salmonella, etc.);
• errors in nutrition (too rough, spicy food, irregular snacking);
• exposure to high temperatures (for example, drinking too hot).

Note: smoking is a risk factor for erosive and ulcerative lesions of the stomach, since nicotine constricts blood vessels and impairs blood supply.

Internal reasons

Erosion of the stomach can develop as a result of the following background pathologies:

• myocardial infarction;
• reverse flow of bile (reflux gastritis);
• with deposition of uric acid salts on the walls of the stomach;
• diseases with metabolic disorders.

Gastritis of mixed etiology can be caused by some forms of allergies, burns, radiation sickness, stress, etc.

Symptoms of erosive gastritis

The main manifestations of the disease are approximately the same for all species.
With the development of erosive gastritis, symptoms may be as follows:

• abdomen or in the left hypochondrium, which worsen immediately after eating, but can also occur on an empty stomach;
• nausea, vomiting of undigested food mixed with mucus and blood, sometimes the vomit has the appearance of “coffee grounds”, which occurs as a result of the action of gastric juice on the spilled blood;
• absence or a sharp decline appetite;
• sour belching;
• heartburn;
• flatulence;
• stool disorders (diarrhea, sometimes constipation), which often has a dark, almost black color as a result of the admixture of coagulated blood.

Features of exogenous erosions

Helicobacter increases the risk of developing erosive gastritis

With acid or alkaline damage to the stomach, a burn of the esophagus is usually observed, which is manifested by salivation, severe pain behind the sternum, inability to eat due to pain. Erosive-hemorrhagic gastritis of drug etiology is characterized by an almost complete absence pain.
If the disease is bacterial in nature, the temperature may increase, chills, weakness, and headaches may appear. IN severe cases Dehydration develops due to repeated vomiting and diarrhea. Visible mucous membranes become dry, the skin loses elasticity and tone, and blood pressure decreases. With diphtheria damage to the stomach, erosions occur after the diphtheria films are rejected.
Erosive antral gastritis often occurs against the background of Helicobacter pylori infection. The localization of erosions in this case is determined using endoscopy.

Features of endogenous erosive inflammation

If the disease is caused by internal pathologies, then the picture of gastritis is superimposed on the symptoms of the underlying disease. For example, there may be signs of myocardial infarction: very severe burning pain behind the sternum, in the shoulder or arm, weakness, dizziness. At erosive reflux gastritis patients are bothered by bitter belching, vomiting bile, pain in the right hypochondrium.
Chronic with uremic intoxication are accompanied by anemia and edema. Uric acid salts can be deposited not only in the stomach, but also in the pleural, pericardial, abdominal cavities and even on the skin (“uremic powder”).

Signs of gastritis with erosions of mixed etiology

In case of burn disease, microcirculation of blood in the gastric wall is disrupted, which causes the appearance of erosions. Radiation affects the epithelium of the mucous membranes of the gastrointestinal tract, cells are rejected with the formation of erosions and ulcers. In this case, erosive gastritis is combined with infectious complications, radiation erosive enterocolitis. At allergic form inflammation, signs of the disease appear some time after the action of the allergen, most often food products play its role. At the same time, urticaria on the skin, swelling of the face, itching of the mucous membranes of the eyes and mouth may occur.

Acute erosive gastritis

Version: MedElement Disease Directory

Acute hemorrhagic gastritis (K29.0)

Gastroenterology

general information

Short description

Acute gastritis- a term denoting a wide range of conditions accompanied by inflammatory changes in the gastric mucosa. Various etiological factors cause different histological changes, but have a similar clinical picture. Inflammation can affect the entire gastric mucosa (pangastritis) or part of it (for example, antral gastritis).

Acute hemorrhagic gastritis - acute gastritis, morphologically manifested by foci of hemorrhages in the gastric mucosa. Histological signs of inflammation are minimal. Sometimes combined with erosions Erosion is a superficial defect of the mucous membrane or epidermis
mucous membranes are also soaked in blood.

Exacerbation of chronic (already existing gastritis) should be distinguished from acute gastritis. Acute gastritis is almost always hemorrhagic. Chronic gastritis rarely has morphological signs of hemorrhagic gastritis. Non-hemorrhagic acute gastritis is usually associated with Helicobacter pylori infection.

Note. Excluded from this subheading K29.0 and from the entire heading K29:
- Stomach ulcer - K25
- Peptic ulcer of unspecified localization - K27
- Other acute gastritis - K29.1
- Alcoholic gastritis - K29.2
- Other specified non-infectious gastroenteritis and colitis (for example, allergic gastritis) - K52.8
- Abnormal gastrin secretion (Zollinger-Ellison syndrome, hypergastrinemia) - E16.4
- Radiation gastroenteritis and colitis - K52.0
- Toxic gastroenteritis and colitis - K52.1

Classification

There is no uniform classification.

Stand out:
1. Superficial erosive gastritis.
2. Deep erosive gastritis.
3. Hemorrhagic erosive gastritis.

Etiology and pathogenesis

Etiology

1. Medicinal (NSAIDs Non-steroidal anti-inflammatory drugs (non-steroidal anti-inflammatory drugs/agents, NSAIDs, NSAIDs, NSAIDs, NSAIDs) are a group of drugs that have analgesic, antipyretic and anti-inflammatory effects that reduce pain, fever and inflammation.
, aspirin, bisphosphonates).

Pathogenesis acute hemorrhagic gastritis is associated with direct damage to the stomach wall by various agents against the background of an imbalance between damaging and protective factors mucous membrane of the gastrointestinal tract.

Note. Acute gastritis associated with Helicobacter pylori infection is rarely hemorrhagic.

Epidemiology

Age: mostly mature

Sign of prevalence: Rare

Sex ratio(m/f): 3

The data varies. About 3-4% of all upper gastrointestinal bleeding is associated with acute hemorrhagic gastritis.

Risk factors and groups

General risk factors for the development of acute hemorrhagic gastritis:
- immunosuppression Immunosuppression - genetically determined or caused external influence loss of the body's immune system's ability to mount an immune response to a particular antigen.
;
- taking medications that adversely affect the gastric mucosa;
- smoking;
- alcohol abuse.

Risk factors for developing stress gastritis:
- respiratory failure, requiring artificial ventilation lungs;
- liver and kidney diseases accompanied by coagulopathy Coagulopathy - dysfunction of the blood coagulation system
;
- major surgery or trauma, burns, sepsis, injuries to the central nervous system.
Within 24 hours after exposure to these risk factors, erosions of the gastric mucosa often occur. In this case, approximately 30% of patients experience gastrointestinal bleeding, which in 3% of cases is massive and life-threatening.

Clinical picture

Clinical diagnostic criteria

Epigastric pain, nausea, hematemesis, melena, belching, heartburn, dyspepsia

Symptoms, course

Characteristic manifestations acute hemorrhagic gastritis:
- dyspeptic disorders (nausea, vomiting);
- pain in the epigastric region;
- symptoms of gastric bleeding: vomiting coffee grounds(sometimes melena Melena - discharge of feces in the form of a sticky black mass; usually a sign of gastrointestinal bleeding.
), signs of blood loss and anemia.

The early stage of the disease is characterized by scant clinical picture: heartburn, mild pain in the epigastric region, nausea. Patients (often also attending physicians) may mistakenly associate these symptoms with poor nutrition or with an exacerbation of pre-existing chronic diseases of the gastrointestinal tract. As a result, quite often the onset of the disease is marked by gastric bleeding without other symptoms of gastritis. The occurrence of bleeding is caused by the presence of multiple erosions on the gastric mucosa, as well as sweating Sweating is the process of “leakage” of blood plasma through the walls of blood vessels, observed with an increase in the permeability of the latter
blood from the inflamed mucous membrane into the lumen of the stomach.
The tendency to gastric bleeding distinguishes erosive gastritis from other types of acute gastritis.

Diagnostics

1. B medical history you should find out:
- presence of previous gastric bleeding;
- episodes of dyspepsia Dyspepsia is a digestive disorder usually manifested by pain or discomfort in the lower chest or abdomen, which may occur after eating and is sometimes accompanied by nausea or vomiting.
, vomiting, dysphagia;
- weight loss over the past month;
- previously diagnosed ulcers in the gastrointestinal tract (GIT) or peptic ulcer of the stomach and duodenum;
- previously diagnosed dilated veins of the esophagus;
- diseases of the liver, kidneys, of cardio-vascular system;
- fact of existence malignant tumors;
- drinking alcohol;
- taking NSAIDs.

2. Laboratory research allow you to establish the fact of bleeding and estimated blood loss.

3. Clinical examination:
3.1. Diagnosis of arterial hypotension Hypotension is reduced hydrostatic pressure in blood vessels, hollow organs or body cavities.
, orthostatic collapse Orthostatic hypotension (orthostatic collapse, synonym - postural hypotension) is a human condition in which, with a sudden change in body position when standing up or when long standing insufficient blood flow to the brain due to decreased blood pressure
and possible shock (blood pressure, pulse, urine output Diuresis is increased secretion of urine by the kidneys. Usually observed after taking more fluid than the body requires, but can also develop as a result of taking diuretics
, assessment of peripheral circulation).
3.2. Diagnosis of gastrointestinal tract lesions (palpation of the abdomen, digital examination to identify melena).
3.3. Assessment of the patient's condition, prognosis, degree of blood loss, risk of rebleeding on various scales. For example, the Rockall scale.

4. Instrumental methods:

4.1. Fibrogastroduodenoscopy(FGDS) is the “gold standard for diagnosis”. Allows you to make a diagnosis, carry out differential diagnosis with others possible reasons bleeding from the upper digestive tract and perform (if necessary) therapeutic manipulations and biopsy. FGDS should be carried out as early as possible (less than 4 hours from admission) after stabilizing the patient’s condition, in the presence of severe bleeding and suspected bleeding from the veins of the esophagus. If these signs are absent, FGDS can be performed in more time. late dates(12-24 hours).

4.2. Scintigraphy and selective angiography are performed when the source of bleeding is not identified during FGD with a high rate of blood loss in order to identify its localization and differential diagnosis.

4.3. X-ray of the stomach with barium suspension. Relatively constant radiological signs of acute gastritis (regardless of etiology):

4.3.1 Thickening of the folds of the mucous membrane: the size of the folds is more than 5 mm in diameter. The thickness of the folds is assessed on radiographs taken with moderate distension of the stomach.
When identifying of this characteristic In a symptomatic patient, Helicobacter pylori inflammation should be assumed.

4.3.2 Nodularity of the mucous membrane:
- nodes are most often detected in the distal parts of the stomach;
- the nodes have the appearance of epithelialized (healing), but still swollen areas of erosion;
- the nodes have a smaller size and less defined boundaries compared to gastric polyps.

4.3.3 Enlargement of the gastric fields (usually the gastric fields are 1-3 mm in size), resulting from swelling of the mucous membrane due to inflammation.

4.3.4 Erosion is one of the most specific signs. Often localized along the greater curvature of the stomach or near it. May be linear or serpiginous Serpiginous - a term used to describe creeping or extended skin lesions (most common), especially those that have jagged, wavy edges
, accompanied by swelling. They are better visualized with double contrast studies.

4.4. Other instrumental methods are also of auxiliary value (differential diagnosis, diagnosis of concomitant diseases).

Laboratory diagnostics

Mandatory studies:
- blood test to detect anemia;
- biochemical blood test (detection of associated diseases): creatinine, transaminases, alkaline phosphatase, bilirubin;
- examination of feces for occult blood;
- bacteriological and toxicological study vomit, feces, remains of consumed food, scatological examination;
- non-invasive methods for diagnosing H. pylori (differential diagnosis).

Additional Research:
- serological test blood (leukocyte migration inhibition reaction, LRGA RNHA - indirect hemagglutination reaction - is used to determine the concentration of virus-neutralizing antibodies in blood serum and swabs from the mucous membrane respiratory tract
), allowing us to identify diagnostic titers and an increase in antibody titers of probable pathogens of infectious diseases of the gastrointestinal tract;
- immunological studies (to identify the fact of immunosuppression);
- pregnancy test;
- tests for tuberculosis (quantiferon test) and syphilis.

Differential diagnosis

Acute hemorrhagic gastritis should be differentiated from all diseases that can cause acute bleeding from the upper gastrointestinal tract. Anamnesis immediately allows you to exclude iatrogenic injuries, burns, and radiation damage to the stomach.