Congestive gastropathy: antral, erythematous, gastric body and antrum

All inflammatory processes of the stomach can be divided into gastritis and gastropathy. The term "gastritis" corresponds to inflammation in which the mucous membrane of the stomach is affected. Gastropathy is defined as a condition when the inner surface of the stomach is not affected or is minimally affected by inflammation, but there is damage and regeneration of epithelial cells. Congestive gastropathy means a violation of the motility of the stomach and the processes of food passage through the digestive tract and its entry into the small intestine.

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Epidemiology

There are studies that provide a picture of the epidemiology of congestive gastropathy based on the causes of its occurrence. Thus, the disease complicated by ulcerative manifestations was observed in 24% of patients taking NSAIDs. If we consider that 5% of people in the world take these drugs, then this is a high prevalence of the disease. In stressful situations resulting from various injuries, burns, operations, erosions and ulcers appear in 65-80% of patients. Portal hypertension gave a clinical picture of congestive gastropathy in 9-80% of those studied, and cirrhosis of the liver - in 20-90% of observations. Such a large gap in data is explained by the lack of uniform criteria for classification and interpretation of the detected lesions. In any case, taking into account the hidden symptoms of the disease in its initial stages, this is far from a complete picture of the epidemiology of the disease.

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Causes congestive gastropathy

The causes of congestive gastropathy are:

• taking medications, including non-steroidal anti-inflammatory drugs (NSAIDs);
• a tumor of the pancreas that causes elevated levels of gastrin in the blood;
• liver cirrhosis and portal hypertension (obstruction of blood flow in the portal vein), accompanied by petechial hemorrhages;
• burn (causes Curling's ulcer);
• severe head injuries (causes stress ulcers);
• bile reflux (bile from the duodenum into the stomach).

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Risk factors

Risk factors for the development of congestive gastropathy include:

• alcohol;
• smoking;
• age after 60 years;
• chronic diseases;
• Helicobacter pylori;
• peptic ulcer, which occurs under the influence of gastric juice;
• uncontrolled or prolonged use of painkillers, anti-inflammatory drugs, antipyretics.

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Pathogenesis

The pathogenesis of the disease is that food, getting into the stomach, cannot be fully processed, most often due to a lack of enzymes. The volume of the mucous increases, the folds become thicker, higher, curved. Mucus accumulations appear between them. Against this background, the pattern of vessels forming a mosaic picture is more clearly distinguished. Growths can form on the thickenings of the folds. In addition, if the sphincter is weakened, bile is thrown from the duodenum into the stomach along with a lump of food (chyme). As a result, the walls of the stomach are damaged, since each section of the gastrointestinal tract has its own active substances and enzymes that are unable to digest food from another zone. Getting into an environment that is not natural to it, chyme negatively affects the mucous membrane, its further movement is hindered, atrophy and damage to the internal parts of the stomach occurs.

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Symptoms congestive gastropathy

At the first stages of the disease, the symptoms may not have clear manifestations indicating the presence of congestive gastropathy. Later, it makes itself known with a whole range of dyspeptic phenomena: nausea, sometimes vomiting, loss of appetite, weakness. In the case of duodenogastric reflux (throwing bile from the duodenum into the stomach), there are painful sensations when palpating the abdomen, heaviness in the stomach, belching, the tongue is coated with a yellow coating.

The first signs of the existence of congestive gastropathy often appear already at the stage of complications in the form of gastric bleeding. Symptoms common to gastritis may also occur, manifested by heaviness of the stomach, belching, heartburn.

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Forms

Congestive gastropathy is divided into two types:

• mild degree, in which the gastric mucosa is characterized by a mosaic pattern, and the likelihood of bleeding ranges from 3% to 30%;
• severe, with diffuse red spots and submucosal hemorrhages present against the background of a mosaic pattern, the risk of bleeding is from 40 to 60%.

Congestive antral gastropathy

The lower part of the stomach, adjacent to the duodenum, is called the antral. Its main task is mixing, grinding food into particles 1.5-2 mm in size and pushing it through the pyloric sphincter into the duodenum. At its very beginning, the antral glands produce alkaline secretion, with the help of which the action of hydrochloric acid is neutralized. When the speed of food movement through the digestive tract decreases, stagnant processes occur, leading to fermentation, excessive secretion of hydrochloric acid and its chemical effect on the walls of the stomach. This can lead to the formation of an ulcer in the antral section, which will make itself known by night pain, heartburn, pain in the epigastric region, vomiting. Complications in the form of bleeding are possible, indicating perforation.

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Focal congestive gastropathy

Characterized by separate local reddenings, most often against the background of superficial gastritis. Ignoring the problem can lead to the formation of an ulcer.

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Erythematous congestive gastropathy

It is a pathological change in the gastric mucosa and looks like redness of individual sections (focal) or larger areas (diffuse). Doctors often do not call it a disease, but only a precursor to gastritis. When examining the surface of the stomach with an endoscope, redness (erythema) is detected, which signals the presence of pathology. How quickly this will progress depends on the body's resistance and the duration of exposure to negative factors.

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Severe congestive gastropathy

The inner surface of the healthy stomach lining is pale or pale pink. In the process of congestive gastropathy, healthy areas alternate with damaged ones, which makes the surface of the stomach granular, similar to a mosaic pattern. Severe congestive gastropathy is characterized by hyperamia - a clearly defined vascular network, which manifests itself as local inflamed areas of red color and during endoscopy can be mistaken for an ulcer.

Complications and consequences

Congestive gastropathy is characterized by a tendency to complications. Unfortunately, the disease is often detected only at the stage when bleeding occurs. Half of the patients have ulcerative defects, some patients have erosions, acute gastric ulcers, and their perforation. The most dangerous consequence and complication is the development of a malignant tumor.

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Diagnostics congestive gastropathy

A distinctive feature of congestive gastropathy is the atypical nature of its symptoms, which complicates diagnosis. The doctor's actions in establishing a diagnosis are based on general clinical methods (finding out the history of the disease, examining the patient), laboratory tests, choosing instrumental diagnostics, analyzing the results of the study, differentiating it from other diseases. Although the main method that allows establishing the correct diagnosis is instrumental and differential diagnostics, all data obtained as a result of the examination are compared and analyzed.

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Tests

Laboratory studies are based on general and detailed blood tests, biochemical tests, and enzyme immunoassay. Low hemoglobin is typical for congestive gastropathy. With portal hypertension, which has caused congestive gastropathy, a decrease in the platelet level is detected.

Histological analysis will provide a picture of the nature of damage to the stomach walls.

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Instrumental diagnostics

Fibrogastroduodenoscopy makes it possible to assess the condition of the gastric mucosa. A flexible optical device inserted through the mouth makes it possible not only to visually assess the condition of the mucosa, but also to take samples for biopsy, which will later become material for histological studies. Both abnormal areas and adjacent healthy ones are subject to biopsy. Ultrasound and computed tomography of the abdominal cavity, and radiography of the upper gastrointestinal tract are also used in the process of examining the stomach.

Differential diagnosis

Differential diagnostics of congestive gastropathy is not an easy task, since its symptoms overlap with other pathologies of the gastroduodenal region. Fibrogastroduodenoscopy makes it possible to visually and with the help of biopsy to make an accurate diagnosis. The most characteristic sign of the disease is an increase in volume, diffuse hyperemia of the mucosa, but the diagnosis is finally confirmed by studying the material taken for biopsy. These tests will help differentiate the disease from gastric polyposis. Since the frequent culprits of the disease are the use of NSAIDs and other drugs, it is necessary to separate drug-induced gastropathy from a number of other diseases. When an ulcer of the gastric mucosa is detected, it is worth excluding relapses of the old, "senile" ulcer, tumors. Also, the absence of markers for Helicobacter pylori will give a negative answer to the presence of infection.

Treatment congestive gastropathy

Congestive gastropathy is most often secondary in nature, the causes of its occurrence are listed above. Therefore, treatment should primarily be aimed at eradicating them. There are many drugs for treating the disease: histamine H2 receptor blockers, antacids, cytoprotectors, proton pump inhibitors, antibiotics, drugs that improve blood circulation. The doctor's task is to select an effective remedy that has the least side effects on the patient's body. The main role in the treatment of congestive gastropathy is given to substances that block the production of hydrochloric acid - the main damaging acid-peptic factor. The most effective of them are proton pump inhibitors (PPIs).

Medicines

Proton pump inhibitors block the enzyme involved in the secretion of hydrochloric acid. It takes up to 18 hours for its production to resume. After the end of the course of treatment, the secretion blockade continues for another week. In addition, they have low interaction with other drugs, they are quite safe for long-term use, all this makes PPIs preferable to other substances. PPI drugs include such drugs as rabeprazole, lansoprazole, omeprazole, pantoprazole.

Rabeprazole - film-coated tablets, single dose 10-20 mg. Treatment regimen: frequency and duration of administration is determined by the doctor. Contraindicated for pregnant and nursing mothers, as well as in case of individual intolerance. Side effects may occur in the form of nausea, vomiting, belching, flatulence, constipation, dizziness, insomnia, there may be a cough.

Lansoprazole - capsules, taken orally 30 mg once a day. The duration of the course of treatment is 4 weeks. If necessary, it can be extended for another 2-4 weeks. It has contraindications during pregnancy in the first trimester, during lactation, and in case of allergy to the drug. Side effects are minor - rarely rashes on the body, diarrhea, constipation.

There are 5 generations of H2-histamine receptor blockers. These include cimetidine, ranitidine, famotidine, quamatel, roxatidine, etc.

Kvamatel is a white powder and a transparent solvent for the preparation of injections. It is administered intravenously, at a dose of 20-40 mg it suppresses the production of hydrochloric acid for 10-12 hours. It is recommended to inject 20 mg twice a day. Contraindicated in case of hypersensitivity, pregnancy, breastfeeding, children, malignant neoplasms. When taking the drug, dry mouth, nausea, abdominal discomfort, increased fatigue, allergic reactions may occur.

Antacid drugs are represented on the pharmaceutical market by such drugs as Alka-Seltzer, Almagel, Gastal, Gasterin, Maalox, sodium bicarbonate, Rennie, Phosphalugel, etc.

Rennie - tablets, the effect of which occurs in 3-5 minutes. Chew in the mouth or hold until completely dissolved. Single dose - 1-2 tablets, but no more than 16 per day. Repeated intake can be 3 hours after the previous one. Not recommended for renal failure, hypercalcemia, hypersensitivity to the drug. Rare side effects may occur in the form of skin rashes. It is not dangerous for pregnant women.

The task of cytoprotectors is to ensure the integrity of the gastric mucosa and its resistance to aggressive environments. Such agents include bismuth preparations: de-nol, sucralfate, misoprostol, pentoxifylline.

Sucralfate is available in tablets, gel form, and suspension. A single dose of 0.5 g is taken 4 times a day, or 2 doses of 1 g can be taken. The duration of therapy is one to one and a half months. If necessary, it can be extended to 3 months. Contraindicated in case of allergies to the components, in children under 4 years of age, and in case of renal failure. The use of the drug may be accompanied by nausea, vomiting, dry mouth, headaches, and skin allergies.

Vitamins

Congestive gastropathy often leads to inhibition of vitamin B12 (cyanocobalamin) absorption, which results in its deficiency in the body. Cyanocobalamin plays a very important role in human life processes: normalization of fat metabolism, hydrogen transfer, protein production, anabolic action, strengthening of the immune system, regulation of hematopoietic processes, normalization of blood pressure, support of reproductive function. Its deficiency leads to chronic fatigue, tinnitus, dizziness, headaches, deterioration of vision, decreased mental abilities, emotional depression. The vitamin can be administered subcutaneously, intramuscularly and intravenously once or twice a day. A single dose is 0.1-0.2 g. It is poorly absorbed, but simultaneous administration with folic acid improves this process. Vitamin B12 is found in such products as seaweed, liver, soy, milk, cheese, eggs, beef, poultry, fish. Parallel intake with large amounts of vitamin C reduces its absorption from food.

Physiotherapy treatment

Physiotherapeutic treatment of congestive gastropathy should primarily include physical exercises and breathing exercises aimed at strengthening the muscle tissue of the internal digestive organs and abdominal muscles. Moderate physical activity and dosed walking in the fresh air tone the body well, enhance motility and improve blood supply to the stomach. In the presence of pain, electrophoresis with novocaine, papaverine is used. Thermal procedures in the presence of erosions, ulcers, polyps are not used. Of the balneological procedures, mineral waters are recommended internally and baths from them. For treatment, the temperature of the water and the time of intake relative to food intake are of great importance. For congestive gastropathy, half a glass of warm mineral water is taken internally 1-1.5 hours before meals. In the event of bleeding, ulcers degenerated into malignant tumors, water therapy is contraindicated.

Folk remedies

Traditional medicine offers its own recipes for treating congestive gastropathy, which are used in combination with the main treatment. One of them is a spoonful of unrefined vegetable oil, preferably olive oil, on an empty stomach before meals. Shilajit dissolved in milk is also used. Take a third of a glass before meals for 10 days. After a three-day break, you can repeat. Many traditional recipes mention honey. Here are a few: add a teaspoon of honey to half a glass of warm oat broth (1 glass of grains per liter of water, simmer over low heat for 2-2.5 hours), take 20 minutes before meals; add honey to carrot juice, drink ¼ glass 3 times a day before meals; stir a teaspoon of honey in 100 ml of fresh potato juice, take on an empty stomach several times a day.

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Herbal treatment

When using herbs for treatment, it is necessary to pay attention to the nature of their effect on the mucous membrane - whether they inhibit the production of gastric juice or promote it. So, for low acidity, calamus is used: the rhizome of the plant is crushed, a teaspoon is placed in a glass of boiling water, and infused for half an hour. Drink a third of a glass before meals. Aloe is very popular in the treatment of gastritis and gastropathy. This plant has a bactericidal, anti-inflammatory, and immunostimulating effect. It has a good therapeutic effect on erosions, high acidity, and heals inflamed areas of the mucous membrane. To obtain juice, use a plant that is at least 3 years old. Drink fresh juice 30 minutes before meals, a teaspoon at a time, and you can add honey. Calendula has a soft but strong positive effect on the organs of the gastrointestinal tract. Calendula infusion (2 tablespoons per liter of water) is drunk before meals 3-4 times a day. Combinations with other herbs that help with congestive gastropathy are possible: chamomile, yarrow, St. John's wort, marshmallow root, etc.

Homeopathy

Homeopathy, along with other conservative treatment methods, is used to combat congestive gastropathy. It is armed with such drugs as gastricumel, gastro-gran, gastrokind, iberogast, mercurid, yazbin, etc.

Gastro-gran has a wide range of action on gastrointestinal tract pathologies. During exacerbations, place 7 granules under the tongue 3-5 times a day. During remission, 5 granules twice a day are enough, for prevention - 5 pieces once in the morning on an empty stomach. No side effects have been identified, there are no contraindications.

Gastrokind - normalizes the digestive system, eliminates heaviness in the stomach, nausea, flatulence. It is used in pediatrics. Children under 6 years of age are prescribed one tablet under the tongue or crushed up to 5 times a day half an hour before or after meals, older - 2 tablets up to 6 times a day. Contraindicated in patients with hypersensitivity to the components of the drug and with lactase deficiency. At the initial stage of treatment, an allergy may occur. In this case, it is necessary to reduce the dose.

Iberogast - normalizes peristalsis of the gastrointestinal tract, reduces symptoms of dyspepsia, spasms. Dose for children - 6-15 drops, depending on age, before meals 3 times a day; 20 drops for adults, washed down with a small amount of water. Contraindication is individual intolerance to the drug. Side effects in the form of nausea, vomiting, allergies are possible.

Mercurid is indicated for gastritis, ulcerative gastrointestinal tract phenomena, polyps. The recommended dose is 3 granules 3 times a day for children, 7 granules for adults. The drug is taken 15 minutes before meals or an hour after. The course of treatment is up to a month.

Yazbin - made from ingredients of plant and animal origin with cytoprotective, anti-inflammatory action, stimulates the digestive process. Take 15-20 minutes before meals, 2 tablets 2 times a day. Rarely, a side effect may occur in the form of nausea, diarrhea, skin rashes. Contraindicated for children under 10 years of age, with ulcerative bleeding, esophageal varices, pregnant women and during lactation.

Surgical treatment

In the case of congestive gastropathy, there are cases that require surgical intervention. Surgical treatment consists of removing the damaged areas of the stomach. A full-fledged operation can be performed or a laparoscopic method can be used. The latter is called a hybrid operation or a manual-assisted operation. Special devices are inserted inside through small incisions, the surgeon controls them, monitoring his actions on the monitor, performing the necessary manipulations, for example, to excise an ulcer or remove a tumor. Such operations are not very common yet, but they are very effective, since they significantly reduce the duration and trauma of the intervention.

Diet for congestive gastropathy

One of the important conditions for successful treatment of congestive gastropathy is diet. In this case, strict restrictions in food are not required, but it is necessary to refrain from eating foods that irritate the mucous membrane, coarse food. The main recipe is not to eat large amounts of food, taking breaks of 2-3 hours between meals. It is necessary to refrain from spicy, fatty, very hot and cold foods.

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Prevention

The best prevention of congestive gastropathy is a healthy lifestyle and the eradication of bad habits. It is also important not to overload the stomach with food that irritates the gastric mucosa. Eat on time, split portions, and avoid dry foods.

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Forecast

The prognosis of congestive gastropathy depends on the causes that caused it. Thus, if the disease is provoked by taking NSAIDs or other drugs, then when they are canceled or replaced with lighter ones and when measures are taken to eliminate the disease, the prognosis is favorable. When congestive gastropathy develops against the background of tumors, cirrhosis, portal hypertension, the prognosis depends on the state of the primary disease. Timely detection of the disease gives a chance for a speedy recovery.

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