Erosive gastropathy: antrum, focal, atrophic

Defect of the gastric mucosa in the form of small ulcers up to 1.5 cm in diameter (erosions) can occur both against the background of pronounced inflammatory process (erosive gastritis), and with minimal manifestations of inflammation or without them at all - erosive gastropathy. While this pathology is considered as part of the conclusion of a diagnostic doctor about the results of endoscopy as a secondary damage, resulting from external factors, bad habits or diseases.

[1], [2], [3], [4]

Epidemiology

The introduction of endoscopic research methods into diagnostic practice increased the interest in this pathology, which was previously found only at autopsies. And now research suggests that a significant part of erosive damage is not found in vivo: in 6-28% of sectional samples of stomach and duodenum tissues there are erosive changes. When diagnosing with esophagogastroduodenoscopy, erosive defects of the gastrointestinal mucosa can be detected in 10-25% of patients who underwent examination. In recent years, there has been a trend towards an increase in the frequency of detection of erosive gastropathy. Currently, this pathology is on the second place among the causes of gastroduodenal bleeding after ulcers of the duodenum.

[5], [6], [7], [8], [9], [10], [11]

Risk factors

Erosions on the surface of the gastric mucosa are due to its violation under the influence of various circumstances. In fact, external and internal risk factors or their combination are the main causes of erosive gastropathy:

• long-term therapy with NSAIDs, cardiac, analgesic, antibacterial, hormonal and other drugs (drug gastropathy);
• traumatic damage to the mucous membrane of the stomach, including badly chewed rough food;
• excessive consumption of alcoholic beverages, smoking;
• infection with Helicobacter pylori;
• prolonged habitual stress or a very strong nervous shock, polytrauma;
• gastritis, duodenal ulcer, chronic cholecystitis;
• hyperkinesia of the stomach, intracavitary hypertension;
• periodic duodenogastric reflux;
• sepsis, Zollinger-Ellison syndrome, malignant neoplasms of the colon and rectum, decompensated form of circulatory failure, severe chronic diseases of the kidneys, liver, blood, lungs, diabetes, immune and hormonal disorders (high gastrin, thyrotropic hormone, cortisol), severe surgical interventions;
• hernia of the esophageal aperture of the diaphragm is often complicated by erosive hemorrhagic gastropathy.

Hereditary low resistance of the gastric mucosa to irritants is also taken into account as an etiologic factor.

[12], [13]

Pathogenesis

The pathogenesis of this phenomenon has not yet been studied enough. It is assumed that under the influence of one or more of the above factors, mucus formation and microcirculation of blood in the gastric arteries are violated and, accordingly, mucosal cells experience oxygen starvation. Ischemia of certain areas (focal) or of the whole organ (common) develops, the protective layer of the epithelial surface of the stomach is thinned, and "gaps" are formed in it. According to some reports, under the influence of excess hydrochloric acid, epithelium forms ulcers-small areas of superficial necrosis that do not exceed the boundaries of the muscular layer of the stomach, healing without scarring. However, the role of excess acidity remains controversial. There is evidence that erosive damage, mainly found in individuals with normal and low acidity.

Etiologies of erosion are divided into primary and secondary. Primary, basically, are observed under the influence of external factors in patients sufficiently young and without accompanying pathologies. They pass literally a week after eliminating the irritating factor.

Secondary develop mainly in older patients against a background of severe chronic liver and cardiovascular diseases complicated by tissue hypoxia, metabolic disorders and decreased immunity.

Erosive gastropathy is currently one of the most under-studied pathologies of digestive organs. Many issues of the etiology and pathogenesis of gastric erosions remain open to this day. The lack of clear ideas about the role and place of erosive defects in the stomach and duodenum in the structure of gastroduodenal pathology proves their absence in the last, tenth, reissue of the International Classification of Diseases.

[14], [15]

Symptoms of the erosive gastropathy

In many young patients, acute erosive gastropathy without inflammation of the gastric mucosa or with minimal manifestations of it can go unnoticed without significant symptoms. However, often it occurs with a clear symptomatology. The first signs - heartburn, sour eructation, occasionally - a weak pain syndrome on an empty stomach in the upper abdomen. Acute erosions of the stomach quite often (up to 4.5% of cases) are accompanied by intragastric hemorrhage. As a rule, the formation of acute forms of erosive gastropathy precedes the presence of subepithelial point hemorrhages, which are treated as hemorrhagic erosions. Histology shows a small depth of damage to the gastric mucosa. When the irritant is eliminated, the damaged mucosa epithelizes rapidly - from two days to ten. Acute (flat) erosion with a diameter of not more than two millimeters, as a rule, is localized in the subcardial part and / or the body of the stomach.

Symptoms of erosive gastropathy in chronic forms are expressed by dyspepsia and a significant pain syndrome. Three-quarters of patients complain of heartburn and eructation, often in combination with bloating and a feeling of heaviness on the right under the ribs. Severe pain on an empty stomach in the upper abdomen with chronic erosive gastropathy can often give back to the spine: patients of the younger age group complain of pain blunt and stinging, older - on paroxysmal, with the development of nausea at the time of attack of pain, and also - on constipation. Against this background, there is an increase in the symptomatology of the main pathologies: cardiovascular, such as increased blood pressure, pressing pain behind the sternum, which increases with walking, especially after eating; hepatic - pain in the right hypochondrium, headache, bitter taste in the mouth, yellowness of the skin, increased fatigue. However, it is impossible to establish an accurate diagnosis and the form of erosive gastropathy only on clinical manifestations, it is necessary to perform an FGDS study with the collection of material for histology.

Chronic erosions are localized in the antral part of the stomach, their strings are oriented towards the pylorus - erosive antral gastropathy. They outwardly resemble pimples with a crater, their diameter, usually, up to seven millimeters. In chronic form, the mucous membrane affects almost the same depth as in the acute, the bottom of erosion is often formed by the gastric glands, occasionally reaches the muscle layer. The course of chronic erosion is quite long - from several months to several years. According to the nature of the histological transformations that occur, erosion is classified into immature (quickly healing) and mature - past all stages of papule formation.

Chronic erosive gastropathy proceeds undulating, with alternation of remissions and exacerbations caused by inappropriate nutrition, alcohol, exacerbation of primary diseases. The dynamics of endoscopic observations of patients with erosion suggests that acute and chronic erosion are stages of a single process.

If in the conclusion of esophagogastroduodenoscopy there is a focal (diffuse) erythematous gastropathy, then - this, only, speaks of the hyperemia of the inner surface of the stomach localized on a separate site or across its entire area. It can be observed with superficial gastritis, but additional diagnostic measures are needed to find out the diagnosis and treatment. Redness usually indicates inflammation, most often diagnose superficial gastritis. Quickly taken measures help to restore the normal state of the stomach.

[16], [17], [18], [19], [20]

Forms

The following types of gastropathy are distinguished:

• focal - localized in a limited area of the epithelium;
• diffuse - spread throughout the mucous membrane.

Erythematous gastropathy is provoked, in most cases, by unhealthy food, by non-observance of the diet, by stressful situations, by infection of the gastric mucosa by pathogenic microorganisms. Gynecological diseases, pathologies of the digestive system, bad habits can contribute to its appearance. Virtually all varieties of gastropathies occur against the background of a number of the same causes, and their symptoms are similar. The degree and type of lesions of the surface of the stomach depends on the duration and strength of the stimulus and hereditary predisposition. Irritation of all or part of the surface of the stomach can be accompanied by erosion - erythematous erosive gastropathy.

Erosion-hemorrhagic gastropathy indicates the presence of bleeding from erosions and that their depth reached the blood vessels. Erosive damage to the bottom and also to the anterior and posterior walls of the stomach is safe enough for hemorrhagic manifestations, but with erosions in the zone of low curvature of the stomach, especially multiple and deep, the risk of bleeding increases many times, because there are large arteries. Risk factors for intraventricular bleeding are arterial hypertension, blood clotting disorders, thrombolytic therapy, NSAIDs. Symptoms of the transition of erosions to the hemorrhagic stage are reduced to a decrease in the severity of pain. And the more bleeding erosion, the weaker the pain. This is because the sympathetic nerves approach the stomach along the arteries, and erosion, deepening, destroys first the nerve fibers, then the walls of the vessels.

Vomiting with impurities of bloody particles, veins almost always accompanies erosive-hemorrhagic gastropathy. The amount and color of bloody discharge in the vomit masses is determined by the intensity of bleeding. The brown color of vomit indicates that bleeding is insignificant, for example, by the point penetration of blood (sweat) through the walls of the vessels into the cavity of the stomach.

Intragastric hemorrhage is accompanied by an increase in signs of anemia: fatigue, dizziness, hypotension, shortness of breath, palpitations, pallor of the skin.

There are so little blood loss that does not cause vomiting. However, the particles of blood destroyed by gastric juice are stained in a dark brown, almost black color, feces, this must also be noted.

Erosive-papular gastropathy is usually the result of damage to the gastric membrane as a result of overproduction of sulfuric acid, reducing the protective properties of gastric mucus, Helicobacter pylori infection. This type of gastropathy is determined by the formation of a number of papules with erosions at the apex (aphthous papules).

With the atrophy of the gastric glands, the formation of mucus that protects the epithelium of the stomach decreases. As a reaction to the stimulus (drugs, alcohol) or under the influence of an autoimmune factor, erosion may appear. Atrophic erosive gastropathy also requires additional diagnosis. To determine whether the patient has atrophic gastritis, a histological analysis of the biopsies taken during the endoscopic examination is necessary.

The clinical symptoms of all variations of erosive gastropathies are distinguished by the absence of specificity, except for the expressed hemorrhagic form of the disease. They resemble ulcerative symptoms, and gastrointestinal erosion can only be determined by gastroscopy.

[21], [22], [23], [24], [25]

Complications and consequences

Acute erosive gastropathy, as a rule, after the elimination of the stimulus results in rapid healing, after which no traces remain on the mucous membrane of the stomach.

Chronic process can take a long time for several years, as a rule, with the time of erosion can disappear. Mature, long-term recurrent erosion can be an impetus for the development of polyposis or warty gastritis.

The most dangerous complication of erosive gastropathy is occult bleeding, which for a long time proceeds asymptomatically and leads to significant blood loss.

Deep multiple erosion can cause severe bleeding, requiring immediate medical intervention.

The likelihood of developing an ulcer or stomach cancer from erosion is small and is not confirmed by studies, although there is no one hundred percent guarantee. Rather, the presence of a malignant process is primary. Long-healing erosions, especially those found in elderly patients, give rise to a suspected oncological pathology from the sigmoid or rectum, pancreas or liver.

[26]

Diagnostics of the erosive gastropathy

Identification of acute and chronic erosions is carried out with instrumental diagnostics using an endoscope that allows you to visually detect lesions of the gastric mucosa and take samples of the affected tissue for histological examination, on the basis of which you can get an idea of the nature of erosion.

The gastropathy itself is a consequence of any disturbance in the body, and the main thing in diagnosis is to establish this cause. Most often, erosive gastropathy accompanies gastritis. However, such lesions sometimes manifest themselves oncopathology, so only after a second study of biopsy specimens can one be sure of the good quality of erosion.

Patients must pass the tests: a clinical blood test to determine the presence of anemia, a stool test for the presence of traces of blood. The modern diagnostic method is the blood analysis "gastropanel", which allows to detect Helicobacteriosis (by the presence of antibodies to Helicobacter pylori), the level of Pineinogen I (proenzyme isolated by the fundal glands of the stomach, the precursor of pepsin), the level of gastrin (digestive hormone, which allows to recognize the disturbances in the formation of hydrochloric acid ). It is not enough to limit ourselves only to the study of the functioning and morphology of the stomach. Based on indications, duodenal sounding, X-ray and endoscopic examination of the colon, ultrasound or magnetic resonance examination of the peritoneum organs is prescribed. At the discretion of the attending physician, other diagnostic tests and consultations with specialists (endocrinologist, rheumatologist, cardiologist) are appointed, since erosive gastropathy can be caused by many factors and it is often necessary to treat the underlying disease, for example, cardiovascular pathology or diabetes mellitus.

[27]

Differential diagnosis

Differential diagnosis allows us to distinguish erosive gastropathy as a primary lesion of the gastric mucosa and secondary, caused by other chronic diseases. For example, associated with decompensated diabetes mellitus, in which there is a breakdown in the motor-evacuation function.

Portal, associated with cirrhosis of the liver in the background of portal hypertension, which is characterized by varicose veins of the esophagus, a very common NSAID-gastropathy, caused by the taking of these drugs.

Differentiate also from ulcers and malignant neoplasms of the stomach and duodenum.

Treatment of the erosive gastropathy

Schemes of therapy for chronic erosive gastropathy are selected individually for each patient. At appointment the factors influencing the mechanism of development of disease are considered. Treatment involves, first of all, the elimination of external and internal causes of erosion: cessation of therapy with ulcerogenic drugs, the creation of a more favorable neuro-psychic climate, the rejection of bad habits, the establishment of a normal diet and diet. With erosive gastropathy, caused by chronic pathologies of other organs, the underlying disease is treated.

Persons with erosive hemorrhagic gastropathy, with clinical manifestations of hemorrhage, are hospitalized in a surgical hospital. Bleeding caused by acute erosions of the gastric mucosa, usually capillary. In the majority (90%) - these are bleeding of mild severity.

Treatment of erosive gastropathy, especially of cases with high acidity of gastric juice and ulcerative symptoms, is carried out with antisecretory drugs. Assign inhibitors of the proton pump - Zerocide, Promesol, Nolpaz, Omeprazole in a daily dosage of 40 mg once.

Omeprazole - inhibits the final stage of production of hydrochloric acid in the stomach, promoting the inactivation of the enzyme, which accelerates the exchange of hydrogen ions in the cellular membranes of the gastric glands, regardless of the type of stimulus. The effect comes quickly, its duration depends on the dose of the medicine taken. Contraindicated in pregnant and lactating women. It is extremely rare to cause side effects from the neuro-psychic, digestive, musculoskeletal, genitourinary and hematopoietic system.

Duration of therapy with omeprazole is about a month, with Zollinger-Ellison syndrome, treatment starts with a daily dosage of 60 mg once, during treatment it can be increased by 1.5-2 times and divided into two doses. The duration of the course is individual.

As a drug that reduces the secretion of sulfuric acid, use Famotidine, selectively blocking histamine-H2 receptors. Usually it is taken once a day before bedtime for 40 mg a month and a half. This drug is addictive, so it is canceled, gradually reducing the dose.

Since erosion is often enough to determine the infection of Helicobacter pylori, eradication of these bacteria is carried out - using standard international methods of influencing the source of infection.

Anti-Helicobacter therapy with De-nol, which helps to remove Helicobacteria from the body, and also that removes inflammation and protects the cells from their pathogenic effects, is prescribed . The active ingredient De-nol bismuth subcitrate is distinguished by versatile efficiency. Its astringent properties are due to the ability to precipitate proteins, forming with them chelate compounds that perform a protective and purifying function. Protective film is formed selectively on the affected areas of the mucosa, facilitating their recovery.

Bismuth subcitrate is active against Helicobacter pylori, inhibiting the activity of enzymes in its cells. Interrupting the development of vital reactions, and destroying the structure of the cell membranes of bacteria, leads to their death. The active substance of the drug, thanks to its good solubility, deeply impregnates the mucous layers, destroying the microorganisms under them. At the moment, no strains of Helicobacter pylori, resistant to bismuth subcitrate, have been identified. The drug is able to reduce the acidity of the stomach and inactivate pepsin.

If the infection with Helicobacter pylori is confirmed, then complex treatment is carried out using the following schemes:

1. Triple scheme of first-line therapy: De-Nol - one tablet half an hour before meals; Clarithromycin - 0.5 g; Amoxicillin - 1g. All drugs are taken twice a day, the duration of therapy is one to two weeks.
2. As an alternative, quadrotherapy is used: De-Nol - one tablet half an hour before meals four meals a day; Tetracycline - 0.5 g four meals a day; Metronidazole - 0.5 g three times a day, Omega (omeprazole, nolpase) according to the standard international protocol for the eradication of Helicobacter pylori twice a day.

Antibiotics are also prescribed to kill the source of infection.

Amoxicillin - semisynthetic penicillin, has a pronounced bactericidal effectiveness. The mechanism of action is based on interrupting the production of the building material of the cell wall - peptidoglycan, causing the decomposition of bacteria. How all antibiotics can cause allergic reactions and side effects.

Allowed to replace him in the scheme of treatment of metronidazole at a dose of 0.5 g three times a day. The active substance of the drug in the process of transformation in the body interacts with the DNA of the bacterium and destroys it, suppressing the biosynthesis of the nucleic acids of the microorganism. Metronidazole mutually enhances the effect of antibacterial drugs. This remedy is contraindicated in case of sensitization and leukocyte insufficiency (including in the anamnesis), epileptics, pregnant women (first trimester categorically, second and third - with great caution) and lactating women. People with liver and kidney dysfunction, especially when high doses are needed, should evaluate the benefit / risk ratio.

In specific cases, the therapeutic regimen of treatment can be adjusted by the doctor, taking into account the results of diagnostic studies, bapsides for sensitivity and the general condition of the patient.

If the above schemes did not work, then you can apply therapy with high dosages of Amoxicillin (75 mg four times a day for two weeks) in combination with four times taking high doses of omeprazole.

Another possible option - Metronidazole in the quadratherapy scheme is replaced by Furazolidone (0.1-0.2 g twice daily). Pharmacodynamic properties of this drug are directly proportional to the prescribed dosage, small - they act bacteriostatically, increasing the dose increases bactericidal activity. In addition, it has moderate immunostimulating properties. The antibacterial effect is that 5-nitrofuranol (the active ingredient) is restored under the action of microorganism enzymes to an amino group that is toxic to a wide range of bacteria. It inhibits bacterial important cellular biochemical reactions, which leads to destruction of cell membranes, cell hypoxia and death of pathogenic microorganisms. The active component of the drug disrupts the process of synthesizing the protein structures of the bacterium, thereby inhibiting their reproduction. In addition to what has been said, immunostimulation gives a rapid therapeutic improvement.

Furazlidon has a slight arousal effect and is absolutely incompatible with the use of alcohol. May cause allergy and provoke dyspepsia. Penetrates into breast milk. Pregnant women are prescribed only according to strict indications. To minimize its side effects, it is recommended to drink a significant amount of water when taking it, and also - B vitamins and antihistamines are prescribed simultaneously.

To treat Helicobacteriosis, it is possible to use complex therapy: proton pump inhibitors, Amoxicillin and Rifabutin (0.3 g per day) or Levofloxacin (0.5 g). Determination of the species belonging to the strain of the bacterium and its sensitivity to a specific type of antibacterial drugs will allow to optimize the scheme of therapy.

According to studies, erosive gastropathy under the influence of ulcerogenic drugs develops much more often in patients with Helicobacter pylori than in Hp-negative ones. Therefore, it is recommended before the appointment of these drugs to conduct a study to detect Helicobacteriosis, and Hp-positive patients to prescribe eradication treatment, which does not completely eliminate, but significantly reduces the likelihood of erosion.

Various authors testify that in complex examination of patients with gastric erosions duodenogastric reflux is detected with a frequency of 22.9-85% of cases. Erosion of the gastroduodenal tract provokes violations of motor-evacuation activity of the stomach, which leads to intracavitary hypertension and serious disorders of the pyloric function. Duodenogastric reflux causes an increase in the bile concentration in the stomach, which in turn breaks the protective mucous surface, which facilitates the introduction of Helicobacter pylori into the epithelial membrane of the stomach. This is the basis for the appointment of patients with erosive lesions of gastroduodenal mucosa with gastrointestinal motility regulators (Metoclopramide, Domperidone) and antacid group drugs (Maalox).

Metoclopramide inhibits the sensitivity of dopamine and serotonin receptors. The drug stops vomiting, hiccups and activates the motor activity of the digestive organs, without altering the secretory function of the gastric glands. According to observations, it contributes to the regeneration of erosive and ulcerative lesions of the stomach and duodenum. Vomitive reflexes of the vestibular genesis does not eliminate.

Take orally one tablet three times a day before meals, wholly, with water. In severe cases, injections may be prescribed.

Regulators of the motor function of the gastrointestinal tract tone the musculature of the stomach, cardiac and antral sphincters, stimulate their motor skills, normalize the evacuation of the food lump from the stomach.

Preparations of the antacid group, in particular, Maalox, effectively eliminate the reflux manifestations. They are designed not so much to neutralize hydrochloric acid (with the formation of buffer compounds), but for the adsorption of pepsin, lysolecithin and bile acids, as well as increasing the resistance of the gastric mucosa to the aggressive effects of these substances. The drug absorbs aggressive substances by 60-95%, acting for a long time (up to six hours).

Maalox also has a cytoprotective effect, which is important in the treatment of erosive gastropathy. This occurs during the formation of a protective film of the drug on the epithelium and as a result of an increase in the synthesis of its own prostaglandins in the gastric mucosa, thereby protecting the mucous and epithelial protective surfaces of the stomach.

The third stage of gastric protection is normal microcirculation of blood in the gastric arteries, which provides energy supply to metabolic processes, support the first (mucous) and second (epithelium) defense stages in working condition and regulate timely renewal of the cells of the gastric mucosa.

Restoration of the protective properties of the gastric mucosa is carried out by assigning cytoprotectors. In addition to Maalox, which can be used to restore all three levels of protection, Enprotil or Misoprostol (synthetic prostaglandins), which improve regional circulation, activate mucus , are also used . A similar action is inherent in De-naught.

Prostaglandin derivatives are successfully used in erosion and ulceration therapy schemes, especially in alcohol abusers and smoking patients, when it is not possible to use H2-histamine receptor blockers or long-term therapy with ulcerogenic drugs.

Regional circulation improves Trental, normalizing the rheological properties of blood and cellular respiration. Sometimes used immunostimulants:

• Tactivin is a polypeptide that restores α- and γ-interferon, T-lymphocyte activity, normalizing hemopoiesis and other cytokine performance;
• ß-leukin - provides acceleration of stem cell repair and hemopoiesis;
• Galavit is an immunomodulatory drug with pronounced anti-inflammatory properties.

In some cases, in combination with preparations that reduce the production of hydrochloric acid, in the case of chronic gastric erosions, injections of Solcoseryl (normalizing the processes of tissue metabolism) and Dalargin (antiulcer antacid medication) were effectively used .

With long-term recurrent erosive gastropathy, a vitamin-deficiency state develops. For compensation, multivitamin complex preparations (Undevit, Decamewith), multivitamins with microelements (Oligovit, Duovit) are prescribed.

Deficient conditions of severe degree with the development of a multifactorial anemia require parenteral administration of vitamins B1, B6, B9, B12, C, PP, proteins and iron preparations.

If Helicobacter pylori infection is not detected, therapy with active antisecretory drugs is sufficient. In combination with them, cytoprotectors (forming a protective film over erosions), reparants (stimulating processes of mucosal repair) and antioxidants (vitamin complexes) are prescribed.

Physiotherapeutic treatment of erosive gastropathy is prescribed in the absence of bleeding. In the phase of exacerbation, sinusoidal modulated currents, Bernard's diadynamic currents, microwave and ultrasound therapy, drug electrophoresis (especially with severe pain syndrome), hyperbaric oxygenation, magnetotherapy, galvanization can be assigned. These same procedures are used during the remission period to prevent exacerbations. In the phase of fading exacerbation, local thermal procedures, mud applications, mineral, coniferous, radon, oxygen baths can be prescribed. Successfully applied acupuncture.

Alternative treatment

Alternative treatment is desirable to use only after a medical consultation, since alternative drugs can cause allergies and not be combined with ongoing medical therapy.

Propolis is used to treat erosion, which has good regenerating properties. Propolis (20g) should be kept in the freezer, crushed into powder and pour a glass of milk, dissolve in a water bath, drink in the morning on an empty stomach.

With erosive hemorrhagic gastropathy with any gastric secretion, walnut milk with propolis is used: boil 15 cups of ground volochki nuts in 1 / 4l of milk, drip a few drops of propolis extract into the mixture.

You can take ten drops of freshly squeezed aloe juice each time half an hour before a meal or mix half a teaspoon of aloe gruel with the same amount of flower honey (take freshly prepared before each meal).

Herbal treatment is based on their ability to relieve inflammation, allergies, spasms, relax and eliminate pain. Plants that have astringent, enveloping and haemostatic properties, strengthen the vessels and promote cellular renewal are used to heal erosions. In plant therapy of erosive damage, plantain, chamomile, nettle, marigold, oak bark and buckthorn, calamus root, flax seed are used.

Infusion of flax seed: overnight pour the flax seed (tablespoon) with warm water (50 ° C, 200 ml). In the morning on an empty stomach to drink with the seeds. Take erosion before healing. The gastric mucosa should be completely restored.

Decoction from the bark of oak: a handful of bark boil with a liter of boiling water, on fire ten minutes. Strain, allow to cool, drink ½ cup before meals for half an hour.

Take in the morning on an empty stomach a tablespoon of oil from sea buckthorn berries.

Fresh juice from the leaves of cabbage - on ½ cup before each meal for a third of an hour (reduced acidity).

With increased acidity, fresh potato juice: 1/2 cup before each meal for a third of an hour.

The duration of juice intake is one and a half to two months.

In season it is recommended to eat fresh strawberries and blueberries.

When the exacerbation begins to fade, you can do phytoapplications and baths. They are imposed, mainly, on the epigastric patch. Collection for phytoapplication is prepared based on 1 cm² of body area 50 g of herbal collection. The layer will be about 5 cm. Calculate the amount of collection pour ½ liter of boiling water and douse on a water bath under the lid for a quarter of an hour or slightly more. Infusion strain and squeeze (you can use to make a bath), warm (≈40 ° C) cake to wrap in a piece of gauze folded several times or in a natural napkin. Distribute the body area in the epigastric zone, cover with food film (oilcloth), and on top - with a wool blanket. Get a herbal compress, lie down with him for twenty minutes.

For the bath you can use a strained infusion, you can prepare it differently: 200 g of phytospora pour two liters of boiling water, insist for about two hours, warm, wrapping the dishes with a warm cloth. The water temperature in the bath is 36-37 ° C, the duration of stay is 15 minutes, do not bathe more than three times a week.

Phytosbora: one tablespoon of celandine herb, two - herbs of the lungwort, elecampane, mother-and-stepmother, licorice root; four - flowers of chamomile and calendula, grass swotty marsh.

These procedures are contraindicated in case of fever, heat, severe circulatory system disorders, tuberculosis, bleeding, hematopoiesis, expressed psycho-neurological disorders, and also to pregnant women.

Homeopathy can give a stable and good result, but homoeopathic medicine should be prescribed by a homeopathic physician, individually, since for individual purposes very many factors seemingly that are not related to the disease - from the state of memory to the color of the hair - are taken into account.

For example, Anacardium (Anacardium) is used in cases of increased acidity of the stomach, hungry pains giving in the back; patients are irritable, have conflicting desires, never satisfied.

Argentum nitricum (Argentum nitricum) - pain syndrome, occult hemorrhage, flatulence and heartburn.

Arnica, Lachesis, Ferrum aceticum and Ferrum phosphoriucum (Farrum Aceticum and Phosphoricum) are occult bleedings.

Among the complex homeopathic preparations of Heel brand there are several intended for the treatment of chronic lesions of the gastrointestinal mucosa:

• Gastricumel, tablets sublingual, in their composition often used homeopathic preparations, prescribed for various symptoms of chronic diseases of the gastrointestinal tract of varying severity and localization (Argentum nitricum, Arsenicum album, Pulsatilla, Nux vomica, Carbo vegetabilis, Antimonium crudum). One tablet should be kept under the tongue until it dissolves. The drug is taken 30 minutes before meals or an hour after. In acute conditions you can resolve one piece every quarter of an hour, but the daily dose should not exceed 12 tablets. Duration of treatment is two or three weeks. Repeated course - on the advice of a doctor. It is possible to use children from the age of three, during gestation and lactation - under medical supervision. Sensitization is not excluded. A combination with other medications is acceptable.
• Nux vomica-homaccord (Nux vomica-Homaccord) - homeopathic drops, consisting of the following ingredients:

Nuks vomica (vomit), is shown in cases of inflammatory processes of the mucosal epithelium of all digestive organs from the top down, as well as to eliminate the consequences of substance abuse;

Bryonia (white perestupen), is indicated for chronic inflammations of the stomach, accompanied by excessive gassing, diarrhea, pain;

Lycopodium (clavate buoyant) - a means for the treatment of the biliary excretory system and liver, restoration of the tone of the musculature of the intestine and elimination of constipation, as well as the normalization of the neuropsychic state;

Kolotsintis (bitter gourd) - a remedy to relieve spasms of digestive organs, inflammation and intoxication, which has a laxative effect.

A single dosage for adults is 10 drops, diluted in 0.1 g of water. Drink, holding in your mouth, thrice a day. Children up to two years old - three drops per appointment; from two to six - five. Take a quarter of an hour before a meal or an hour after. Pregnant and lactating women should not be used. Allergic reactions are possible.

[28], [29]

Operative treatment

Surgical intervention in erosive gastropathy is performed in cases of severe symptoms of gastric bleeding, which can not be stopped and its cause eliminated.

The risk factor for gastric bleeding is erosive hemorrhagic gastropathy, when the erosion is already sufficiently deep and reached the bedding layer of the blood vessels. Surgery is indicated for patients with non-curable pain syndrome and bleeding. Its volume is determined by the state of the organ and can consist of stitching the areas with bleeding that has opened, sometimes in the removal of part of the stomach.

In some cases, it is possible to avoid surgical intervention, using the method of endoscopic treatment. This is a modern method, it is prescribed individually, conducted in surgical hospitals. This method allows directly through the endoscope to treat erosion with drugs or a laser beam. It is prescribed to patients in cases when there are no complications (for example, obstruction) and conservative treatment is ineffective. The result of treatment is the rapid healing of erosions, and the onset of prolonged remission, the patient gets rid of the possibility of complications (bleeding, malignancies).

In case of erosive gastropathy

Successful treatment of erosive lesions of the stomach is impossible without observing certain rules of nutrition. First, getting an advisory opinion: "erosive gastropathy" is an excuse for any sane person to completely abandon alcohol and tobacco products. To erosion quickly healed, and the gastric mucosa as much as possible recovered, it should be taken care of.

Eat small meals several times a day, preferably five to six. Food should not be baking hot or cold (≈45 ° C).

In the diet should not include foods that irritate the gastric mucosa. It excludes fatty, smoked, salted, spicy dishes, strong meat and fish broths, mushrooms, fresh dough products, buttery biscuits, biscuits. During the acute state it is forbidden to eat raw fruits, vegetables, chocolate, drink strong tea, coffee and carbonated drinks. At this time, the food should be mashed, cooked steamed or boiled. This regime should be eaten for about three days, then the food is not rubbed, but the principles of fractional nutrition remain, gradually introduced fresh vegetables and fruits, stewed and baked meat and vegetable dishes, but without crispy crust. Obligatory products are low-fat cheese, butter, low-fat sour cream, cottage cheese, milk or sour-milk non-fatty drinks. The use of these products stimulates the synthesis of enzymes, the catalysts for the restoration of the gastric mucosa. The usual attributes of dietary nutrition are steamed croissants and cutlets, crumbly and milk porridges (oatmeal, buckwheat, semolina), eggs boiled soft-boiled, steam omelette, gizzard and soup puree are also relevant for erosive gastropathy.

These are the basic principles, and a specific diet for this pathology is appointed depending on the causes that caused it.

If it is Helicobacter pylori, then in dietary nutrition, you need to include more bright vegetables and fruits containing flavonoids, as well as sulforaphane (an antagonist of this bacterium). It is found in kohlrabi, broccoli, cauliflower, watercress. Vegetables should not be short for a couple. If the acidity is increased - then before meals you can drink a decoction of flaxseed, lowered - you can eat citrus, drink carrot and cabbage juice, infusion of plantain leaves.

Decoction of flax seeds or a tablespoon of sea buckthorn oil before eating will not be superfluous and with erosions, provoked by the herpes virus.

When Duodenogastric reflux is usually appointed table number 5, because it is associated with the pathology of outflow of bile. This diet excludes "three F" - fatty, fried and egg yolks.

Acute erosions associated with alcohol or drug intoxication suggest daily fasting with abundant drink and a gradual transition to normal diet.

Diet with erosive gastropathy is quite individual, take into account all the nuances and tell what to focus on, only the attending physician can. The main thing is not to starve and not overeat, include a variety of foods in the diet and provide the body with the necessary set of vitamins, minerals and nutrients.

Prevention

The most important thing in preventing gastric erosions, like most other diseases, is the preference for bad habits of a healthy lifestyle. Do not abuse alcohol, especially on an empty stomach, since such drinks are aggressive to the mucous membranes. It is also recommended to refuse smoking because nicotine has a vasoconstrictive effect, the organs and tissues of smokers constantly experience hypoxia.

You need to monitor your diet, try to eat quality foods, eat regularly, do not go hungry for a long time and do not overeat. Learn not to rush for food and thoroughly chew food.

If therapy with ulcerogenic drugs is prescribed, good prophylaxis will take them after eating, and before eating, or at least before taking the drug, drink half a glass of infusion or decoction from the flax seed.

According to specialists, erosive lesions of the gastric mucosa are most often diagnosed in persons with severe chronic diseases, patients taking non-steroidal anti-inflammatory drugs and actively drinking alcoholics.

[30], [31], [32]

Forecast

In time, the treatment started and the responsible attitude to one's own health, including adherence to the doctor's recommendations and the rejection of bad habits, usually ends with the restoration of the mucous membrane. According to observations of specialists, only a small part of erosive defects recur. In most patients recurrent erosions were not observed. Even erosion complicated by polyposive sprouting after surgery does not usually recur, and the prognosis is favorable in most cases.

[33], [34], [35]