Erosive gastropathy: antral, focal, atrophic

A 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 a pronounced inflammatory process (erosive gastritis), and with minimal manifestations of inflammation or without them at all - erosive gastropathy. For now, this pathology is considered within the framework of the conclusion of the diagnostician on the results of endoscopy as secondary damage that appeared as a result of external factors, bad habits or diseases.

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Epidemiology

The introduction of endoscopic methods of examination into diagnostic practice has increased interest in this pathology, which was previously detected only during autopsies. And currently, studies indicate that a significant portion of erosive lesions are not detected during life: erosive changes are observed in 6–28% of autopsy samples of stomach and duodenal tissue. When diagnosing with esophagogastroduodenoscopy, erosive defects of the gastrointestinal mucosa can be detected in 10–25% of patients who have undergone examination. In recent years, there has been a tendency toward an increase in the frequency of detection of erosive gastropathy. Currently, this pathology is in second place among the causes of gastroduodenal bleeding after duodenal ulcers.

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Risk factors

Erosions on the surface of the gastric mucosa occur as a result of its disruption under the influence of various circumstances. In essence, external and internal risk factors or their combination are the main causes of erosive gastropathy:

• long-term therapy with NSAIDs, cardiac, pain-relieving, antibacterial, hormonal and other drugs (drug-induced gastropathy);
• traumatic damage to the gastric mucosa, including from poorly chewed coarse food;
• excessive consumption of alcohol, smoking;
• Helicobacter pylori infection;
• prolonged habitual stress or very severe nervous shock, multiple trauma;
• gastritis, duodenal ulcer, chronic cholecystitis;
• gastric hyperkinesia, 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 mellitus, immune and hormonal disorders (high levels of gastrin, thyroid-stimulating hormone, cortisol), serious surgical interventions;
• Hernia of the esophageal opening 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 etiological factor.

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Pathogenesis

The pathogenesis of this phenomenon has not yet been sufficiently studied. It is assumed that under the influence of one or several of the above factors, mucus formation and blood microcirculation in the gastric arteries are disrupted and, accordingly, the cells of the mucous membrane experience oxygen starvation. Ischemia of individual areas (focal) or the entire organ (widespread) develops, the protective layer of the epithelial surface of the stomach becomes thinner, and "gaps" are formed in it. According to some data, under the influence of excess hydrochloric acid, ulcers are formed on the epithelium - small areas of superficial necrosis that do not go beyond the boundaries of the muscular layer of the stomach, healing without scars. However, the role of excess acidity remains controversial. There is data that erosive lesions were mainly found in people with normal and low acidity.

Etiologically, erosions are divided into primary and secondary. Primary ones are mainly observed under the influence of external factors in patients who are quite young and without concomitant pathologies. They pass literally within a week after the elimination of the irritating factor.

Secondary ones develop mainly in older patients against the 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 insufficiently studied pathologies of the digestive organs. Many questions of the etiology and pathogenesis of gastric erosions remain open today. The lack of clear ideas about the role and place of erosive defects of the stomach and duodenum in the structure of gastroduodenal pathology is also proven by their absence in the latest, tenth, reprint of the International Classification of Diseases.

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Symptoms erosive gastropathy

In many young patients, acute erosive gastropathy without inflammation of the gastric mucosa or with minimal manifestations thereof may proceed unnoticed without pronounced symptoms. However, it often proceeds with distinct symptoms. The first signs are heartburn, sour belching, and occasionally a mild pain syndrome on an empty stomach in the upper abdomen. Acute gastric erosions are quite often (up to 4.5% of cases) accompanied by intragastric bleeding. As a rule, the formation of acute forms of erosive gastropathy is preceded by the presence of subepithelial punctate hemorrhages, which are interpreted as hemorrhagic erosions. Histology shows a small depth of damage to the gastric mucosa. When the irritating agent is eliminated, the damaged mucosa is quickly epithelialized - from two to ten days. Acute (flat) erosions with a diameter of no more than two millimeters are usually localized in the subcardial part and / or body of the stomach.

Symptoms of chronic erosive gastropathy are expressed by dyspeptic and significant pain syndrome. Three quarters of patients complain of heartburn and belching, often in combination with bloating and a feeling of heaviness on the right side under the ribs. Severe pain on an empty stomach in the upper abdomen with chronic erosive gastropathy can often radiate to the spine: younger patients complain of dull and aching pain, older patients - of paroxysmal pain, with the development of nausea at the time of an attack of pain, as well as constipation. Against this background, an increase in the symptoms of the main pathologies is noted: cardiovascular, such as high blood pressure, pressing pain behind the sternum, intensifying when walking, especially after eating; liver - pain in the right hypochondrium, headache, bitterness in the mouth, yellowness of the skin, increased fatigue. However, it is impossible to establish an accurate diagnosis and form of erosive gastropathy based only on clinical manifestations; an FGDS study with the collection of material for histology is necessary.

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

Chronic erosive gastropathy proceeds in waves, with alternating remissions and exacerbations caused by unhealthy diet, alcohol, and exacerbation of primary diseases. The dynamics of endoscopic observations of patients with erosions suggests that acute and chronic erosions are stages of the same process.

If the esophagogastroduodenoscopy report indicates focal (diffuse) erythematous gastropathy, this simply indicates hyperemia of the inner surface of the stomach, localized in a separate area or over its entire area. It can be observed with superficial gastritis, but additional diagnostic measures are needed to clarify the diagnosis and treatment. Redness usually indicates inflammation, most often superficial gastritis is diagnosed. Quickly taken measures help to completely restore the normal state of the stomach.

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Forms

The following types of gastropathy are distinguished:

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

Erythematous gastropathy is provoked, in most cases, by unhealthy food, non-compliance with the diet, stressful situations, infection of the gastric mucosa with pathogenic microorganisms. Gynecological diseases, pathologies of the digestive organs, bad habits can contribute to its appearance. Almost all types of gastropathy occur against the background of a number of the same reasons, and their symptoms are similar. The degree and type of damage to the surface of the stomach depends on the duration and strength of the irritant and hereditary predisposition. Irritation of all or part of the surface of the stomach can be accompanied by erosions - erythematous erosive gastropathy.

Erosive-hemorrhagic gastropathy indicates the presence of bleeding from erosions and that their depth has reached the blood vessels. Erosive lesions of the fundus, as well as the anterior and posterior walls of the stomach are quite safe in terms of hemorrhagic manifestations, but with erosions in the area of the lesser curvature of the stomach, especially multiple and deep, the risk of bleeding increases many times over, since large arteries are located there. Risk factors for intragastric 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. Moreover, the more the erosions bleed, the weaker the pain. This is explained by the fact that the sympathetic nerves approach the stomach through the arteries, and erosions, deepening, first destroy the nerve fibers, then the walls of the vessels.

Vomiting with blood particles and streaks almost always accompanies erosive-hemorrhagic gastropathy. The amount and color of bloody discharge in the vomit is determined by the intensity of bleeding. Brown color of the vomit indicates minor bleeding, for example, point penetration of blood (sweating) through the walls of blood vessels into the stomach cavity.

Intragastric bleeding is accompanied by increasing signs of anemia: fatigue, dizziness, hypotension, shortness of breath, rapid heartbeat, and pale skin.

There are such minor blood losses that they do not cause vomiting. However, the blood particles destroyed by the gastric juice color the feces dark brown, almost black, this is also something to pay attention to.

Erosive-papular gastropathy is usually the result of damage to the stomach lining due to overproduction of sulfuric acid, decreased protective properties of gastric mucus, and Helicobacter pylori infection. This type of gastropathy is determined by the formation of multiple papules with erosions at the top (aphthous papules).

With atrophy of the gastric glands, the formation of mucus that protects the epithelium of the stomach decreases. Erosions may appear as a reaction to an irritant (medicines, alcoholic beverages) or under the influence of an autoimmune factor. Atrophic erosive gastropathy also requires additional diagnostics. To determine whether the patient has atrophic gastritis, a histological analysis of biopsies taken during an endoscopic examination is necessary.

The clinical symptoms of all variations of erosive gastropathy are distinguished by the absence of specificity, except for the pronounced hemorrhagic form of the disease. They resemble ulcer symptoms, and gastric erosions can only be determined using gastroscopy.

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Complications and consequences

Acute erosive gastropathy, as a rule, ends with rapid healing after the irritant is eliminated, after which no traces remain on the gastric mucosa.

The chronic process can last for several years, as a rule, erosions may disappear over time. Mature, long-term recurring erosions can become an impetus for the development of polypous or warty gastritis.

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

Deep multiple erosions can cause severe bleeding requiring immediate medical attention.

The probability of developing an ulcer or stomach cancer from erosion is low and is not confirmed by studies, although there is no 100% guarantee of this. Rather, the presence of a malignant process is primary. Long-term non-healing erosions, especially those found in elderly patients, give reason to suspect oncological pathology in them from the sigmoid or rectum, pancreas or liver.

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Diagnostics erosive gastropathy

Acute and chronic erosions are identified using instrumental diagnostics with an endoscope, which allows for visual detection of damage to the gastric mucosa and taking samples of the affected tissue for histological examination, on the basis of which one can form an idea of the nature of the erosion.

Gastropathy itself is a consequence of some disorder in the body, and the main thing in diagnostics is to establish this cause. Most often, erosive gastropathy accompanies gastritis. However, oncopathology sometimes manifests itself in such lesions, therefore, only after repeated examination of biopsies can one be sure of the benign nature of erosions.

Patients are required to undergo tests: a clinical blood test to determine the presence of anemia, a stool test for traces of blood. A modern diagnostic method is the "gastropanel" blood test, which allows identifying helicobacteriosis (by the presence of antibodies to Helicobacter pylori), the level of pesinogen I (a proenzyme secreted by the fundic glands of the stomach, a precursor of pepsin), the level of gastrin (a digestive hormone that allows identifying abnormalities in the formation of hydrochloric acid). It is not enough to limit ourselves to just examining the functioning and morphology of the stomach. Duodenal intubation, X-ray and endoscopic examination of the colon are performed according to indications, ultrasound or magnetic resonance examination of the abdominal organs is prescribed. At the discretion of the attending physician, other diagnostic tests and consultations with specialists (endocrinologist, rheumatologist, cardiologist) are prescribed, since erosive gastropathy can be caused by many factors and it is often necessary to treat the underlying disease, such as cardiovascular pathology or diabetes mellitus.

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Differential diagnosis

Differential diagnostics 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 a disorder of the motor-evacuation function is observed.

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

It is also differentiated from ulcers and malignant neoplasms of the stomach and duodenum.

Treatment erosive gastropathy

Treatment regimens for chronic erosive gastropathy are selected individually for each patient. When prescribing, factors that influenced the mechanism of disease development are taken into account. Treatment involves, first of all, eliminating external and internal causes of erosions: stopping therapy with ulcerogenic drugs, creating a more favorable neuropsychic climate, giving up bad habits, establishing a normal regime and diet. In case of erosive gastropathy caused by chronic pathologies of other organs, the underlying disease is treated.

People with erosive-hemorrhagic gastropathy, with clinical manifestations of hemorrhage, are hospitalized in a surgical hospital. Bleeding caused by acute erosions of the gastric mucosa is usually capillary. In most cases (90%), these are mild bleedings.

Treatment of erosive gastropathy, especially cases with increased acidity of gastric juice and ulcer-like symptoms, is carried out with antisecretory drugs. Proton pump inhibitors are prescribed - Zerocid, Promezol, Nolpaza, Omeprazole in a daily dosage of 40 mg once.

Omeprazole - inhibits the final stage of hydrochloric acid production in the stomach, promoting the inactivation of the enzyme that accelerates the exchange of hydrogen ions in the cell membranes of the gastric glands, regardless of the type of irritant. The effect occurs quickly, its duration depends on the dose of the drug taken. Contraindicated in pregnant and lactating women. Very rarely can cause side effects from the neuropsychic, digestive, musculoskeletal, genitourinary and hematopoietic systems.

The duration of Omeprazole therapy is about a month, in Zollinger-Ellison syndrome, treatment begins 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.

Famotidine, which selectively blocks histamine receptors H2, is used as a drug that reduces the secretion of sulfuric acid. It is usually taken once before bedtime at 40 mg for a month and a half. This drug is addictive, so it is discontinued by gradually reducing the dose.

Since Helicobacter pylori infection is often detected in erosions, eradication of these bacteria is carried out using standard international methods of influencing the source of infection.

Anti-Helicobacter therapy is prescribed using De-nol, which helps remove Helicobacter from the body, and also relieves inflammation and protects cells from their pathogenic effects. The active ingredient of De-nol, bismuth subcitrate, is distinguished by its versatile effectiveness. Its astringent properties are due to the ability to precipitate proteins, forming chelate compounds with them that perform a protective and cleansing function. A protective film is formed selectively on the affected areas of the mucous membrane, promoting their restoration.

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 bacterial cell membranes, it leads to their death. The active substance of the drug, due to its good solubility, deeply penetrates the mucous layers, destroying the microorganisms located underneath. At the moment, Helicobacter pylori strains resistant to bismuth subcitrate have not been identified. The drug is able to reduce stomach acidity and inactivate pepsin.

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

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

Antibiotics are also prescribed to destroy the source of infection.

Amoxicillin is a semi-synthetic penicillin, has a pronounced bactericidal effect. The mechanism of action is based on the interruption of the production of the building material of the cell wall - peptideglycan, causes the decomposition of bacteria. Like all antibiotics, it can cause allergic reactions and side effects.

It is allowed to replace it in the treatment regimen with Metronidazole in a dosage of 0.5 g three times a day. The active substance of the drug in the process of transformations in the body interacts with the DNA of the bacterium and destroys it, suppressing the biosynthesis of nucleic acids of the microorganism. Metronidazole mutually enhances the effect of antibacterial drugs. This drug is contraindicated in case of sensitization and leukocyte deficiency (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 if high dosages are necessary, should evaluate the benefit/risk ratio.

In specific cases, the therapeutic treatment regimen may be adjusted by the physician, taking into account the results of diagnostic tests, bacterial cultures for sensitivity, and the general condition of the patient.

If the above regimens do not work, further therapy with high doses of Amoxicillin (75 mg four times a day for two weeks) in combination with four times a day high doses of Omeprazole can be used.

Another possible option is to replace Metronidazole in the quadruple therapy regimen with Furazolidone (0.1-0.2 g twice a day). The pharmacodynamic properties of this drug are directly proportional to the prescribed dosage, small ones act bacteriostatically, increasing the dose increases bactericidal activity. In addition, it has moderate immunostimulating properties. The antibacterial effect is that 5-nitrofuranol (the active component) is restored to an amino group under the action of microorganism enzymes, which is toxic to a wide range of bacteria. It inhibits cellular biochemical reactions important for bacteria, which leads to the destruction of cell membranes, cell hypoxia and the death of pathogenic microorganisms. The active component of the drug disrupts the process of synthesizing protein structures of bacteria, thereby inhibiting their reproduction. In addition to the above, immunostimulation provides rapid therapeutic improvement.

Furazrlidone has a slight stimulating effect and is absolutely incompatible with alcohol consumption. It can cause allergies and provoke dyspepsia. It penetrates into breast milk. Pregnant women are prescribed only for strict indications. In order to minimize its side effects, it is recommended to drink a significant amount of water when taking it, and also - vitamins of group B and antihistamines are prescribed at the same time.

For the treatment of Helicobacter pylori, it is possible to use complex therapy: proton pump inhibitors, Amoxicillin and Rifabutin (0.3 g per day) or Levofloxacin (0.5 g). Determining the species of the bacterial strain and its sensitivity to a certain type of antibacterial drugs will allow optimizing the treatment regimen.

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

Various authors indicate that duodenogastric reflux is detected in 22.9–85% of cases during a comprehensive examination of patients with gastric erosions. Erosion of the gastroduodenal tract provokes disturbances in the motor-evacuation activity of the stomach, which leads to intracavitary hypertension and serious disorders of the pylorus function. Duodenogastric reflux causes an increase in the concentration of bile in the stomach, which, in turn, disrupts the protective mucous surface, which facilitates the introduction of Helicobacter pylori into the epithelial lining of the stomach. This is the basis for prescribing regulators of the motor function of the gastrointestinal tract (Metoclopramide, Domperidone) and antacid drugs (Maalox) to patients with erosive lesions of the gastroduodenal mucosa.

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

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

Regulators of the motor function of the gastrointestinal tract tone the muscles of the stomach, cardiac and antral sphincters, stimulate their motility, and normalize the evacuation of the food bolus from the stomach.

Antacid drugs, in particular Maalox, effectively eliminate reflux symptoms. They are intended not so much to neutralize hydrochloric acid (with the formation of buffer compounds), but to adsorb pepsin, lysolecithin and bile acids, as well as to increase 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 in the process of forming a protective film of the drug on the epithelium and as a result of increasing the synthesis of its own prostaglandins in the gastric mucosa, thus protecting the mucous and epithelial protective surfaces of the stomach.

The third stage of stomach protection is normal microcirculation of blood in the gastric arteries, which provides energy for metabolic processes, supports the first (mucous) and second (epithelium) stages of protection in working order and regulates the timely renewal of cells of the gastric mucosa.

Restoration of the protective qualities of the gastric mucosa is carried out by prescribing cytoprotectors. In addition to Maalox, which can be used to restore all three stages of protection, Enprostil or Misoprostol (synthetic prostaglandins) are also used, improving regional blood circulation, activating mucus formation. De-nol has a similar effect.

Prostaglandin derivatives are successfully used in treatment regimens for erosions and ulcers, especially in patients who abuse alcohol and smoke, when it is impossible to use H2-histamine receptor blockers or long-term therapy with ulcerogenic drugs.

Regional blood circulation is improved by Trental, which normalizes the rheological properties of blood and cellular respiration. Immunostimulants are sometimes used:

• Taktivin is a polypeptide agent that restores α- and γ-interferon, T-lymphocyte activity, normalizes hematopoiesis and other indicators of cytokine function;
• ß-leukin – ensures acceleration of stem cell reparation and hematopoiesis;
• Galavit is an immunomodulatory drug with pronounced anti-inflammatory properties.

In some cases, in combination with drugs that reduce the production of hydrochloric acid, injections of Solcoseryl (normalizing tissue metabolism processes) and Dalargin (anti-ulcer antacid drug) were effectively used for chronic gastric erosions.

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

Severe deficiency states with the development of polyfactorial anemia require parenteral administration of vitamins B1, B6, B9, B12, C, PP, proteins and iron preparations.

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

Physiotherapeutic treatment of erosive gastropathy is prescribed in the absence of bleeding. In the acute phase, sinusoidal modulated currents, Bernard diadynamic currents, microwave and ultrasound therapy, medicinal electrophoresis (especially in case of severe pain syndrome), hyperbaric oxygenation, magnetic therapy, galvanization can be prescribed. The same procedures are used during remission to prevent exacerbations. In the phase of fading exacerbation, local thermal procedures, mud applications, mineral, pine, radon, oxygen baths can be prescribed. Acupuncture is successfully used.

Alternative treatment

It is advisable to use folk remedies only after consulting a doctor, as folk remedies can cause allergies and are not compatible with ongoing drug therapy.

Propolis, which has good regenerative properties, is used to treat erosions. Keep propolis (20g) in the freezer, grind into powder and pour a glass of milk, dissolve in a water bath, drink in the morning on an empty stomach.

For erosive-hemorrhagic gastropathy with any gastric secretion, nut milk with propolis is used: boil 15 kernels of crushed walnuts in 1/4 liter of milk, drop a few drops of propolis extract into the mixture.

You can take ten drops of freshly squeezed aloe juice half an hour before each meal, or mix half a teaspoon of aloe pulp 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, and to relieve and eliminate pain. Plants with astringent, enveloping, and hemostatic properties, strengthening blood vessels, and promoting cell renewal are used to heal erosions. In herbal therapy for erosive lesions, plantain, chamomile, nettle, calendula, oak and buckthorn bark, calamus root, and flax seed are used.

Flaxseed infusion: pour flaxseed (tablespoon) with warm water (50°C, 200ml) overnight. Drink together with seeds on an empty stomach in the morning. Take until erosions heal. The gastric mucosa should be completely restored.

Oak bark decoction: brew a handful of bark with a liter of boiling water, simmer for ten minutes. Strain, let cool, drink ½ glass half an hour before meals.

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

Fresh juice from white cabbage leaves – ½ glass before each meal a third of an hour (reduced acidity).

For increased acidity - fresh potato juice: ½ glass before each meal a third of an hour.

The duration of taking juices is one and a half to two months.

During the season, it is recommended to eat fresh strawberries and blueberries.

When the exacerbation begins to subside, you can do herbal applications and baths. They are applied mainly to the epigastric area. The herbal application mixture is prepared at the rate of 50 g of herbal mixture per 1 cm² of body area. You will get a layer of ≈5 cm. Pour the calculated amount of mixture into ½ l of boiling water and simmer in a water bath under a lid for a quarter of an hour or a little more. Strain and squeeze out the infusion (can be used to prepare a bath), wrap the warm (≈40 ° C) pulp in a piece of gauze folded several times or in a natural napkin. Distribute over the body area in the epigastric zone, cover with cling film (oilcloth), and on top - with a woolen blanket. You will get a herbal compress, lie down with it for about twenty minutes.

For a bath, you can use the strained infusion, you can prepare it differently: pour 200 g of herbal mixture with two liters of boiling water, leave for about two hours, in a warm place, wrapping the dishes in a warm cloth. The water temperature in the bath is 36-37 ° C, the duration of stay is 15 minutes, do baths no more than three times a week.

Herbal collection: one tablespoon of celandine herb, two of lungwort, elecampane, coltsfoot, licorice root; four of chamomile and calendula flowers, marsh cudweed herb.

These procedures are contraindicated in cases of fever, heat, severe circulatory system disorders, tuberculosis, bleeding, hematopoietic diseases, severe psychoneurological disorders, and also for pregnant women.

Homeopathy can give a stable and good result, however, a homeopathic medicine should be prescribed by a homeopathic doctor, individually, since when prescribing individually, many factors are taken into account that would seem to have nothing to do with the disease - from the state of memory to hair color.

For example, Anacardium is used in cases of increased stomach acidity, hunger pains radiating to the back; patients are irritable, have conflicting desires, and are never satisfied.

Argentum nitricum (Argentum nitricum) – pain syndrome, occult bleeding, flatulence and heartburn.

Arnica, Lachesis, Ferrum aceticum and Ferrum phosphoriucum – occult bleeding.

Among the complex homeopathic preparations of the Heel brand, there are several intended for the treatment of chronic lesions of the mucous membranes of the gastrointestinal tract:

• Gastricumel, sublingual tablets, containing frequently used homeopathic preparations prescribed for various symptoms of chronic gastrointestinal diseases 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, one tablet can be dissolved every quarter of an hour, but the daily dose should not exceed 12 tablets. The duration of treatment is two or three weeks. A repeated course is recommended by a doctor. It can be used by children from the age of three, during pregnancy and lactation - under medical supervision. Sensitization is possible. Combination with other medications is acceptable.
• Nux vomica-Homaccord is a homeopathic drops containing the following ingredients:

Nux vomica (vomit nut) is indicated in cases of inflammatory processes of the mucous epithelium of all digestive organs from top to bottom, as well as to eliminate the consequences of abuse of psychoactive substances;

Bryonia (white bryony) is indicated for chronic inflammation of the stomach, accompanied by excessive gas formation, diarrhea, pain;

Lycopodium (club-shaped diving beetle) is a remedy for the treatment of the biliary system and liver, restoration of intestinal muscle tone and elimination of constipation, as well as normalization of the neuropsychic state;

Colocynthus (bitter gourd) is a remedy that relieves spasms of the digestive organs, inflammation and intoxication, and has a laxative effect.

A single dose for adults is 10 drops diluted in 0.1 g of water. Drink, holding in the mouth, three times a day. Children under two years old - three drops per dose; from two to six - five. Take a quarter of an hour before meals or an hour after. Pregnant and lactating women are not recommended to use. Allergic reactions are possible.

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Surgical treatment

Surgical intervention for erosive gastropathy is performed in cases of severe symptoms of gastric bleeding that cannot be stopped and its cause cannot be eliminated.

A risk factor for gastric bleeding is erosive-hemorrhagic gastropathy, when the erosions are already deep enough and have reached the layer of blood vessels. Surgical intervention is indicated for patients with intractable pain syndrome and bleeding. Its scope is determined by the condition of the organ and may consist of suturing areas with bleeding, sometimes - removing part of the stomach.

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

Diet for erosive gastropathy

Successful treatment of erosive lesions of the stomach is impossible without following certain dietary rules. Firstly, receiving an advisory opinion: "erosive gastropathy" is a reason for any sensible person to completely give up alcohol and tobacco products. In order for the erosions to heal quickly, and the gastric mucosa to recover as much as possible, it must be protected.

You need to eat small portions several times a day, preferably five or six. The food should not be scalding hot or cold (≈45°C).

The diet should not include foods that irritate the gastric mucosa. Fatty, smoked, salty, spicy dishes, strong meat and fish broths, mushrooms, fresh dough products, rich cookies, biscuits are excluded. During the acute stage, it is forbidden to eat raw fruits, vegetables, chocolate, drink strong tea, coffee and carbonated drinks. At this time, food should be mashed, steamed or boiled. This diet should be followed for about three days, then the food is not mashed, but the principles of fractional nutrition remain, fresh vegetables and fruits, stewed and baked meat and vegetable dishes are gradually introduced, but without a crispy crust. Mandatory products are low-fat cheeses, butter, low-fat sour cream, cottage cheese, milk or fermented milk low-fat drinks. The use of these products stimulates the synthesis of enzymes - catalysts for the restoration of the gastric mucosa. The usual attributes of dietary nutrition - steamed meatballs and cutlets, crumbly and milk porridges (oatmeal, buckwheat, semolina), soft-boiled eggs, steamed omelette, jelly and cream soups are also relevant for erosive gastropathy.

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

If it is Helicobacter pylori, then the diet should include more bright vegetables and fruits containing flavonoids, as well as sulforaphane (an antagonist of this bacterium). It is found in kohlrabi, broccoli, cauliflower, and watercress. Vegetables should be steamed for a short time. If acidity is high, you can drink a decoction of flaxseed before eating; if it is low, you can eat citrus fruits, drink carrot and cabbage juice, and an infusion of plantain leaves.

A decoction of flax seeds or a tablespoon of sea buckthorn oil before meals will not be superfluous for erosions caused by the herpes virus.

In case of duodenogastric reflux, table No. 5 is usually prescribed, since it is associated with pathology of bile outflow. This diet excludes the "three F's" - fatty, fried and egg yolks.

Acute erosions associated with alcohol or drug intoxication require a 24-hour fast with plenty of fluids and a gradual transition to a normal diet.

The diet for erosive gastropathy is quite individual, only the attending physician can take into account all the nuances and suggest what to focus on. The main thing is not to starve or 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, as well as most other diseases, is to prefer healthy lifestyle to bad habits. Do not abuse alcohol, especially on an empty stomach, as such drinks are aggressive to mucous membranes. It is also recommended to give up smoking, since nicotine has a vasoconstrictive effect, and smokers' organs and tissues constantly experience hypoxia.

It is necessary to monitor your diet, try to eat quality products, eat regularly, do not go hungry for a long time and do not overeat. Learn not to rush for food and chew food thoroughly.

If therapy with ulcerogenic drugs is prescribed, a good preventative measure would be to take them after meals, and before eating, or at least before taking the drug, drink half a glass of infusion or decoction of flax seed.

According to experts, erosive damage to the gastric mucosa is most often diagnosed in people with severe chronic diseases, patients taking non-steroidal anti-inflammatory drugs and active alcoholics.

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Forecast

Timely treatment and responsible attitude to one's own health, including following the doctor's recommendations and giving up bad habits, usually result in restoration of the mucous membrane. According to specialists, only a small part of erosive defects recurs. Most patients did not experience repeated occurrences of erosions. Even erosions complicated by polypous growths after surgery usually do not recur, and the prognosis is favorable in most cases.

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