Gastritis with reduced acidity: atrophic, chronic, erosive

One of the main components of gastric juice is hydrochloric acid, without which the process of complete digestion of food is impossible. Its concentration in the composition of gastric juice is determined by the acidity of the stomach. The acidity level is measured in pH units, the norm of basal acidity in the body of the stomach is from 1.5 to 2pH. Both excessive and insufficient acidity bring the body a feeling of discomfort in the epigastric zone and contribute to the development of gastritis - a serious chronic disease of the stomach.

Hypoacid gastritis begins to develop due to dysfunction of the gastric glands that arises for some reason, producing insufficient hydrochloric acid and enzymes to break down the food that enters the stomach. In this case, the course of natural chemical processes of food digestion is disrupted, which is accompanied by specific clinical manifestations and can lead to pathologies of the gastrointestinal tract.

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Epidemiology

In countries with well-developed medical statistics, chronic gastritis of all types accounts for up to 90% of cases of gastric pathologies in adult patients. Presumably, approximately 4/5 cases of chronic gastritis are associated with Helicobacter pylori, the probability of infection is the same for both male and female populations. Hyperacid gastritis is more common, hypoacid gastritis is much less common. This gastric pathology is mainly observed in mature patients who systematically neglect a healthy lifestyle and abuse bad habits. Although sometimes there are episodes of hypoacid gastritis in childhood and adolescence. Before adolescence, girls are more likely to get sick, during puberty, the incidence rates among adolescents of both sexes equalize.

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Causes gastritis with low acidity

To date, it is not known for certain what causes insufficient secretory activity of the gastric glands. It is assumed that this is based on a genetically determined defect in the reparation of the gastric mucosa epithelium, damaged as a result of an endogenous or exogenous irritant. Therefore, the existence of such a disease in close relatives is in itself a risk factor for the development of chronic hypoacid gastritis.

Also, gastritis with increased acidity (hyperacid), if not treated properly, can after some time be replaced by gastritis with acid deficiency. This happens because in the stomach, which is constantly inflamed due to excess hydrochloric acid, most of the parietal cells (which produce this very acid) gradually die off, the acidity normalizes, and then begins to decrease. If this process is not stopped, anacid gastritis will occur, when sulfuric acid is practically not produced (basal acidity> 6 pH).

Thus, in people with a genetic predisposition to disorders of the process of restoration of the gastric mucosa, gastritis with low acidity is formed under the influence of additional external and internal circumstances. Risk factors for the occurrence of this disease:

• regular preference for unhealthy foods (too fatty, fried, spicy, sweet, rough and difficult to digest);
• regular failure to follow a meal schedule – eating dry food and on the go, fasting compensated by overeating;
• alcohol abuse, smoking and other bad habits;
• taking NSAIDs, glucocorticosteroids, non-steroidal anti-inflammatory drugs, cytostatics, antibacterial and other medications;
• accidental ingestion of irritating or toxic substances;
• thyroid disease, neurosis-like disorders, immune disorders, intolerance to certain foods;
• chronic pathologies of other digestive organs (hepatitis, pancreatitis, colitis);
• sinusitis, rheumatic diseases, renal and hepatic failure and other foci of chronic infection;
• parasitic invasions, bacterial or fungal infection of the gastric mucosa;
• Incorrect treatment of acute gastritis, premature interruption of treatment or failure to follow a diet can lead to chronicity of the disease.

The negative emotional environment during meals plays a significant role in the development of the disease.

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Pathogenesis

Reduced acidity of gastric juice is typical for chronic forms of gastritis, acute forms of hypoacid gastritis are extremely rare. The mechanism of development of this disease has not been fully studied to date. Previously, it was believed that the chronic form is a consequence of repeated acute inflammations of the gastric mucosa. However, this assumption was not confirmed by convincing facts. At present, the prevailing opinion is that chronic gastritis is an independent disease.

For normal digestion, the stomach must contain enzymes that break down the food that has entered it. The main digestive enzyme, pepsin, is synthesized and works exclusively in an acidic environment. Further high-quality absorption of food in the intestine is possible only after neutralization of hydrochloric acid. The stomach is divided into two zones, the acid-forming zone (its body and bottom, lined with parietal or parietal cells) and its antral section, the epithelial cells of which secrete a mucous mass that neutralizes hydrochloric acid. Parietal cells secrete acid evenly and constantly, so a decrease in acidity occurs only with a quantitative decrease in their number. Reduced acidity of gastric juice provokes serious digestive disorders. In particular, it negatively affects the functioning of the intestine and pancreas, which secretes enzymes depending on the pH level. If the acidity of gastric juice exceeds 2.5, the process of protein breakdown is disrupted, which can subsequently result in the development of autoimmune pathologies, allergies and idiosyncrasies to certain products. With reduced acidity, essential minerals (iron, zinc, magnesium, calcium) and vitamin B12 are practically not absorbed. As a result, anemia develops.

Hydrochloric acid has a pronounced disinfectant property, with its help the food entering the body is disinfected; and also with a lack of acid the digestion process is delayed, the prolonged presence of undigested food in the stomach causes its rotting. Deficiency of hydrochloric acid leads to the proliferation of pathogenic microorganisms, which in turn cause various diseases.

In the pathogenesis of the disease, an important role is given to the perforation of the barrier located above the parietal cells of the epithelial surface of the stomach, formed from mucous secretion and the cover of the mucus-forming epithelium. This can occur due to the ingestion of coarse, poorly chewed food or due to the ingestion of corrosive or toxic substances. With a decrease in the number of parietal cells, the main gastric glands containing them gradually atrophy, which can lead to atrophic gastritis.

The development of chronic gastritis is also facilitated by a disruption of the renewal of the gastric mucosa and its trophism, since as a result of the disease, the processes of exfoliation and restoration of the epithelial cells of the glands of the mucosa slow down. Often this is facilitated by insufficient blood supply, which develops against the background of other chronic diseases (hypertension, diabetes).

Not the least role in the pathogenesis of the disease is given to the insufficiency of the formation of gastric mucus, which protects epithelial cells from damage. Patients with atrophy of the gastric glands are found to have pronounced disorders in the biosynthesis of various mucus-forming components, which is caused by a decrease in the number of cells that form mucus. But the methods for studying the formation of gastric mucus are not yet perfect enough to make accurate conclusions about the primacy of this factor in the development of chronic gastritis.

Inflammation of the mucous membrane in gastritis with acid deficiency is characterized by some features. The fundus (body and bottom) of the stomach, where the largest number of parietal cells are located, is primarily subject to autoimmune or bacterial damage. The inflammation is usually insignificant, however, the atrophic process begins almost immediately and progresses very quickly. To compensate for the underproduction of hydrochloric acid, gastrin production increases. Undigested food in the stomach activates the synthesis of this hormone. A direct relationship has been found between the degree of atrophic changes in the gastric mucosa and the level of gastrin in the blood.

The renewal of mucosal cells is replaced by excessive growth of connective tissue, the cells of which are unable to produce the hormones, enzymes and hydrochloric acid necessary for digestion. The stomach tissue is gradually replaced by intestinal tissue. The degree of atrophic changes is assessed as follows:

• mild – destructive changes affected 1/10 of the number of parietal cells;
• average – from more than 1/10, but less than 1/5;
• heavy - more than a fifth of the gastric glands.

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Symptoms gastritis with low acidity

Hypoacid gastritis can be asymptomatic for quite a long time. The first signs of low acidity are a feeling of fullness and heaviness in the epigastric region after eating. Moreover, the food is not necessarily abundant, sometimes such symptoms appear after a light snack. Nausea with gastritis with low acidity, belching that smells like rotten eggs, heartburn, a possible metallic taste on the tongue and hypersalivation are all essential attributes of this disease, caused by acid and enzymatic deficiency. The stomach to a greater or lesser extent loses the ability to digest food, which provokes the activation of fermentation processes.

Almost always, the bowel function is disrupted (diarrhea or constipation), and pain under the ribs often reminds of acid deficiency. Pain syndrome appears after eating, almost immediately, but it may also be absent. Pain in gastritis with acid deficiency is caused not by a spasm of the stomach muscles, but by its stretching. Dull, aching pain is characteristic, the degree of severity of which is directly proportional to the quantity and quality of food consumed. Overeating and eating spices intensify painful sensations.

It is very likely that the development of putrefactive bacteria in the stomach, deprived of the necessary disinfection, will lead to excessive gas formation, flatulence and bloating.

Patients with hypoacid gastritis often want something sour, as they intuitively try to compensate for the deficiency of hydrochloric acid. However, this usually does not bring relief.

Secondary symptoms arising against the background of problems with the stomach should prompt you to consult a gastroenterologist. Deterioration of the digestion process and absorption of food intake leads to a deficiency of proteins, vitamins and minerals. This manifests itself in dry and brittle hair and nails, iron deficiency anemia, which in turn causes increased fatigue, weakness, and reluctance to move. Lactose intolerance, decreased blood pressure, weight, tachycardia, and dizziness after eating may be observed. The appearance of secondary symptoms indicates the development of achylia - such a significant decline in the secretory function of the parietal cells that the presence of hydrochloric acid and pepsin is practically not detected in the gastric juice.

Gastritis with low acidity in children

The most common cause of gastritis in a child is failure to follow the diet and nutrition regime. The manifestation of the disease in many cases occurs in the first years of school, when the rhythm of the child's life, his diet changes, and the workload on the child increases due to the start of school.

In preschoolers, acute gastritis can be caused by any food, since the formation of the gastrointestinal tract occurs only by the age of seven. In addition, the content of hydrochloric acid in a child's stomach is low, as is its activity. Therefore, even a small number of bacteria can infect a child's body. The motor activity of a child's stomach is also not very intense, so food mixes for a long period of time and can gradually irritate the epithelial surface of the stomach.

Symptoms of acute gastritis in a child are accompanied by pain in the epigastrium of varying intensity, nausea and vomiting. The acute period lasts two to three days, the main therapeutic measures are dietary nutrition and general strengthening therapy. In the vast majority of cases, acute gastritis in children is accompanied by increased acid production. If a child is found to have reduced acidity with acute gastritis, this may indicate some kind of sluggish chronic process and it is advisable to examine him thoroughly.

The causes of chronic gastritis in a child may be liver, pancreas, and intestinal diseases; food allergies; neuroendocrine disorders; various chronic infections; long-term drug therapy; the presence of parasites. The hereditary factor should not be discounted either. Acute inflammation may also develop into a chronic form, which may be facilitated by incorrect treatment, premature interruption of treatment, or failure to follow a dietary diet.

Gastritis is divided into primary (an autonomous disease localized directly in the stomach) and secondary (a consequence of some other disease that provokes inflammation of the gastric mucosa). The second variant is more common in children.

In children, acid deficiency manifests itself as dull, diffuse abdominal pain that occurs after eating any food. The pain syndrome is usually moderate or mild, and the reaction to palpation in the epigastrium is painful.

Common symptoms include nausea and vomiting, which occur two or three hours after eating, loss of appetite, and intolerance to certain foods, particularly milk porridge.

The body weight indicators of some children suffering from chronic hypoacid gastritis are below the norm, however, many children do not lag behind their peers in either weight or height. Most young patients with this diagnosis are easily excitable and emotionally unstable.

For children, superficial gastritis is predominant; glandular lesions without atrophy may be observed. If an atrophic process occurs, its degree of expression is moderate.

Correct and consistent treatment of a child usually results in the restoration of all impaired functions of the gastric glands.

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Forms

Acute gastritis with low acidity is extremely rare. It is usually accompanied by overproduction of hydrochloric acid. Acute inflammation develops as an immune response to any damage to the epithelium of the stomach. The cells of the immune system perform their function of eliminating the antigen, and this entire process results in a pronounced inflammatory reaction. Acute gastritis in a patient with reduced secretory function of the gastric glands can rather be interpreted as an exacerbation of asymptomatic chronic hypoacid inflammation provoked by external irritants.

Morphological classification distinguishes the following types of acute gastritis:

Catarrhal (simple) - the most common, occurring when pathogenic microorganisms enter the stomach with poor-quality food (so-called food intoxication), as a reaction to some medications and food products. This is an inflammation of the superficial gastric epithelium, its defects in which are insignificant, reparation occurs quickly after the irritant is eliminated.

Erosive – a consequence of the penetration of corrosive substances (alkalis, high concentration acids, heavy metal salts) into the stomach cavity, which can lead to deep destruction of its tissues.

Phlegmonous - purulent inflammation caused by a foreign body (a sharp bone, for example, a fish bone) that damaged the stomach wall and infected the damaged area with pyogenic bacilli. It can be a complication of an ulcer or stomach cancer, some infectious diseases. This type is characterized by symptoms such as fever and severe pain in the epigastric zone.

Fibrinous (diphtheritic) – a rare type of gastritis caused, for example, by blood poisoning or mercury chloride poisoning. The last three types of gastritis require immediate medical attention.

With proper diagnosis and treatment, acute inflammation, depending on the type, lasts no more than a week, but the final cellular renewal of the mucous epithelium occurs much later. Premature termination of treatment and failure to adhere to the diet can lead to chronicity of the disease.

The principles of classification of chronic forms of gastritis are ambiguous and do not take into account such an important functional symptom of the disease as an assessment of the secretory activity of the gastric glands. Previously, a classification was widely used that distinguished the following types of gastritis:

• type A – autoimmune, when the body begins to produce antibodies against parietal cells, usually localized in the body of the stomach;
• type B – caused by Helicobacter with primary localization in the antral part;
• type C – chemical-toxic;
• pangastritis (mixed type A and B).

This systematization is still used today, but its modern interpretation identifies the following main types of the disease: superficial (non-atrophic), atrophic and its special forms.

Chronic gastritis with initially reduced production of sulfuric acid is not as common as with excessive (normal) production. The course of this disease is often characterized by the absence of disturbing symptoms. Exacerbation of gastritis with low acidity periodically gives way to long-term remission, when almost all symptoms disappear.

Relapses of the disease can be seasonal, and more often - provoked by non-compliance with dietary rules, alcohol consumption, smoking, long-term drug therapy. Exacerbations are characterized by short-term pain attacks, nausea after eating, a feeling of fullness and pressure in the epigastric region, heartburn, indicating dysfunction of the natural gastric "valves" and gastroduodenal reflux (occurring in patients with low acidity). Exacerbations can be accompanied by dyspeptic symptoms: diarrhea or constipation, alternating with each other, rumbling in the upper abdomen, flatulence.

Helicobacter pylori infection, which initially usually causes hyperacid gastritis, disrupts the natural cycle of restoration of the gastric mucosa. Old parietal cells, dying, are not replaced by new ones in time, the renewal of the glandular epithelium is disrupted, epithelial cells gradually atrophy and are replaced by connective tissue. This, first of all, affects the decrease in the production of pepsin and hydrochloric acid, which are so necessary for the complete digestion of food.

Over time, atrophic gastritis with low acidity develops, which is characterized by a significant decrease in the surface of the gastric mucosa, and, accordingly, the number of functioning parietal cells. Atrophy of the gastric glands is accompanied by proliferation of cells of the epithelial cover, muscle layer and connective tissue.

This type of gastritis can be more or less pronounced, depending on the degree of atrophy. Formation of atrophic gastritis occurs in the process of progression of any of its forms, including as a result of autoimmune damage to the parietal cells. Due to their atrophy, acidity gradually decreases to almost zero (anacid gastritis). Long-term insufficient secretion of gastric juice leads to loss of the ability to digest food. The condition when gastric juice is completely devoid of pepsin and hydrochloric acid (achilia) is the final stage of the inflammatory process, both with low and high acidity - achylic gastritis. With this pathology, digestive disorders prevail in the symptoms: belching air or rotten eggs, a feeling as if the stomach, filled with food, "stands", nausea. Pain is not typical, however, after an hour and a half, aching, not very intense pain may appear. When inflammation is localized in the pyloric part of the stomach or gastroduodenitis, the pain syndrome is more pronounced. A person's appetite is greatly impaired (up to anorexia), there is a constant unpleasant taste in the mouth, dystrophic or inflammatory lesions (gums, tongue), vomiting on an empty stomach, achylic diarrhea alternating with constipation may also appear there.

Erosive gastritis with low acidity is a hemorrhagic inflammation of the mucous epithelium. Its chronic form can be the result of prolonged drug therapy, alcohol abuse, Crohn's disease or a common acute respiratory viral infection. Reduced secretion of gastric juice leads to circulatory disorders, thinning of the vascular membranes, and, as a consequence, to increased permeability and bleeding. In some cases, the cause is not established - idiopathic erosive gastritis. This form of the disease is often asymptomatic at first. Later, the patient begins to be bothered by signs of blood loss - frequent dizziness, weakness, desire to lie down, sit down, palpitations, with increased hemorrhagic manifestations - bloody vomiting, black feces (tarry).

Antral gastritis with low acidity occurs due to autoimmune damage to the cells of the gastric glands. Another factor is long-term parasitism of Helicobacter pylori. In the pyloric part of the stomach, hydrochloric acid in the digested bolus of food is neutralized before it enters the duodenum. Inflammation of the mucous membrane of this part of the stomach leads to the formation of areas of atrophy with the proliferation of connective tissue there, insufficient neutralization of hydrochloric acid and subsequent damage to the small intestine. Rigid gastritis develops in the pyloric (antral) part of the stomach. This part is deformed - the lumen narrows due to swelling of the mucous membrane and tissues located under it, thickening of the serous cover and spasms of muscle tissue. At the initial stages, the symptoms are not pronounced, but as the disease progresses, very severe pain appears in the upper abdomen an hour and a half after eating, later - pain on an empty stomach. Typical symptoms are nausea and vomiting, since food cannot pass through the narrowed lumen of the antrum, and weight loss due to lack of appetite.

Hypertrophic gastritis is a benign tissue proliferation. Damage to the tissues of the inner surface of the stomach can affect not only the mucous, but also the muscular layer. Excessive mucus formation occurs in the stomach against the background of insufficient production of hydrochloric acid. Hypertrophic gastritis can occur with alternating exacerbations and remissions for many years. The patient periodically feels discomfort in the upper abdomen and nausea. Frequent diarrhea is characteristic. Neoplasms can be single (focal hypertrophic gastritis) and multiple (diffuse). This form of gastritis is interpreted ambiguously, basically, several of its subtypes are distinguished: giant hypertrophic gastritis (often considered a separate disease), granular or cystic, warty, polypous. Polypous growths of epithelial tissue can be asymptomatic or, in rare cases, manifest themselves as recurrent bleeding. It is assumed that polyps grow as a result of inflammatory hyperplasia of the gastric mucosa against the background of widespread atrophic gastritis. Gastric polyps can become malignant.

The earliest stage of chronic hypoacid gastritis is superficial gastritis with low acidity. This form of the disease is characterized by normal stomach thickness, occasionally with slight thickening and moderate dystrophy of the mucous membrane. Mucus formation is already increased, there is a slight decrease in the production of pepsin and hydrochloric acid, however, there are no total changes yet. But it is from this stage that the progression of the disease begins. There are no symptoms, basically, gastritis at this stage is discovered by chance. Superficial gastritis does not require specific therapy. At this stage of the disease, diet, folk remedies and general health measures are used.

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Complications and consequences

Gastritis with low acidity is less common than hyperacid gastritis, but the consequences that it can entail are much more serious. These are, for the most part, sluggish diseases with weakly expressed symptoms over a long period. However, low acidity of gastric juice can provoke significant complications in the digestive system, especially the intestines and pancreas. The presence of a normal acidity level provides the antiseptic effect of gastric juice. Acid deficiency weakens its bactericidal properties, together with pepsin deficiency, impairs digestion of food. It is not sufficiently disinfected, and pathogenic microorganisms, together with the remains of undigested food, cause fermentation, putrefaction and disrupt the natural biocenosis in the stomach. This contributes to exacerbations in the form of inflammation of the gastric mucosa. Against the background of acid deficiency, proteins are not broken down, vitamins and mineral components are not absorbed, which contributes to a decrease in immunity, the development of intolerance to certain foods, and an increased risk of developing the most dangerous complications of impaired bone formation - ulcers and stomach cancer, pernicious anemia.

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Diagnostics gastritis with low acidity

Physical diagnostics of the patient is of relatively modest importance in recognizing gastritis with low acidity. Symptomatic differences between gastritis with high and low acidity can only lead to an assumption about the presence of one or another form. The leading place in the diagnostics of this pathology is occupied by tests and instrumental diagnostics: esophagogastroduodenoscopy with biopsy of the gastric mucosa and intragastric pH-metry using a single/multichannel probe or radiocapsule.

Esophagogastroduodenoscopy is perhaps the main diagnostic method that allows identifying both the form of chronic gastritis - superficial, atrophic, hypertrophic, the localization of the process, and the period of the clinical course - relapse or remission. The role of gastroscopy in differentiating gastritis from peptic ulcer disease and stomach cancer is currently irreplaceable.

An accurate diagnosis is established by histological examination of gastric mucosa biopsies taken during esophagogastroduodenoscopy. These studies allow us to evaluate morphological changes in the mucosa of the antral and fundal parts of the stomach, since the nature of these changes in different forms of gastritis differs significantly. Changes in the mucosa are usually uneven, so biopsies are taken repeatedly and several times from the same area of the mucosa.

Examination of biopsies allows detection of heliobacteriosis and the degree of colonization of the gastric mucosa.

Endoscopic pH-metry is performed during gastroscopy, and the usual procedure is extended by approximately five minutes.

In case of contraindications or other reasons for the impossibility of performing intragastric probing, a urine test is performed to determine the level of uropepsinogen, although this method is likely to have errors in the test results. It is possible to recognize disturbances in the production of acid in gastric juice by the content of serum gastrin, the basal level of which should be increased in case of insufficient acid formation, and significantly reduced in case of antral atrophic gastritis.

The features of acid formation disorders in gastritis can be clarified using: histochemical examination of the ultrastructure of the main and parietal cells, morphometry of the fundal glands of the gastric mucosa with calculation of their proportional correspondence, determination of the density of G-cells in the mucous membrane of the antral part of the stomach. These studies allow us to clarify the mechanisms of disorders in the formation of pepsins and hydrochloric acid by changing the number of cells synthesizing digestive enzymes and acid, growth or contraction of the fundal gland area, etc. The motor activity of the stomach and the formation of mucus are also studied.

Recently, Helicobacter pylori infection has been diagnosed by detecting antibodies to this bacterium in patients.

The role of radiography, although not the main one in the diagnosis of gastritis with low acidity, can be useful in determining special forms of the disease, for example, polypous gastritis, as well as in differentiating chronic gastritis from other chronic gastric pathologies.

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Differential diagnosis

Symptoms characteristic of hypoacid gastritis are also inherent in other diseases of the gastrointestinal tract. Differential diagnostics based on the results of a comprehensive examination of patients with suspected chronic gastritis allows us to distinguish it from other diseases of the stomach, intestines, esophagus, and pancreas. It is also necessary to take into account the fact that the presence of chronic gastritis in any form does not exclude another, more serious disease in the patient. It is not enough to limit ourselves to just examining the functioning and morphology of the stomach. Patients with chronic gastritis are additionally prescribed an ultrasound diagnostic examination of the abdominal organs, an X-ray examination of the gallbladder, as well as a study of its functioning. Duodenal intubation, X-ray and endoscopic examination of the colon, sigmoid and rectum, bacterial culture for dysbacteriosis and other examinations prescribed by the attending physician are carried out according to indications. As a result of a comprehensive examination, various diseases hidden behind the symptoms of chronic gastritis are identified, for example, chronic cholecystitis or colitis, dyskinesia of the gallbladder and colon, hernia of the esophageal opening of the diaphragm, and others.

Differential diagnostics allows to exclude malignant neoplasms, pernicious anemia, conditions associated with vitamin deficiency caused by other reasons (sprouse, pellagra) in gastritis with insufficient acid formation. The absence of hydrochloric acid and pepsin in elderly people can be of a functional nature, in which destruction of the gastric mucosa is not detected.

A complete medical history allows for a more accurate assessment of the patient’s condition and the selection of the most appropriate treatment strategy.

Treatment gastritis with low acidity

Therapeutic regimens for patients with chronic hypoacid gastritis are prescribed individually, taking into account the degree of acid deficiency, morphological and functional changes in the state of the stomach, and concomitant diseases. The goal of treatment is to reduce the manifestations of inflammation, transfer the patient to the remission phase, inhibit atrophic changes, and maximize the possible restoration of secretory and motor gastric activity.

As a rule, treatment is carried out on an outpatient basis, but in the case of severe exacerbation symptoms, as well as if a thorough examination is necessary, it is advisable to hospitalize the patient.

In the treatment of acute gastritis with low acidity, great importance is attached to the patient's adherence to a dietary ration and diet. During an exacerbation of gastritis, food should be consumed five or six times a day, moderately warm and mechanically processed. The purpose of dietary nutrition is to reduce the load on the parietal cells of the stomach. As acute symptoms subside, food becomes less gentle. In addition to the diet, drugs are prescribed that stimulate the activity of the gastric glands. Enzyme and acid deficiency is compensated for by the following drugs: Acidin-pepsin, Pepcidil, Pancreatin. These drugs facilitate the process of digestion. The first two drugs are used for hypoacid gastritis up to the complete absence of pepsin and hydrochloric acid (achilia).

Acidin-pepsin is taken orally with or after food three or four times a day, dissolving two tablets in half a glass of water.

Pepcidil is taken orally with food three times a day, measuring out one or two tablespoons of the solution, preferably drunk through a straw.

Contraindicated in cases of high acidity and allergies to its ingredients.

Panzinorm is used for atrophic gastritis, inflammation of the gallbladder, and decreased function of the pancreas. Taken orally with food three times a day. Contraindicated in hepatitis, lack of bile outflow, gastrointestinal obstruction, and allergies to the components of the drug.

If acute gastritis develops in a patient with chronic pancreatitis, then drug therapy involves the administration of Pancreatin or Festal, nausea, vomiting and heartburn are relieved by the drugs Cerucal or Reglan.

For chronic gastritis with low acidity, diet No. 2 is recommended. The menu should include a variety of products that activate acid formation, increase appetite, and provide adequate nutrition: low-fat fish or meat broths and soups cooked in them; stewed, boiled, and steamed low-fat meat, fish, and vegetable dishes; crumbly porridge cooked in water; fruit and vegetable juices; greens. The duration of adherence to dietary nutrition standards for chronic hypoacid inflammation of the stomach is individual (from one month to several years).

Excluded are dishes that take a long time to digest, irritate the gastric mucosa and provoke increased fermentation in the intestines: fatty, spicy, smoked, salty, cold drinks, fresh bakery products, cabbage and grapes in large quantities. Patients with this form of gastritis often have an intolerance to fresh "sweet" milk, in such circumstances it is recommended to consume fermented milk products.

The choice of dietary table is also based on the presence of concomitant diseases. Table No. 4 is prescribed in the presence of frequent diarrhea, table No. 5 - in diseases of the pancreas.

The use of drugs is determined by the degree of disruption of hydrochloric acid production. In the treatment regimens for gastritis with low acidity, agents that promote acid formation are introduced:

• plantain juice, which is taken one tablespoon three times a day a quarter of an hour before meals;
• plantaglucid (a granulated preparation from plantain extract) - half or one teaspoon of granules is dissolved in a quarter glass of water and taken twice or three times a day half an hour before meals.

Romazulon is a preparation made from chamomile flowers or Rotokan (chamomile, yarrow, calendula) – it is included to eliminate inflammation, excessive gas formation and flatulence, provide pain relief, disinfection and accelerate epithelialization.

Patients with achylia are prescribed replacement therapy:

• natural gastric juice, which is taken during or after meals one or two times or three times a day;
• acidinpepsin, pesidil.

As part of replacement therapy, polyenzyme drugs are prescribed as needed: Pancrenorm, Pancreatin, Festal, Digestal, Pancurmen, Mezim forte. They are taken orally, one or two tablets three times a day with food.

As the patient's health improves and the symptoms of acid and enzymatic deficiency are eliminated, the dosage of polyenzyme replacement drugs is reduced; when the patient's health returns to normal and there are no signs of digestive disorder, the doctor may cancel these drugs. However, in cases of severe forms of anacid gastritis, aggravated by chronic pancreatitis and enterocolitis, enzyme replacement therapy may be long-term and often permanent.

Treatment regimens for chronic gastritis include medications that stimulate blood circulation in the gastric mucosa:

• subcutaneous injections of aloe extract 1 ml, but not more than 4 ml per day,
• Methyluracil tablets - one tablet during meals three or four times a day;
• Pentoxil, a stimulator of leukocyte formation, is taken orally after meals, one tablet three times a day;
• Vitamins B6, B9, B12, A, PP, vitamin-mineral complexes (depending on the degree of mucosal atrophy and the patient’s condition).

These drugs are prescribed by a doctor individually depending on the diagnostic results. A course of treatment with these drugs is carried out for a month, usually in winter or spring.

If the course of chronic anacid gastritis is accompanied by a lack of appetite and noticeable weight loss, anabolic steroid hormones are used:

Retabolil - intramuscular injections of the drug (25-50 mg of oil solution) are prescribed every two to three weeks, the course of treatment is from eight to ten injections. Contraindicated in malignant neoplasms of the mammary glands, prostate. It is prescribed with caution in case of liver and kidney dysfunction, insulin-dependent diabetes mellitus (with simultaneous use, it may be necessary to reduce the usual dose of insulin).

Therapy for hypoacid gastritis cannot be done without gastroprotectors – drugs that have enveloping and astringent properties, providing a bactericidal and anti-inflammatory effect on the atrophied mucous membrane.

De-nol, the active ingredient of which is bismuth subcitrate, has a 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.

This drug is also included in the treatment regimen for infectious gastritis caused by Helicobacter pylori, using the eradication method for these bacteria – a standard international tactic for influencing the source of infection.

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, it leads to their death. The active substance of the drug, due to its good solubility, penetrates deep into the mucous layers, destroying the bacteria located under them. At the moment, Helicobacter pylori strains resistant to bismuth subcitrate have not been identified. However, the drug is able to reduce the acidity of the stomach and inactivate pepsin, which is already insufficient for gastritis with low acidity. However, if infection with Helicobacter is confirmed, then complex treatment is carried out using the following schemes:

1. Dosage of the drugs: 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. Dosage of the drugs: De-Nol - one tablet half an hour before meals twice 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.

In cases of detection of Helicobacter pylori, it is necessary to destroy the infection, for this purpose proton pump inhibitors (omeprazole, nolpaza) and antibiotics are included in the therapeutic complex. Proton pump inhibitors are excluded from the therapeutic scheme only in the case when the basal acidity of gastric juice pH> 6. Despite the fact that these drugs tend to reduce the production of hydrochloric acid by stomach cells, the conducted trials have established that eradication of Helicobacter pylori in cases of insufficient acid formation stops the development of atrophic processes and prevents the development of malignant neoplasms of the stomach. After completion of treatment and elimination of the infection, an improvement in the renewal and restoration of cells of the gastric mucosa was observed.

Antibiotics for gastritis with low acidity, as well as with high acidity, included in the treatment complex, are also necessary to destroy the source of infection. Considering that the eradication of Helicobacter pylori is carried out with drugs that reduce the production of hydrochloric acid, in gastritis with low acidity, it is of great importance to determine the species of this bacterium and its sensitivity to a certain type of antibacterial drugs in order to carry out treatment quickly and effectively.

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.

In complex therapy, the absolutely natural medicine Iberogast can be prescribed, which is an alcohol solution of extracts from medicinal plants: chamomile flowers, bitter iberica and celandine herbs, angelica and licorice roots, caraway and milk thistle fruits, lemon balm leaves and peppermint. The herbal collection is selected in such a way that Iberogast removes muscle spasms in the digestive tract and tones their smooth muscles without affecting their normal motor activity. Experiments have shown that the drug inhibits the reproduction and development of six types of heliobacteria, and its action is selective: in areas of the stomach and intestines with weak smooth muscle motor activity, thanks to bitter iberica, muscle tone increases, reducing flatulence and a feeling of heaviness. In areas with increased tone, this drug has an antispasmodic effect, regulating motility and normalizing the motor activity of the gastrointestinal tract.

Hilak forte is a medicinal product consisting of metabolites of E. coli, streptococci and lactobacilli in an aqueous solution of a nutrient medium. An absolutely natural medicinal product that regulates the balance of the biocenosis of the gastrointestinal tract. Metabolites of microorganisms that normally inhabit the environment of the stomach and intestines promote natural regeneration of the normal balance of the microflora of the gastrointestinal mucosa, and biosynthetic lactic acid and its buffer salts normalize both insufficient and excessive acid formation. Restoration of the normal ratio of microorganisms promotes high-quality reproduction and absorption of vitamins B and K.

The drug is prescribed for chronic digestive disorders caused by various reasons. Its use by infants, pregnant and lactating women is quite acceptable.

Hilak Forte drops are taken orally, diluted in a certain amount of liquid, but not in milk, three times a day with food or before meals. Children under one year are prescribed from 15 to 30 drops; over one year - from 20 to 40 drops; adult patients - from 40 to 60 drops. When the therapeutic effect occurs, the daily dosage is halved.

Contraindicated in case of allergy to the ingredients; no side effects have been recorded to date.

Concomitant use with antacid drugs is not recommended due to possible neutralization of lactic acid.

At the discretion of the attending physician, the following medications may be included in the treatment regimen:

• to relieve dyspeptic disorders: Polyphepan, Almagel - against diarrhea; Motilium, Cerucal - to eliminate vomiting; Espumisan - to relieve flatulence; Motilak, Ganaton - to activate intestinal motility; No-Shpa, Papaverine - to relieve muscle spasms; antihistamines and sedatives.

Physiotherapeutic treatment is contraindicated in case of relapses of the disease, polypous gastritis, rigid antral gastritis.

Of the physiotherapeutic procedures for gastritis with low acidity, the doctor may prescribe UHF therapy, high-frequency magnetic therapy, diadynamics, medicinal electrophoresis with calcium preparations or novocaine, galvanization, ozokerite therapy and paraffin therapy.

Alternative treatments

In case of non-infectious gastritis with low acidity, folk treatment can be effective, but it should be taken into account that treatment with folk remedies should be started in the early stages of the disease, it will be long-term and courses of medication will have to be repeated regularly. It is also necessary to follow a diet. The diet includes: lean meat and fish, vegetables - stewed, boiled, steamed; low-fat cottage cheese, kefir, yogurt; mild cheeses; soft-boiled eggs; porridge; yesterday's bread; fresh vegetables, fruits and berries (sour or sour-sweet); coffee, tea, juices. It is necessary to eat small portions at least five times a day, chewing thoroughly. Eliminate alcohol and do not smoke. Such a diet and diet will contribute to the gradual activation of the parietal cells and the normalization of acid formation.

The most famous folk remedy used for stomach discomfort is flax seed. It contains polysaccharides, vegetable proteins (superior in nutritional value to soy proteins), fiber - a mucus-forming component that coats the inner surface of the stomach. These seeds also contain vegetable fibers (lignans) - which have an antioxidant and antiseptic effect, Omega acids, phytohormones and vitamins E, B and D, provitamin A. Due to such a rich composition, flax seed can relieve pain, disinfect, protect the surface and promote its restoration, strengthen blood vessels and improve blood circulation. Such a wide range of action opens up the possibility of using flax seed for gastritis with low and zero acidity. Its properties allow a lump of food to move freely along the thinned walls of the stomach, without damaging them and significantly reducing pain. For the treatment to be effective, it is necessary to tune in to long-term treatment. You will have to take a daily prepared decoction of flax seed for two months before each meal every day. The recipe for making an infusion of flax seed is usually published on the pharmacy box, but it is possible to use other methods of making the infusion:

• Brew 10g of flax seeds in one liter of boiling water, seal and leave in a warm place until morning, strain, drink half a glass, and then eat after a third of an hour;
• Pour 0.2 liters of boiling water over five grams of seeds, leave for two to three hours, shaking occasionally, strain, drink a tablespoon before each meal;
• Pour 70g of seeds with a liter of boiling water, strain after two hours, cool, drink 250 ml, then eat after an hour;
• grind flax seeds in a coffee grinder, then brew with boiling water (at the rate of one teaspoon of seeds per glass of water), mix well to make a thick jelly, drink ¾ of a glass, then eat after half an hour;
• make a mixture of flax seeds, thyme, chamomile, bearberry, coriander and tansy in equal proportions, grind as much as possible, brew two tablespoons of the herbal mix with 1/2 liter of boiling water, strain through cheesecloth after a few hours, drink 1/3 cup before meals.

You can make porridge for breakfast from flaxseed flour or seeds ground in a coffee grinder: pour two or three spoons of flour into a bowl and pour boiling water or boiling milk (if there is no intolerance), you can use milk and water in equal parts, add sugar or a little salt, cover with a lid. In five minutes the porridge is ready.

You can buy a ready-made, portioned, packaged Flaxseed Cocktail online, which is recommended for patients with gastritis. According to the instructions, the duration of treatment is ten days, provided that the product is taken three times a day.

You can make it at home: brew one or two tablespoons of flaxseed with boiling water (0.2 l), leave until morning. In the morning, add a teaspoon of honey and beat in a mixer (blender).

In folk medicine, flaxseed oil is recommended for gastritis as a mild anti-inflammatory, disinfectant, analgesic and healing agent. You can buy ready-made flaxseed oil. It is obtained by cold pressing, while it retains all its valuable qualities and can be used for medicinal purposes. Flaxseed contains up to 48% of the oil component.

Flaxseed oil is taken orally on an empty stomach, one teaspoon at a time (you can wash it down with warm water) for three months. It is effective even in cases of erosive damage to the gastric mucosa.

You can simply use the oil in food, seasoning salads, vinaigrettes, purees, adding it to yoghurts. It is not contraindicated for children either.

If desired, it is possible to make flax seed oil at home. To do this, grind the seeds and pour them into a sieve lined with gauze. Then hang the sieve, placing a bowl underneath. Press down the flour in the sieve with something heavy. The weight of the press will begin to squeeze the oil into the bowl. As soon as it stops coming out, squeeze out the gauze and pour from the bowl into a glass container for storage.

There, no less flax has some contraindications, first of all - hypersensitivity, in addition - intestinal obstruction, gallstones, infectious and inflammatory processes in the liver, acute esophagitis and enterocolitis. Asthmatics, endocrinology patients, pregnant and lactating women, as well as people prone to increased bleeding should not get carried away with flax seed products.

Beekeeping products, in particular honey and propolis, are effective in treating both acute and chronic inflammations of the gastric mucosa. These products are non-toxic, have a broad spectrum of action and are rich in vitamins and minerals. The anti-inflammatory, antiseptic and analgesic properties of propolis and honey have been known for a long time, with the longest use they do not cause intoxication and dysbacteriosis, are able to regenerate the gastric mucosa, increase immunity and normalize the acidity of gastric juice.

The easiest way, if there is no intolerance, is to take a tablespoon of honey 10 minutes before meals, you can dissolve it in cold water and drink it. The dosage should not exceed 150g of honey per day, given that a tablespoon holds 30g of thickened and 35g of liquid honey. During treatment, you cannot eat other sweets except honey, the duration of apitherapy is from one and a half to two months.

You can make an emulsion from honey, Kalanchoe juice and 10% propolis tincture. Dosage: one tablespoon three times a day for one to two months. Have breakfast, lunch and dinner an hour after taking the emulsion. This remedy is prepared as follows: mix 78 g of linden or acacia honey with 15 ml of freshly squeezed juice from Kalanchoe leaves and seven milliliters of propolis alcohol tincture (10%). This mixture is kept in a water bath for about half an hour, stirring continuously - the water temperature is 45 ° C.

For gastritis with low acidity, it is recommended to take herbal infusions and alcohol tincture of propolis simultaneously.

1. A herbal infusion is made from equal parts of mint leaves, plantain and bogbean, chamomile and calendula flowers, calamus and dandelion roots, finely chopped and mixed. Then three tablespoons of the herb are brewed in a thermos with ½ liter of boiling water, closed and infused for two to three hours. Start taking it 40 minutes before meals with half a glass of infusion. 20 minutes after taking the infusion, drink 20 drops of propolis alcohol tincture (20%) diluted in 15 ml of water. After another 20 minutes, you can eat. The treatment procedure is repeated three times a day for a month. If necessary, the course can be extended for another two weeks, but no more.
2. For hypoacid gastritis with frequent diarrhea and increased gas formation, the following treatment option is recommended. Make a decoction from a herbal collection of crushed and mixed in equal proportions calendula and chamomile flowers, plantain and nettle leaves, yarrow and St. John's wort herbs as follows: brew two tablespoons of the mixture in 1/2 liter of boiling water, simmer over low heat for five to seven minutes, leave for an hour and a half, strain. Start taking with propolis tincture alcohol (10%) - drip 40-50 drops into ¼ glass of water and swallow 40 minutes before the start of a meal, then after 20 minutes drink half a glass of decoction, after another 20 minutes you can eat. The procedure is repeated 3-4 times a day for a month. If necessary, you can extend the course for another two weeks, but no more.

You can prepare a water tincture of propolis and drink half a glass of it every day. Just keep in mind that this medicine needs to be renewed every week, and you will have to prepare it four times a month. The solution is prepared in proportions of 20 g of propolis - 100 ml of water in an enamel bowl (stainless steel is possible). Before preparation, the propolis should be kept in the freezer, so it is easier to grind. Grate a piece of propolis into the selected bowl, pour water and simmer in a water bath at a water temperature of 80 ° C for about an hour. The finished tincture should be a rich brown color, with a deep, pleasant balsamic aroma. Once it cools, strain it. It is better to keep it in a dark glass container, at a low but positive temperature, without light, you can in the refrigerator.

Long-term use of propolis preparations can lead to an overdose, fraught with weakened immunity and nervous system disorders, such as dizziness, drowsiness. People who know about their allergy to bee products, in particular, honey, should not use these treatment methods. In addition, honey is contraindicated for people with insulin-dependent diabetes.

In case of acid deficiency, fresh sea buckthorn berries will come in very handy. They are picked after the first frosts have passed and the taste becomes slightly sour. It is good to freeze them for the winter in small portions in the freezer and use them to make compote, fruit drink, tea, sauce. The berries can be ground with sugar, or jam can be made. In case of insufficient acid formation, they are useful in any form. Sea buckthorn not only regenerates the gastric epithelium, but also helps to normalize the synthesis of hydrochloric acid. In case of gastritis with low acidity, it is good to brew tea from dried sea buckthorn berries. Brew three tablespoons of berries in 1/2 liter of boiling water and boil for about ten minutes. It can be drunk without restrictions, however, for people with high acidity, it, like fresh berries, is contraindicated.

Sea buckthorn oil, which has an enveloping, analgesic and restorative effect, is used to treat erosive gastritis with any acidity. It envelops the mucous epithelium of the stomach and creates a protective film, preventing the progression of the disease and the spread of erosive lesions.

Sea buckthorn oil is sold in pharmacies, however, if these berries grow in the country, it makes sense to make it at home. The required ingredients for this process are sea buckthorn berries and any unrefined cold-pressed vegetable oil. The juice must be squeezed out of the berries, and the pulp is covered with vegetable oil in a 1:1 ratio. This mixture is kept in a cool, protected from sunlight room for two weeks, shaking the container with it as often as possible. Then the oil is filtered, squeezed out and poured into a dark glass container for storage. For forty days, drink an hour before meals three times a day, one tablespoon. The healing process cannot be interrupted, which must be taken into account when determining the required volume of oil to prepare.

Sea buckthorn oil is contraindicated in acute and chronic inflammatory diseases of the pancreas, gall bladder and liver. Eating fresh berries is undesirable for hyperacid gastritis, stones in the urinary organs, and a tendency to diarrhea.

In medicine (folk and official) in conservative therapy of gastritis, herbal treatment is widely used, both in the form of pharmaceutical preparations, for example, Romazulon - a pharmacy drug from chamomile flowers, and homemade decoctions and infusions. Medicinal chamomile is used in almost all compositions of herbal mixes. Its flowers are included in many herbal mixtures used for secretory disorders of the digestive glands, gastritis, ulcerative lesions of the gastrointestinal tract. It helps eliminate edema of the gastrointestinal mucosa, activates the outflow of bile, and eliminates increased gas formation.

The active component of chamomile flowers is chamazulene, which has a wide range of medicinal properties - regenerating, analgesic, anti-inflammatory and anti-allergic. The essential oil from the flowers of this plant is rich in glycosides and acids (ascorbic, palmitic, oleic, linoleic, stearic), flavonoids and coumarins, gum, provitamin A, as well as potassium, copper, zinc, selenium. Heating over direct fire destroys chamazulene, so it is recommended to prepare herbal infusions in a water bath.

In order for the healing properties of chamomile to manifest themselves to the fullest, after taking the infusion, it is advisable to lie down, periodically turning over to the left and then to the right side.

In addition to the chamomile infusions already mentioned above, you can prepare the following remedies.

1. Make a mixture of the following ingredients:

• peppermint leaf – 20g;
• knotweed and marsh cudweed grass, chamomile and yarrow flowers - 15g each;
• dill and caraway seeds, valerian root - 10g each;
• hop cones – 5g.

Grind everything, mix well, brew with a liter of boiling water and put in a preheated oven, leave there for 10-12 hours. Strain, drink a glass of infusion on an empty stomach in the morning and continue drinking a glass every two hours until the infusion is finished.

2. Make a herbal mixture, taking equal proportions of chamomile, wormwood, peppermint, sage, yarrow, chop and mix well. Brew two teaspoons of the herbal mix with a glass of boiling water for half an hour, strain, drink three times throughout the day, slightly warming each portion. Drink the first portion on an empty stomach.

Chamomile and mixed infusions with it are contraindicated in the case of absolute lack of acidity in gastric juice.

Orange marigolds or calendula are a storehouse of various bioactive components. The main ones are carotene and carotenoids, which give the flower petals a bright carrot color. And the regenerating, anti-inflammatory and antiseptic properties of this plant have long been used for medicinal purposes. From the extracted marigold flowers, a tablet preparation called Caleflon is produced, which is indicated for gastritis and stomach ulcers to restore and renew the mucous membrane. They are taken after meals, 100-200 mg three times a day.

At home, you can prepare medicinal honey infusions from calendula:

• brew three tablespoons of flowers in ½ liter of boiling water overnight (about eight hours), strain in the morning, mix with three tablespoons of light honey;
• For half a liter of water, take three tablespoons of calendula flowers and two of chamomile, pour boiling water over them and leave for six hours, strain and mix with four tablespoons of linden honey.

Such infusions are taken 100 ml one hour before meals three or four times a day.

It is not recommended to use calendula if you have low blood pressure or heart rate. In pregnant women, calendula can cause a miscarriage.

Aloe juice stimulates the stomach muscles and the production of gastric juice, which is necessary for acid deficiency. It relieves inflammation, destroys pathogenic microflora, relieves pain and eliminates constipation. Aloe leaves that are at least three years old are suitable for making juice. Cut the leaves and put them in the refrigerator for a couple of weeks. Then squeeze the juice out of the leaves and take a teaspoon three times a day half an hour before meals. Since aloe juice is bitter, you can mix it with honey or sugar. The duration of treatment is three weeks. You should not squeeze out a lot of juice at once; it is advisable to prepare it before use or once a day.

Aloe juice can also be found in the pharmacy and is taken in the same way.

This natural stimulant is contraindicated only in case of intolerance.

Ivan-tea or fireweed narrow-leaved relieves inflammation well and envelops the mucous membrane of the gastrointestinal tract. Its leaves contain carotene and vitamin C, which is three times more in this plant than in oranges. Fireweed is effective in metabolic disorders and hematopoiesis, these properties are very valuable for chronic gastritis with low acidity. This drink can eliminate diarrhea due to its astringent and antibacterial properties.

Tea brewed from the leaves of this plant stimulates the restoration of damaged gastric mucosa, has a strengthening and tonic effect on the body. Ivan tea is prepared for hypoacid gastritis as follows: 60 g of leaves are poured with a liter of water, brought to a boil, and filtered after half an hour. Drink 150 ml before each meal until the discomfort in the stomach area completely disappears. Contraindicated in cases of a tendency to thrombosis.

You can always buy Gastric Collection in pharmacies, such collections are also offered in online stores. The annotation to them indicates indications, contraindications and method of preparation. They are produced both in a mixture of herbs for decoctions and infusions, and in bags for brewing.

For example, a packaged herbal tea consisting of chamomile and marigold flowers, yarrow and St. John's wort, rose hips and fennel. This tea stimulates the production of gastric juice and, accordingly, appetite, helps reduce inflammation and bile flow, relieves spasms and relaxes, and also calms the nervous system.

The method of preparation is very simple - put a bag in a glass, pour boiling water, cover and in 10-15 minutes the infusion is ready for use. Patients from 15 years old can drink a third or half a glass of infusion during meals in the morning and evening. The duration of the course is not limited, but not less than three weeks.

Gastric collection No. 2 has a more varied composition and is produced as a mixture for infusion: nettle leaves, plantain, fireweed, peppermint, wild strawberry and currant, calendula and immortelle flowers, St. John's wort, wormwood, yarrow and knotweed, rose hips, corn silk and hop cones, dill seeds, valerian and angelica roots.

It has all possible properties: anti-inflammatory and antibacterial, hemostatic and healing, antioxidant and renewing, calming and appetite-inducing and gastric juice production. The herbal collection is rich in various vitamins, microelements and other nutritional components.

Place two tablespoons of plant material in a half-liter container and fill to the top with boiling water, leave for three hours, strain. Drink a glass half an hour before three meals.

Gastric collection No. 3 consists of buckthorn bark, nettle and peppermint leaves, valerian roots and calamus in the ratio of 3:3:2:1:1. It has a pronounced laxative and anti-inflammatory effect of anthraglycosides and saponins, which are abundant in buckthorn bark; exhibits astringent properties (nettle, calamus and buckthorn bark), binding proteins of pathogenic microorganisms and forming a protective film enveloping the mucous membrane; acorin and calamus essential oil promote the production of gastric juice and increase appetite, vitamins and minerals promote rapid healing and pain relief, eliminate spasms of the gastrointestinal tract muscles and restore its motor activity.

Method of preparation:

1. Pour a tablespoon of the herbal mixture into an enamel bowl, brew 200 ml of boiling water, cover with a lid and keep in a water bath at boiling temperature. Let it brew for three quarters of an hour, strain and squeeze into the infusion. Add boiled water to the infusion to a volume of 0.2 liters. Drink a quarter of an hour before meals three times a day, warming and shaking before use, in the dosage: children aged 5-6 years - one tablespoon, 7-9 years - two tablespoons, 10-14 years - a third of a glass, patients 15 years and older - half a glass.
2. Place two bags in a glass or enamel container, pour a glass of boiling water over them, cover and leave for a quarter of an hour. Drink a quarter of an hour before meals twice a day, warming up before use, in the following dosage: children aged 5-6 years - two tablespoons, 7-9 years - a third of a glass, 10-14 years - half a glass, patients aged 15 years and older - a glass.

Take for 20 to 25 days, can be repeated at intervals of ten days.

People with low stomach acidity are advised to stimulate its production before meals:

• drinking several sips of water with half a teaspoon of light honey dissolved in it;
• half a glass of infusion or decoction of dried rose hips;
• a third of a glass of freshly squeezed carrot juice;
• apricot juice, as well as eating several fresh or dried apricots;
• eating 20-25 fresh grapes, a handful of blueberries (by the way, it’s good to eat them in all forms – pies, dumplings, compotes);
• eating finely chopped fresh cucumber, fresh turnip salad with vegetable oil.

Among food products, good stimulants for the production of gastric juice are beans, stewed (boiled) cabbage, and dietary meats.

It is important to remember that treatment with any folk remedies is carried out after consultation with a doctor, in the absence of allergies to the ingredients of herbal preparations. It is not recommended to use folk remedies for the "acute abdomen" syndrome on your own or to wash down tablets or capsules with infusions, decoctions, medicinal teas, or dilute powders of medicines.

Homeopathy can give a stable and good result, however, a homeopathic medicine should be prescribed by a homeopathic doctor, individually, since there are more than thirty medicines used only for acute gastritis.

For example, Antimonium crudum is used in cases of acute inflammation, as well as exacerbations of digestive disorders. The characteristic feature of patients who are prescribed this drug is overeating and a grumpy disposition. They do not tolerate heat and other people's touches well.

Carbo vegetabilis (Carbo vegetabilis) - for gastritis associated with food poisoning, accompanied by flatulence and stomach upset; Ipecacuanha (Ipecacuanha) - this drug is used mainly to treat superficial gastritis.

For chronic hypoacid gastritis, Arsenicum album, Bryonia, and Mercurius solubilis are often prescribed.

In order to correctly prescribe a drug, and its use will bring about an improvement in the patient’s condition and long-term remission, it is necessary to take into account many factors and symptoms, which may, at first glance, have no relation to the disease.

Among the complex homeopathic preparations of the Heel brand, there are several intended for the treatment of gastritis:

• Gastricumel, sublingual tablets, containing frequently used homeopathic preparations prescribed for various symptoms of gastritis 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 completely dissolved. The drug is taken 30 minutes before meals or an hour after. In acute conditions, one tablet can be taken every quarter of an hour, but the daily dose should not exceed 12 tablets. The course duration is two or three weeks. Repeated course - as prescribed by a doctor. Can be used by children from three years of age, pregnant and lactating women under the supervision of a doctor. Sensitization is possible. Combination with other drugs is possible.
• Nux vomica-Homaccord are homeopathic drops consisting of the following components: Nux vomica (vomit nut), indicated for inflammatory processes of the mucous epithelium of all digestive organs from top to bottom, as well as for eliminating the consequences of substance abuse;
  Bryonia (white bryony), indicated for chronic gastritis accompanied by excessive gas formation, diarrhea, pain; Lycopodium (club-shaped diving beetle) is a remedy for the treatment of the liver, biliary system, lack of tone of the intestinal muscles and constipation, as well as a depressive state; Colotsintis
  (bitter gourd) is a remedy that relieves spasms of the digestive organs, inflammation and intoxication, having 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. Not recommended for pregnant and nursing women. Allergic reactions are possible.

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Surgical treatment

Surgical intervention in gastritis with low acidity is an extreme measure. However, if the patient has pronounced symptoms of gastric bleeding, it cannot be stopped and its cause cannot be determined, an urgent operation is prescribed. It may involve suturing the areas with bleeding, partial or complete removal of the stomach.

A risk factor for gastric bleeding is hypertrophic gastritis, which occurs with the growth of neoplasms (polyps, warts, cysts). Giant hypertrophic gastritis (Menetrier's disease) is described in two variants - hyperplastic polyps and multiple sheet-like adenomas.

Surgery is indicated for patients with intractable pain, pathological decrease in albumin biosynthesis, bleeding, and pyloric stenosis. After removal of the part of the stomach where the tumors are localized, the patient often experiences clinical improvement: pain goes away and albumin production is restored. Although partial gastrectomy is used more often, in severe cases, complete removal of the stomach is justified, since it completely removes the pathological mucous membrane and prevents malignancy of the tumors. Most postoperative fatalities have been recorded in patients after subtotal (partial) gastrectomy. High mortality is associated with the difficulty of creating a hermetic connection between the normal and hyperplastic mucous membranes.

After surgical treatment, such a complication as gastritis of the stomach stump is also not excluded. It can be provoked by various reasons, both medical errors and the irresponsibility of the patient himself. Gastritis of the stomach stump is treated mainly by therapeutic methods, as an extreme measure - total gastrectomy is performed.

Exercises for gastritis with low acidity

Physical activity in patients with acid deficiency stimulates the production of hydrochloric acid, as well as pepsin, the main digestive enzyme. Exercises should be performed at a moderate speed, with the pulse rate not exceeding 150 beats per minute. Meals should be organized so that at least an hour and a half passes between meals and physical exercise.

Breathing exercises are useful for hypoacid gastritis. Changing the intra-abdominal pressure with deep rhythmic inhalations and exhalations stimulates the work of the vessels and improves the blood supply to the stomach. Exercises that strengthen the abdominal muscles also promote blood microcirculation. Leisurely walking is very useful for this pathology.

When starting to do therapeutic exercises, you need to master several exercises, gradually expanding their range and increasing the number of repetitions. You can't overexert yourself, you need to increase the load little by little, listening to your body.

Treatment of exacerbation of gastritis with low acidity can be combined with training, giving the body a small physical load, which will speed up the process of stopping the symptoms of relapse. From the treatment complex, you can choose exercises that are performed from a sitting or lying (on your back) position, and do them to the best of your ability, avoiding sudden movements. As the condition improves, the load can be gradually increased, and also - master exercises performed lying on your side and standing. After 6-8 weeks after the relapse of the inflammatory process, you can include exercises that are done lying on your stomach.

During the period of remission, therapeutic exercises continue for preventive purposes.

This set of exercises is intended for people suffering from chronic inflammation of the gastric mucosa with acid deficiency, for whom ten or more days have passed since the exacerbation. Each exercise is done approximately ten times, you can start with five times or less, gradually adding their number, while being guided by your well-being. It is recommended to breathe at a tempo of 4×4 (four seconds inhale, pause, four seconds exhale, pause).

1. Starting position: standing, feet shoulder-width apart, arms down along the body:
   • inhale, slowly raise your head and look at the ceiling, exhale - lower your head and look at your feet;
   • straight, without lowering, turn your head as much as possible towards the right shoulder (inhale), then towards the left (exhale);
   • voluntary breathing - rotation of the hands of arms extended to the sides forward, then backward;
   • inhale - slowly raise your arms up through the sides, exhale - lower them down in the same way.
2. Starting position – standing:

• place your feet slightly wider than your shoulders, hands on your waist: inhale - bend backwards, moving your elbows back, exhale - move your elbows forward and bend your back;

• legs together, breathing is arbitrary: lowering your arms down, bend your knee and lift your heel off the floor as much as possible, standing on the toe of your left foot, then your right;
• feet together, breathing freely: roll from toe to heel with both feet at the same time.

3. Sit on a chair, bend your knees at a right angle, place your feet on the floor, hands on your waist, breathe freely:

• bend your torso left and right;
• half-minute "walk" with the knees raised as high as possible.

4. Stand with your left side to the back of the chair, holding onto the back, and swing your right leg: inhale – forward, exhale – backward, then do the same for the other leg.
5. Lie on your back, hands on your waist:

• inhale - lift your head and shoulders, look at your toes - exhale - starting position;
• inhale, raise your left arm, while bending your right leg, without lifting your foot off the floor, exhale - take the starting position;
• inhaling, we raise the straightened right leg, exhaling, we lower it, then the left one.

5. Lie on your back, slightly raise your torso, rest on your elbows: inhale - raise your straight right leg, exhale - lower it, then the left one.
6. Lie on your back, lower your arms along your body, breathe freely: bend your legs and pedal a bicycle for one minute.
7. Sit on the floor, stretch your legs, and place your hands behind you: inhale and bend, raising your pelvis, exhale and return to the starting position.
8. Get on all fours:

• inhaling - raise your head, exhaling - lower it, pull your right leg towards it between your hands, arching your back upward, then your left;
• inhale - raise your left arm to the side and up, exhale - lower it back;
• inhale - raise your pelvis, straighten your knees, tilt your head (hill) - exhale;
• inhale - arch your back, lowering your head, exhale - arch your back, raising your head.

6. Lie on your stomach, lift your body parallel to the floor, rest on your forearms, positioned in front of you parallel to each other, and your toes, stand in this position, looking ahead, breathing calmly and deeply as much as you can.
7. Lie on your back and take several full, deep breaths in and out, trying to breathe through your abdomen.

It is not necessary to do the entire complex at once, you need to take into account the capabilities of your body.

Contraindications for therapeutic gymnastics are: exacerbation of peptic ulcer, hemorrhagic gastritis, gastric stenosis, severe nausea with frequent vomiting, acute pain.

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Prevention

The most important thing in preventing gastritis, as with most other diseases, is to give up bad habits and lead a healthy lifestyle.

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 to eat and chew food thoroughly. Already during chewing, gastric juice begins to be released, in addition, food is partially disinfected by saliva, even Helicobacter pylori may not reach the stomach, dying in the mouth. Office workers who spend a lot of time sitting should try to lead a more active lifestyle, moderate physical activity will help activate all natural processes in the body.

The first signs of digestive disorders should be a reason to see a doctor. When diagnosing acute gastritis, timely treatment and careful adherence to doctor's orders will help the patient to quickly and completely restore the damaged gastric mucosa, and adjusting habits towards a healthy lifestyle will help avoid gastrointestinal diseases.

People who know that they have low acidity, and especially those with anacid gastritis, are recommended to undergo an annual endoscopic examination as a preventative measure against worsening atrophic processes.

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Forecast

Inflammation of the gastric mucosa with decreased production of hydrochloric acid is generally not a dangerous disease if you do not ignore the symptoms and start treatment in a timely manner. Patients are able to work for a long time, almost their entire lives. If you eat right, give up bad habits and maintain your health, then this disease does not limit human capabilities.

However, if the symptoms that arise are ignored, complications such as atrophy, hypertrophy, erosion and bleeding may occur, and the need for surgical intervention may arise.

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