Reflux gastritis: biliary, superficial, chronic, erosive, atrophic, antral

The orientation of the treatment process in this disease is reduced to the achievement of the following goals: restoring the normal motor function of the digestive system and compensating for the destructive effect of refluxate on the epithelium of the stomach. Therapy of reflux gastritis includes drugs of different pharmacological groups: digestive tract motility stimulants (prokinetics), acid production inhibitors (antacids), ursodeoxycholic acid derivatives (hepatoprotectors), cytoprotectors, enterosorbents and proton pump inhibitors.

Primer  (active ingredient - tacopride hydrochloride) is a modern prokinetic of selective action, which enhances the propulsive peristalsis of all organs of the digestive tract and prevents the development of duodenogastric reflux. The effect of this drug is due to the stimulation of the release of endogenous acetylcholine and an increase in the time of its activity, which is achieved by inhibiting the activity of the enzyme acetylcholinesterase. This tones the muscles, including sphincter, leads to an increase in the duration of contractions of the smooth muscle tissue of the stomach and intestines, accelerates the movement of the contents of these organs in the right direction.

Absorption of the active substance (approximately 90%) occurs in the intestine, the largest plasma concentration is fixed after ¾ hours from the moment of Primer administration. Absorption is not dependent on food intake. Metabolism of this drug is carried out in the liver with flavone monooxygenase without the involvement of cytochrome P450, which makes it possible to avoid the negative interaction when combined with the intake of other drugs, the metabolism of which is realized by the enzymes of the CYP450 system. Primer practically does not have a toxic effect on the liver, it does not cumulate and does not pass through the blood-brain barrier. Inactive metabolites of the active ingredient are excreted in the urine, for a complete elimination of one dose, ½ day is enough.

The recommended single dose is 50 mg, it is taken every eight hours. The maximum permissible dose is 800 mg per day. Duration of treatment - from two to three weeks.

It is not prescribed to pregnant and lactating women, aged 0-11 years, persons with bleeding, perforation, obstruction of the digestive organs, sensitization, increased prolactin level.

Hydrotalcite  is a medicine used for increased acid formation. The active ingredient of the same name is aluminum-magnesium hydroxide-carbonate-hydrate-neutralizes excess hydrochloric acid in the gastric juice, normalizes acidity and protects the epithelium of the stomach from the damaging effects of hydrochloric and bile acids. It has a stratified-mesh structure with a specific action. The outer layer of the tablet containing the active ingredient enters into contact with the acid. Once the acidity is reduced, the release of aluminum and magnesium ceases until the next moment of its increase, when the next layer of the active substance enters the reaction. This allows long enough, in comparison with other antacids, to maintain a close to normal acidity of gastric juice. In addition, hydrotalcite possesses sorbent qualities, absorbing bile acids and lysolecithin. It is taken orally. Dosage is 0.5-1g with an interval of at least an hour after meals and at night, thrice-four times a day, children over the age of six-0.25-0.5g. Interacts with some antibiotics and other medications, so if necessary combined therapy should maintain a time interval of at least an hour. Contraindicated in the age of 0-5 years, with exacerbations of kidney pathologies, sensitization to components, pregnant and lactating women.

Therapy in combination with inhibitors of acid formation is more effective than monotherapy with each of these drugs.

For example, simultaneous reception with  rabeprazole.  This drug with the same active substance depresses acid production by reducing the enzymatic activity of hydrogen-potassium adenosine triphosphatase on the surface of the cells. The effect of the application depends on the dose and reduces both the main and stimulated release of hydrochloric acid. It has slightly alkaline properties, is quickly absorbed and cumulated in the lining cells. The effect of the drug is somewhat potentiated with the daily intake of one tablet, a stable effect occurs on the fourth day of admission, after the end of therapy, acid formation normalizes after two to three days. Metabolized by the cytochrome 450 system, which should be considered when prescribing drugs with a similar metabolism, does not interact with the hydrotalcite. Has a lot of side effects, with prolonged treatment, patients need to be monitored. Contraindicated in children, pregnant and lactating women, sensitized persons. It is prescribed in dosages of 10 to 20 mg, per day - once. Duration of treatment is from one to two months.

The use of therapeutic agents in the regimen of reflux-gastritis therapy, whose active ingredient is bear bile (ursodeoxycholic acid), is based on its cytoprotective action. It translates toxic bile acids into a hydrophilic form, the aggressiveness of refluxate decreases. Improves the clinical condition of the patient, endoscopic examination shows a decrease in the foci of the epithelial surface of the stomach. Experimentally proved the effectiveness of the use of ursodeoxycholic acid derivatives in both reflux gastritis and helicobacter-positive gastritis, which is important, since the damaging effect on the mucosa in the combination of duodenogastric reflux and infection with this bacterium increases synergistically. These drugs have a positive effect in the treatment of patients with operated organs of digestion (stomach, gall bladder).

Such properties are possessed by the drug  Ursosan  (synonyms Ursofalk, Ursahol, Cholacide). When ingested, the active ingredient is well absorbed by the tissues of the digestive organs, combines with the sulfur-containing amino acid taurine and aminoacetic acid. Ursodeoxycholic acid accumulates in the bile, the level of accumulation depends on the state of the liver. Metabolism of the active ingredient of the drug occurs in the intestine and liver, is derived mainly from the feces, a small part - bile. Contraindicated in inflammatory processes in the bile excretory organs, chronic hepatic and renal dysfunctions, at the age of up to five years and in the first three months of pregnancy (the remaining six - according to vital indications). It is not prescribed to lactating women. Patients of childbearing age should be reliably protected. The drug can cause side effects, more often on the part of the digestive system, and affect the properties of other drugs, in particular, antacids, which contain aluminum and magnesium.

Ursosan take once a day, at night. Dosing and duration of the course are individual. The standard dose is calculated as follows: per kilogram of body weight - 10 mg of the drug. Treatment can last up to 12 months.

Medical measures to eliminate duodenogastric reflux and regeneration of the gastric mucosa include dopamine receptor antagonists, preferably  Domperidone, as the safest drug of this group that does not overcome the protective barrier between blood and brain tissues and does not lead to motor dysfunction. It tones the muscles of the pyloric sphincter, stimulates the motility of the stomach, accelerating the evacuation of the food lump from it, normalizes the consistency of muscle contractions of the stomach and duodenum. The drug can be given to pregnant and lactating women according to vital indications. It is not appointed to persons sensitized to it, with bleeding, perforations, obstruction of the digestive tract, increased level of prolactin. May cause a number of side effects and negatively interact with certain medications. It is produced in the form of a solution, suspension, suppositories and tablets.

Dosages for adults: one or two tablets (with severe symptoms) three times or four times a day before meals. Suppositories rectal from two to four units (60 mg each).

Dosage for children:

• solution (1%) - at the rate of one drop per kilogram of weight from three to four meals per day;
• oral suspension - 0.25 ml per kilogram of weight three times a day;
• ½ tablets twice a day with a body weight of 20 to 30 kg;
• more than 30kg - one tablet twice a day;
• for the age group 0-2 years of the suppository 10 mg - from two to four units;
• for the age group of two years and older suppositories 30 mg - from two to four units.

The treatment regimen can include antibacterial drugs (with the detection of Helicobacter pylori infection), enzymatic agents and probiotics depending on the symptomatology and condition of the patient.

With chronic, especially untimely diagnosed prolonged reflux gastritis, avitaminosis develops. Vitamins are not digested in patients with digestive organs, especially in the case of B group vitamins that are involved in hematopoiesis. Their lack leads to anemia, manifested by fatigue, dizziness, nervous system and psyche disorders. The lack of retinol (vitamin A) inhibits regeneration, ascorbic acid - lowers the immune barrier. With increased acidity, vitamin E can be useful, which helps reduce its level. This is all taken into account when appointing a therapy regimen, a doctor can prescribe a course of individual vitamins or vitamin-mineral complexes, which should be taken according to the recommendations of the doctor and the instructions attached to them.

Physiotherapeutic treatment is also included in the therapeutic scheme, standard procedures are electrophoresis or phonophoresis with medications. Are carried out with the purpose of removal of painful sensations and an inflammation.

Amplipulse therapy restores muscle motility, beneficial effect on gastric epithelium and secretory function.

Acupuncture activates the functions of the digestive organs, affecting them through active points on the human body.

DMV-therapy (electromagnetic decimeter waves), UHF-therapy (ultra-high-frequency) - improve blood circulation, stimulate healing and eliminate swelling and pain.

It should be taken into account that physical procedures are contraindicated in case of erosive-ulcerative lesions and the presence of tumors.

Alternative treatment

Alternative medicine is very rich in recommendations for the treatment of diseases of the gastrointestinal tract. However, it is not worth replacing medication with alternative methods. They can help in the complex treatment and recovery of the body, but necessarily after consultation with the attending physician.

So, the alternative treatment for heartburn, which is one of the main symptoms of reflux gastritis, is in such simple procedures:

• chew a small piece of the root of the calamus and swallow it, you can drink it with water;
• take the tip of a teaspoon of powder from the root of the calamus and swallow it;
• Drink a tablespoon morning and evening before meals freshly squeezed juice from the celery root;
• crush the roots, leaves and seeds of angelica officinalis, brew one pinch of powder with boiling water, drink like tea, after five minutes.

A good help is flaxseed, the broth from which envelops the gastric mucosa and protects it from the damaging effect of refluxate. The recipe for cooking infusion from it is usually published on a packing box. With reflux gastritis, another method of preparation is recommended: pour a tablespoon of seeds with ½ cup of cool water and leave until the seeds swell and mucus appears, then strain and drink before eating.

You can prepare a vegetable mixture for infusion: two tablespoons of flaxseed, the same amount of chamomile, one tablespoon of powdered root of ara, licorice, melissa leaves and plantain. Place two tablespoons of vegetable raw material in enameled dishes, brew with boiling water (400ml). Strain on a water bath for a quarter of an hour, let it brew for two hours, strain and bring the infusion of boiled water to 400ml. Take ½ cup four times a day before meals.

Herbal treatment of this disease can not do without chamomile medicinal. It is present in almost all alternative recipes in combination with other herbs and as a monophytopreparation. Even Greenfield tea with chamomile, according to reviews, helps with gastritis.

However, chamomile (itself) is recommended for gastritis with low acidity, since it stimulates the production of gastric juice. However, in combination with yarrow and St. John's wort, chamomile is recommended for use in the form of herbal tea from approximately equal parts of all these herbs. He is drunk in the mornings and evenings, adding light blossom honey.

Alternative healers offer the following recipe for syrup from chamomile, fresh flowers which are laid in layers in glass or enamel ware, interspersed with layers of sugar. The laid layers must be suppressed well before the juice is isolated. Dilute a teaspoon of expressed syrup in ½ cup of water and drink three times during the day. In the same way come with dandelion flowers, only before eating in ½ cup water dilute a tablespoon of expressed syrup.

With pains and bile vomiting recommend infusions of medicinal herbs: two tablespoons of herbs brew 500ml of boiling water, insist under the lid for about an hour. Take with an interval of two hours before the disappearance of symptoms, then it is recommended to switch to tea from yarrow, St. John's wort and chamomile. However, the fog, in addition to choleretic properties, has the ability to increase the secretion of gastric juice.

Recipes of alternative medicine have been used for a long time, when the treatment was purely symptomatic, and nobody knew about the acidity of the stomach. The benefits of decoctions and infusions were determined empirically. Reflux gastritis is often accompanied by high acidity, although with prolonged course and atrophic changes in the gastric epithelium, acidity decreases with any form of gastritis. Therefore, before being treated by alternative means, it's a good idea to analyze your diagnosis, consult a doctor and take into account all aspects of your condition. Many recipes contain mixtures of herbs that enhance, and often neutralize, each other's actions. The answer to the question: what herbs are forbidden in reflux gastritis is ambiguous and depends on several components, in particular, on acid formation. For example, chamomile, fume, plantain, calendula, dandelion is recommended for gastritis with low acidity. However, in mixtures of herbal remedies recommended for acidity, they are also present. Their anti-inflammatory and antimicrobial properties, as well as vitamins, micro- and macronutrients, essential oils, flavonoids and other utilities are suitable here. Peppermint has the ability to reduce acid formation, narrow-leaved spraying is used for any secretion, Swamp Sweetling activates the motor motility of the stomach. Infusions of herbs have a milder effect than medicines, their active components are rapidly excreted and do not possess a cumulative capacity. In short, they are universal.

Homeopathy, appointed individually at the reception of a practicing homeopathic physician, can lead to persistent remission even in neglected cases, but for this it is necessary to have patience, to change habits and eating habits. Classical homeopathy applies one medication to treatment, and only an experienced doctor can select it correctly. After reflux, more than twenty drugs are used, among them Baptisia, Brionia, Hamomilla or the same chamomile medicinal, not avoided by homeopaths. Many drugs are prescribed with a predominance of any symptoms, for example, Conium is prescribed to patients with excessive acid formation, with symptoms of heartburn, acid burping, frequent nausea, Kali bichromicum - with a feeling of heaviness in the upper abdomen, with a decrease in appetite and flatulence, Argentum nitrikum - he stops strong stomach pains, Robinia - burning pains, severe heartburn, regurgitation, acid burps.

If it is not possible to visit a homeopath, you can, together with your doctor, choose the complex drugs offered in the homeopathic pharmacy or the Heel brand drug.

For example, Gastricumel-Heel, intended for the cure of various dyspeptic disorders and inflammatory processes in the stomach. The complex means include: Argentum nitricum, Arsenicum album, Pulsatilla, Nuks Vomica, Carbo vegetabilis, Antimonium krudum, the most popular remedies for digestive and gastrointestinal function disorders. This drug can be used both independently, especially at the initial stages of the development of the disease, and in combination with medications. Gastricumel's tablet 30 minutes before meals or an hour later put under the tongue and dissolve until it dissolves. To relieve an acute attack, you can dissolve every quarter of an hour on a pill, but make sure that you do not take more than 12 pieces a day. Treatment is continued for two or three weeks. Repeated reception is possible in the event that it is appointed by the attending physician. The drug can be taken from three years of age, future and nursing mothers - only under medical supervision. It is impossible to exclude the development of allergic reactions.

In the case of severe acute inflammation of the gastric mucosa can be combined with Traumeel C, to accelerate the recovery process. Traumeel is able through the activation of its own immunity to quickly stop the inflammatory process, swelling, tenderness, hyperemia.

If the digestive system is not functioning properly, Gastricumel-Heel can be used in conjunction with Nux vomica-Homaccord drops that eliminate the effects of unwanted effects on the gastric mucosa of toxic substances, tone up its musculature and activate the motor, not only the stomach, but the entire digestive canal from top to bottom, eliminate the symptoms of dyspepsia.

Perhaps the combination with Mucosa compositum, especially with erosive ulcerative lesions of the mucosa of the digestive canal, to enhance motility and normalize coordinated organ movements, eliminate bleeding, accelerate the regenerative process. If necessary, the combination is supplemented by Traumeel.

Dosage of a combination is prescribed by the attending physician. If necessary, all these tools can be combined with anthelicobacter therapy.

Operative treatment

Surgical interventions for reflux gastritis are extremely rare. Emergency operations are performed in cases of bleeding, which are opened due to erosive damage to the gastric epithelium. Indications for planned operations are tumor formations, non-healing ulcers and erosions, disorders of the sphincter function, which are not amenable to conservative treatment.

Diet with reflux gastritis

In the treatment of this disease, one of the main roles is given to dietary nutrition, without which it is simply impossible to achieve a positive result. Since treatment is most often outpatient, the patient independently organizes a diet for himself, based on medical recommendations. Catering and a set of used products should help normalize the motor activity of the intestine and reduce acidity, do not irritate the gastric mucosa and do not provoke reflux. During the period of exacerbation, table 1 can be taken as the basis, with some adjustments, leaving the main principle - the food should be cooked without frying and baking with crispy crust, not greasy, not sharp, not hot and not cold, food - fractional (≈ 5-6 meals per day, portions should be small). It is desirable to eat by the hour, food, if possible, should be freshly prepared. When eating, do not rush, you need to learn how to chew your food well. Is in the evening for the last time recommended about two hours before going to bed.

Eliminate from the diet:

• drinks - containing alcohol, caffeine, mint, fizzy, kvass;
• any fried dishes, smoked products, pickles;
• cabbage soup, borsch, okroshka;
• products that cause fermentation and flatulence - beans, beans, cabbage, black bread and others;
• fatty foods (buttery, sandy, flaky pastries, dairy, nonfat foods, even with low fat content, fatty meat and poultry, fish, ice cream, chocolate);
• fresh bread;
• any conservation and semi-finished products;
• eggs, hard-boiled;
• broths - meat, fish, mushroom, rich vegetable;
• sour, immature, rich in fibrous structures fruits and berries, in the acute period it is better not to eat vegetables and fruits without heat treatment at all;
• ketchups, hot sauces, mustard, horseradish, pepper, mayonnaise;
• salt - is limited (no more than a teaspoon per day).

The simplest way to make a menu for reflux gastritis for each day of the week, based on the list of allowed products, trying to ensure that the same dishes are repeated no more than twice. And stick to it, along the way making some adjustments. Mainly the patient's diet will include:

• well-boiled porridge (a variant of "mash") from buckwheat, oatmeal, rice cereal, it is possible in skim milk, (occasionally, for variety, you can use other cereals);
• rubbed soups from vegetables with the addition of cereals, you can chopped meat (but not on meat broth);
• boiled meat, chopped in a meat grinder or in a blender, steamed (stewed) cutlets, meatballs, soufflé from dietary - fillets of beef, turkey, chicken, rabbit;
• not fatty fish varieties, steamed, boiled, stewed;
• mashed potatoes from boiled, stewed or steamed vegetables; vegetable ragout from well-pressed and chopped vegetables;
• not sour low-fat cottage cheese and dishes cooked from it - lazy vareniki, casseroles; low-fat firm cheese (grated, later - slices); fresh skim milk;
• eggs (not more than twice a week), boiled soft-boiled, steam omelettes, souffle;
• wheat bread not fresh, crackers, biscuit biscuits;
• butter, vegetable, a small amount of sour cream (add to the dish);
• desserts in the form of jelly, soufflé, baked apples, marmalade, pastilles from the store (1-2 pieces a couple of times a week);
• compotes, kissels, herbal teas.

The daily ration can be compiled as follows:

• in the morning it is best to eat porridge cooked on water or skim milk with a small piece of butter, you can supplement it with soft-boiled eggs or meatballs, drink it with herbal tea (it's even better to drink tea first and then eat);
• for a second breakfast, toast from white bread, sprinkled with grated cheese, a decoction of rose hips;
• you can dine with vegetable mashed soup, boiled pasta with added crushed meat, compote of dried fruits;
• a mid-morning snack will make a baked apple, a glass of jelly with a biscuit biscuit;
• supper can be lazy dumplings, drinking them with chamomile tea;
• for an hour and a half before going to bed, drink ½ cup of milk with a biscuit biscuit or cracker.

Recipes for reflux gastritis

Any dietary diet is based on cereals, the most suitable ones being buckwheat and oatmeal. They are rich in vitamins and minerals, are well absorbed, contribute to the rapid evacuation of intestinal contents. They can be eaten every day several times. Rice porridge is also completely digestible, it can be used to make the mucous "mash" during the exacerbation, adding more water than necessary, however, a small amount of fiber is not very suitable for patients who suffer from constipation. Other cereals can also be consumed, but less often, for example, once a week. Since reflux gastritis, as a rule, is accompanied by increased acidity, it is possible to eat porridge from the flax seed. It is quite easy to prepare it: grind the flax seed in a coffee grinder, take three to five teaspoons of flour, pour boiling water, stir the fresh sour cream until thick, add it, close it with a lid and wait at least five minutes. Starting the day with this porridge, get the effect - two in one: nutrition and therapy.

Any cereal is well combined with boiled chopped meat (just to mix), oatmeal - with berries and apple puree. When the disease recurs - apples boiled or baked, when the condition improves - you can use raw - ripe and sweet (without skin).

Meat dishes are prepared from tender loin parts, peeled from the skin and tendons. For example, you can make meatballs with buckwheat. In the minced meat, add an egg and damp, rinsed, washed, buckwheat, paddle, form the meatballs. Fold them in one layer in the saucepan. Pour hot water almost to the top of the meatballs, add to the water a large chopped onion, a tablespoon of sour cream, salt. Cover with a lid, put on fire, simmer for about an hour on low heat or put on an hour in the oven (t = 150 ° C).

• Fish patties: to make mincemeat from white fish of cod family (hake, cod, white-blue), preliminary having removed from it a skin. Add the egg, ground on a blender or on a small grater onion and carrots, a little semolina (do not overdo it, the mince should be gentle), salt. Allow to stand for a while (20 minutes). You can cook cutlets in a double boiler, add to a saucepan, add a little uncut onions, carrots, two tablespoons of vegetable oil, put two hot water on the bottom, add gravy and cook in the oven or on the cooker until it is ready (≈30 min).
• Lazy vareniki: mix cottage cheese with egg and a little sugar, add flour to the dough was molded. Make it small balls (3 cm in diameter), boil them in boiling water. Serve with sour cream or butter.

Classical vareniki can be made from an unleavened dough consisting of flour, water and salt (no egg, as there are restrictions on this product). The filling can be cottage cheese, mashed potatoes, finely chopped apples without peel, in summer fresh berries.

• Jelly: boil a rich compote of allowed berries and / or fruits. Strain, dilute with instant gelatin or agar-agar in the proportion indicated on the package. Spill on the bowls, cool - put in the refrigerator. Doing jelly from shop bags with food paint, flavor substitutes and preservatives is strictly not recommended.
• Stuffed beet: boil the beets, peel and remove the inside, giving it the shape of a cup, which is filled with a mixture slightly sugared with the addition of 10 g melted butter, consisting of boiled rice, finely chopped apples without skin, finely chopped apricots (prunes, raisins - to taste and tolerance). Beetroot cups are poured over with sour cream and baked in the oven. You can serve with sour cream.