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

This is one of the forms of inflammation of the gastric mucosa due to a change in the current of the duodenal contents and a reverse casting of it into the stomach. Detergent components of refluxate have a traumatic epithelium of the stomach action, which ultimately leads to an inflammatory process, most often in the antral part of the stomach.

[1], [2], [3], [4], [5], [6], [7]

Epidemiology

Epidemiology of reflux gastritis is determined by the frequency of surgical interventions on the digestive organs, the use of pharmacological drugs, the prevalence of alcoholism and other risk factors for duodenogastric reflux.

For example, duodenogastric reflux is a consequence of suturing duodenal ulcers in 52.6% of cases, cholecystectomy - at 15.5%.

There is evidence that symptomatology similar to duodenogastric reflux affects up to 40% of the fourth part of the population, but about 5-7% of them handle such complaints. More than 50% of the applicants, found anthroduodenal dissotorics - one of the causes of the development of reflux gastritis.

The vast majority of episodes of chronic gastritis (about 80%) are associated with Helicobacteriosis, up to 15% - cases of autoimmune atrophic inflammation of the stomach and only about 5% remains for special types of pathology, among them reflux gastritis.

[8], [9], [10], [11], [12], [13], [14], [15]

Causes of the reflux gastritis

This pathological condition is provoked by a disorder of the muscular function of the sphincter, which closes the return of duodenal contents back to the stomach in a healthy person. Significant risk factors for the development of this condition are gastrectomy, gastroenterostomy, cholecystectomy, pyloroplasty and other interventions on the digestive organs that lead to abnormal motor coordination disorder and evacuation of contents in the digestive canal, chronic inflammation of the duodenum, its dyskinesia and hypertension, bacterial Helicobacter pylori invasion , gastroposis (gastric emptying). As a result of non-hormonal anti-inflammatory drugs, reflux gastritis may develop. This is facilitated by the treatment of some other drugs, for example, antibiotics or analgesics, iron and potassium-containing drugs, alcohol abuse. An important role in the mechanism of the development of pathology is given to the state of the nervous system - irritable, easily excitable people are considered more prone to this disease.

[16], [17]

Pathogenesis

The pathogenesis of reflux in modern medicine is treated as follows:

• sphincter insufficiency, allowing the contents of the duodenum, without passing through the antral and cardiac sphincters, to get back into the stomach and esophagus;
• anthroduodenal discoordination - lack of regulation of the direction of movement of the food lump in the duodenum;
• surgical removal of the stomach or part of it, which violates the natural obstacle to the refluxate reflux.

The contents that fall back into the stomach contain substances aggressive for it - bile, its acids and salts, enzymes synthesized by the pancreas, lysolecithin, intestinal juice. It activates the secretion of gastrin (in the antrum the number of cells producing this digestive hormone increases), and in the presence of hydrochloric acid it forces the dissolution of the fat components of the cell walls of the gastric mucosa with a dense, moving in the opposite direction, an avalanche of hydrogen ions.

Constant damage to the gastric epithelium by the contents of the duodenum causes dystrophy and necrobiotic transformation of its cells. In this case, only the epithelial surface of the stomach is affected, and the process is focal. This form of inflammatory process is referred to as a chemical-toxic-induced gastritis (type C).

There is, nevertheless, a position that allows one to doubt the importance of duodenogastric reflux in the mechanism of the development of an inflammatory disease of the gastric mucosa. In fact, the epithelium of the stomach is very resistant to the action of bile and other components of reflux. Even prolonged exposure to duodenogastric reflux causes minor damage to its structure. Some clinicians consider the return of contents from the duodenum as a protective reaction to the overproduction of hydrochloric acid or regulating the secretory activity of the gastric glands, that is, the replacement one, if it is deficient. The role of duodenogastric reflux is still in the process of polemic and study.

[18], [19], [20], [21], [22], [23]

Symptoms of the reflux gastritis

Symptomocomplex of this form of inflammation of the gastric epithelium is often not commensurate with the degree of its lesion established during the examination. Often diagnosed for another reason, the apparent presence of this form of gastritis may have an asymptomatic course.

Nevertheless, with severe symptoms, the first signs that you should pay attention to are pain in the epigastrium or the appearance of a feeling of heaviness during or immediately after eating, the appearance of belching with air, and also - eaten food (regurgitation), heartburn, nausea, flatulence, repellent bitter taste in the mouth, vomiting of bile. Later, frequent constipation or diarrhea, a yellowish plaque in the tongue, loss of appetite and weight loss can join. Over time, the dryness of the skin, cracks in the corners of the lips (seizures), weakness and rapid fatigue - so it manifests anemia and vitamin deficiency.

Pain syndrome with reflux gastritis is not a characteristic symptom, but some patients complain of intense burning pain localized in the upper abdomen. Usually it appears periodically, characterized by paroxysmal and is often the result of physical exertion or emotional outbursts and stressful situations.

To the above described symptoms, a cough, which is usually considered the prerogative of colds, can join, however, in practice it is often caused by gastroesophageal reflux. Cough with reflux gastritis usually has a debilitating effect, it is not accompanied by a runny nose and reddened throat. Usually he is accompanied by other dyspeptic disorders, general weakness and malaise.

Acute reflux gastritis is not a correct definition, since acute refers to the inflammation of the gastric epithelium due to the action of one-time intense stimuli. Reflux gastritis develops due to constant irritation of the gastric mucosa by regular casting of intestinal contents. In most cases, it is characterized by an asymptomatic course and is often detected by chance. Therefore, when it comes to reflux gastritis, chronic disease is meant. If the endoscopist's conclusion refers to the acute stage of this disease, then, most likely, is meant exacerbation of gastritis reflux.

Acute reflux gastritis appeared, according to some authors, as secondary, in patients, after carrying out operations on the digestive organs. In postoperative patients with the development of reflux gastritis, infection with Helicobacter, polypous hyperplasia and peptic ulcers were often detected.

Chronic reflux gastritis proceeds wavy, with prolonged latency periods. Expressed (described above), the symptomatology corresponds to the stage of exacerbation of the disease.

Moderate reflux gastritis can occur asymptomatically or with mild symptoms, there may be any one symptom, such as heartburn, flatulence or other dyspeptic manifestations. They can be persistent and exhausting. Moderate or severe reflux gastritis is a conclusion made after a gastroscopy, and speaks more about the degree of damage to the gastric mucosa. As practiced by gastroenterologists, the degree of symptom severity in this form of the disease does not always correspond to the severity of the lesion of the gastric epithelium.

Forms

Bile is the most studied ingredient in reflux. Its acids play a major role in the pathogenesis of this disease. Bile acids, which are surface-active substances, have the ability to dissolve the basic lipid components of the cellular membranes of the gastric mucosa, causing it to damage. Pathologies of the bile excretory system in combination with anthroduodenal dysmotoric and insufficiency of the sphincter apparatus lead to regular casting of bile-saturated intestinal contents into the stomach. Constant burns with bile cause biliary reflux-gastritis. Specific symptoms that allow for clinical manifestations to distinguish it from other types of this pathology, no, most often the gallstick reflux manifests a belch and heartburn.

Morphological transformation of the gastric mucosa due to biliary reflux - increased proliferation of mucous cells of the surface of the stomach and, accordingly, proliferation of the epithelium, swelling against the background of a moderate inflammatory process. The epithelial surface acquires a basophilic structure, saturated with nucleic acids, with a practical absence of mucus. Epithelial cells undergo dystrophic changes (vacuolar degeneration, karyopicnosis) leading to the onset of necrobiosis and the formation of erosions, because the gastric glands located there cease to produce protective mucus. This process may eventually evolve into erosive reflux gastritis, which is manifested by bleeding from erosion and the presence of brownish and bloody veins in vomiting and feces.

The defeat of the gastric mucosa, caused by the casting of duodenal contents, is often provoked by inflammatory pathology and hypertension in the duodenum (reflux gastritis duodenitis). Diagnosis of pathological changes can only be done by duodenogastroscopy, as well as by analyzes of biopsy specimens of the gastroduodenal mucosa. Specific symptoms of this type of gastritis is not.

Catarrhal reflux-gastritis  (simple) - usually in this case it is an acute gastritis and superficial injuries of the epithelium. With this type of disease, the mucous membrane swells, there is a possibility of spreading to the entire surface of it and dystrophic changes begin in it. Symptomatology is usually pronounced, but without specificity.

Superficial inflammation, localized in the pyloric part of the stomach, in combination with the muscular insufficiency of the sphincter between the stomach and duodenum leads to the fact that the food lump, richly flavored with hydrochloric acid, can uncontrollably enter the gut, burning its bulb and causing in it an inflammatory process called bulbite. The same sphincter deficiency does not interfere with the return of the contents to the stomach. Such unobstructed passage of not completely processed food in one (correct) direction and its reverse casting eventually ends with a diagnosis - reflux gastritis-bulbit.

As already mentioned, the most common lesion of the epithelium when throwing duodenal contents occurs in the antral part of the stomach (antral reflux-gastritis). It is also called distal reflux gastritis, since the antrum part, the pyloric canal and the pyloric sphincter are included in this gastric department. This zone suffers the most when refluxat is thrown and the first is affected. Focal reflux gastritis develops. If the disease is not diagnosed in a timely manner and the treatment is not started, then atrophic changes subsequently increase. Sometimes there is a mixed reflux-gastritis, in which the areas of the inflamed, but still "working" epithelium surface, are combined with the zones of atrophy of the gastric glands - the foci of the hyperemic surface interspersed with the grayish areas of atrophy.

At the beginning of its development, non-atrophic reflux-gastritis, focal and superficial, and moreover, proceeding without expressed symptoms, looks not too serious a disease. The progressive process of proliferation and dysplastic changes lead to the development of atrophic reflux gastritis in the future. The main characteristic of this type of disease is the atrophy of zymogenic and parietal cells in the deep layers of the gastric epithelium and their displacement by so-called pseudopiloric cells, unable to produce digestive hormones and sulfuric acid. Atrophic transformations of the gastric mucosa, in particular, large intestine metaplasia, represent a risk of malignancy.

The same can be said about hyperplastic reflux gastritis, which is characterized by the proliferation of the gastric mucosa and the appearance of cystic, folded or polyposic lesions.

Erythematous reflux gastritis  - this formulation suggests that a gastroscopic examination found that there is reddening of the mucous membrane. This is not a diagnosis, but rather a statement of a fact that suggests the existence of gastritis or other gastric pathology. For the final diagnosis, more research is needed.

[24], [25], [26]

Complications and consequences

In fact, the types of any form of chronic inflammatory process in the stomach are stages or stages of a single course of the disease and reflect morphological changes in the course of its development. In the conditions of regular damage to the epithelial surface of the stomach, the process of its restoration is disturbed. The renewed epithelium in chronic gastritis differs from healthy gastritis and stops performing natural functions. The development of the pathological process is a demonstration of the disregeneration of the gastric mucosa.

Negative changes that occur with the gastric mucosa are exacerbated by untimely diagnosis and a prolonged absence of treatment. The most unpleasant consequence of ignoring this pathology may be the development of a malignant neoplasm. Especially dangerous in this sense are the stages of development of atrophic and hyperplastic transformations of the epithelium.

[27], [28], [29], [30]

Diagnostics of the reflux gastritis

The assumption of the presence of reflux gastritis is made on the basis of the patient's complaints, his careful examination and questioning, during which the cause of the disease is revealed. Particular attention is paid to persons who have undergone surgery on the digestive organs. Instrumental diagnosis allows you to confirm or deny a presumptive diagnosis. According to the results of fibrogastroduodenoscopy, a focal inflammatory process is revealed (more often in the antrum), often the epithelial toxicity, the color of the stomach is yellowish. Inflammatory process with reflux gastritis is usually insignificant. The sphincter between the pyloric section of the stomach and the duodenum is enlarged.

Currently, gastritis (duodenitis, esophagitis) is a histological diagnosis, so an accurate conclusion is given on the basis of microscopy of biopsy samples taken during fibroadastroduodenoscopy. When studying them, there are hyperplastic changes in the mucosa, plethora in the absence of significant inflammation, irreversible changes in cells and their death, and occasionally - metaplasia in the intestinal type.

With the help of anthroduodenal manometry or gastrography, the contractile activity and consistency of muscle contractions of different parts of the gastroduodenal zone are investigated, pH-metry or histamine (gastrin) test allows to assess the level of acidity, contrast rengenoscopy or daily pH-metry using "Gastroscan-24" - the presence of duodenal reflux .

Ultrasonography of the digestive organs is prescribed to detect concomitant pathologies and analyzes: blood, urine, feces.

[31], [32], [33], [34]

Differential diagnosis

Differential diagnosis is performed with ulcerative and neoplastic lesions of the anthroduodenal and gastroesophageal region.

[35], [36], [37], [38], [39], [40], [41]

Treatment of the reflux gastritis

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.

[42], [43], [44], [45], [46]

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.

Prevention

Prevention of inflammation of the gastric mucosa caused by duodenogastric reflux consists, first of all, in preventing backfilling of the contents of the duodenum. Not too original thought, but first of all, you need to follow the rules of a healthy lifestyle, eat well, try to increase your stress-resistance, do not get irritated and do not get nervous over trifles.

If, as a result of anatomical or other reasons, reflux periodically makes itself felt, it is worthwhile to observe simple rules. First, to be examined, since, the earlier treatment is started, the more effective it is. Secondly, one should adhere to dietary norms and part with bad habits.

Before eating, some nutritionists recommend drinking a glass of water to reduce the acidity of the gastric juice. Immediately after eating, avoid stress on the abdominal muscles (do not bend or lift heavy objects). It is not necessary and fit to rest. It is much better to walk in this case. Do not wear loose clothing and clothes (pants, belts, skirts). The pose for sleeping is preferably semi-sitting (on a high pillow).

[47], [48], [49], [50], [51], [52], [53], [54], [55]

Forecast

This disease, as a rule, does not prevent a person from working and leading an active lifestyle, not counting the periods of exacerbations. However, in the case of a reasonable approach to the problem (timely diagnosis, treatment, suitable lifestyle), the forecast is quite favorable.

Long ignoring of symptoms, delaying the application for medical help, failure to follow medical recommendations on the diet regime usually results in complications, surgical interventions and a serious deterioration in the quality of life.

[56], [57], [58], [59], [60]