Congestive gastropathy: antral, erythematous, body and antrum of the stomach

All inflammatory processes of the stomach can be divided into gastritis and gastropathy. The term "gastritis" corresponds to inflammation, in which the mucous membrane of the stomach is affected. Gastropathy determines the state when the internal surface of the stomach is not affected or minimally affected by inflammation, but there are damages and regeneration of epithelial cells. Under congestive gastropathy is meant a violation of gastric motility and the processes of passage of food through the digestive tract and getting it into the small intestine.

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

Epidemiology

There are studies that give a picture of the epidemiology of congestive gastropathy, based on the causes of its occurrence. Thus, a disease complicated by ulcerative manifestations was observed in 24% of patients taking NSAIDs. If we consider that in the world, 5% of people take these drugs, then this is a large incidence of the disease. In stressful situations, resulting from various injuries, burns, surgeries, erosion and ulcers appear in 65-80% of patients. Portal hypertension gave a clinical picture of congestive gastropathy in 9-80% of the examined, and cirrhosis - in 20-90% of observations. Such a large data gap is due to the lack of common criteria for classifications and interpretations of the lesions identified. In any case, taking into account the latent symptomatology of the disease at its initial stages, this is far from a complete picture of the epidemiology of the disease.

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

Causes of the congestive gastropathy

The causes of congestive gastropathy are:

• taking medications, including non-steroidal anti-inflammatory drugs (NSAIDs);
• a pancreatic tumor that causes an elevated level of gastrin in the blood;
• cirrhosis of the liver and portal hypertension (obstruction of blood flow in the portal vein), accompanied by pinpoint hemorrhages;
• burn (causes ulcer Kurling);
• severe head injuries (culprits of stress ulcers);
• reflux of bile (ingestion of bile from the duodenum into the stomach).

[11], [12], [13], [14], [15]

Risk factors

The risk factors for the development of congestive gastropathy include:

• alcohol;
• smoking;
• age after 60 years;
• chronic diseases;
• Helicobacter pylori;
• peptic ulcer arising under the influence of gastric juice;
• uncontrolled or prolonged use of painkillers, anti-inflammatory, antipyretic agents.

[16], [17],

Pathogenesis

The pathogenesis of the disease lies in the fact that food, getting into the stomach, can not be completely processed more often due to a lack of enzymes. The volume of the mucosa increases, the folds become thicker, higher, the curvature. There are congestions of mucus between them. Against this background, the pattern of the vessels forming the mosaic pattern is more clearly defined. Overgrowth of folds can form proliferation. In addition, if the sphincter is weakened, the bile from the duodenum is thrown into the stomach together with a lump of food (chyme). As a result, the walls of the stomach are damaged. In each department of the gastrointestinal tract their active substances and enzymes, unable to digest food from another zone. Getting into an environment unusual for him, the chyme adversely affects the mucosa, further progress is difficult, there is atrophy and damage to the internal parts of the stomach.

[18], [19]

Symptoms of the congestive gastropathy

At first, the symptoms may not have clear manifestations, indicating the presence of congestive gastropathy. Later it manifests itself as a whole complex of dyspeptic phenomena: nausea, sometimes vomiting, deterioration of appetite, weakness. In the case of duodenogastric reflux (throwing bile from the duodenum into the stomach), there are painful sensations in the palpation of the abdomen, heaviness in the stomach, belching, the tongue is covered with a yellow coating.

The first signs of the existence of congestive gastropathy often appear at the stage of complications in the form of gastric bleeding. Symptoms typical for gastritis may also occur, manifested by the severity of the stomach, belching, and heartburn.

[20], [21]

Forms

Stagnant gastropathy is divided into two types:

• light degree, in which the gastric mucosa is characterized by a mosaic pattern, and the probability of bleeding is from 3% to 30%;
• heavy, against the background of the mosaic pattern there are diffuse red spots and submucosal hemorrhages, the risk of bleeding is from 40 to 60%.

[22]

Congestive antral gastropathy

The lower part of the stomach, adjacent to the duodenum, is called antral. Its main task is to mix, grind food to particles of 1.5-2mm and push through the pyloric sphincter into the duodenum. At the very beginning, the antral glands produce an alkaline secretion, which neutralizes the action of hydrochloric acid. With a decrease in the speed of food movement along the digestive tract, stagnant processes result, leading to fermentation, excessive release of hydrochloric acid and its chemical action on the walls of the stomach. This can lead to the formation of ulcers in the antrum, which will make itself felt night pains, heartburn, pain in the epigastric region, vomiting. Possible complications in the form of bleeding, indicating the perforation.

[23]

Focal stagnant gastropathy

Characterized by individual local redness, most often against a background of superficial gastritis. Ignoring the problem can lead to the formation of ulcers.

[24], [25]

Erythematous stagnant gastropathy

It is a pathological change in the gastric mucosa and has the appearance of redness of its individual areas (focal) or of more extensive areas (diffuse). Often doctors do not call her a disease, but only a harbinger of gastritis. When examining the surface of the stomach with an endoscope, redness (erythema) is revealed, which signals the presence of pathology. How quickly this will progress depends on the resistance of the body and the duration of the impact of negative factors.

[26], [27], [28]

Severe congestive gastropathy

The inner surface of the shell of a healthy stomach has a pale or pale pink color. In the process of congestive gastropathy, healthy areas are intermixed with the damaged ones, which makes the surface of the stomach granular, similar to a mosaic pattern. For pronounced stagnation gastropathy is characterized by hyperaemia - a clearly expressed vascular network, which manifests itself in local inflamed areas of red and during endoscopy can be taken for ulcers.

Complications and consequences

Stagnant gastropathy is characterized by a propensity for complications. Unfortunately, the disease is often detected only at the stage when bleeding occurs. In half of patients ulcerative defects are observed, in some patients - erosion, acute stomach ulcers, their perforation. The most dangerous consequence and complication is the development of a malignant tumor.

[29], [30], [31], [32], [33], [34]

Diagnostics of the congestive gastropathy

A distinctive feature of congestive gastropathy is the atypicality of its symptoms, which complicates the diagnosis. The doctor's actions in establishing the diagnosis are based on general clinical methods (clarifying the history of the disease, examining the patient), laboratory studies, choosing instrumental diagnostics, analyzing the results of the study, differentiating it from other diseases. Although the main method for establishing the correct diagnosis is instrumental and differential diagnosis, all the data obtained as a result of the survey are compared and analyzed.

[35], [36], [37]

Analyzes

Laboratory studies are based on general and detailed blood tests, biochemical tests, and enzyme immunoassay. For congestive gastropathy, low hemoglobin is characteristic. With portal hypertension, which has become the cause of congestive gastropathy, a decrease in the level of platelets is detected.

Histological analysis will give a picture of the nature of damage to the walls of the stomach.

[38], [39]

Instrumental diagnostics

To assess the state of the gastric mucosa makes it possible to perform fibrogastroduodenoscopy. A flexible optical device, introduced through the mouth, makes it possible not only to visually assess the condition of the mucosa, but also to take samples for biopsy, which will later become a material for histological studies. Biopsies are subject, as abnormal areas, and adjacent to them healthy. Also during the study of the stomach, ultrasound and computed tomography of the abdominal cavity are used, radiography of the upper sections of the gastrointestinal tract.

Differential diagnosis

Differential diagnosis of congestive gastropathy is not an easy task, because her symptomatology is in line with other pathologies of the gastroduodenal region. Fibrogastroduodenoscopy gives an opportunity to visually and by means of a biopsy to put the exact diagnosis. The most characteristic sign of the disease is an increase in volume, diffuse hyperemia of the mucosa, but finally confirm the diagnosis of the study of the material taken for biopsy. These tests help differentiate the ailment from polyposis of the stomach. Since the frequent culprits of the disease is the intake of NSAIDs and other medications, it is necessary to separate the drug gastropathy from a number of other diseases. When revealing ulcers of the gastric mucosa it is necessary to exclude relapses of the old, "senile" ulcer, tumors. Also, the absence of markers on Helicobacter pylori will give a negative response to the presence of infection.

Treatment of the congestive gastropathy

Congestive gastropathy often has a secondary character, the causes of its occurrence are named above. Therefore, treatment, in the first place, should be aimed at their eradication. There are many medicines for the treatment of ailment: histamine H2 blockers, antacids, cytoprotectors, proton pump inhibitors, antibiotics, blood circulation improving agents. The doctor's task is to select an effective agent that has the least side effects on the patient's body. The main role in the treatment of congestive gastropathy is given to substances that block the production of hydrochloric acid, the main damaging acid-peptic factor. The most effective of these are proton pump inhibitors (PPIs).

Medications

Proton pump inhibitors block the enzyme involved in the secretion of hydrochloric acid. It takes up to 18 hours to resume production. After the course of treatment, the blockade of secretion lasts another week. In addition, they have low interaction with other drugs, they are safe enough for long-term use, all this makes PPIs preferable to other substances. The drugs IPP include drugs such as rabeprazole, lansoprazole, omeprazole, pantoprazole.

Rabeprazole - coated tablets, single dose 10-20 mg. Treatment schedule: the frequency and duration of the appointment is determined by the doctor. Contraindicated in pregnant and lactating mothers, as well as with individual intolerance. Side effects can occur in the form of nausea, vomiting, belching, flatulence, constipation, dizziness, insomnia, there may be a cough.

Lansoprazole - capsules, taken orally 30mg in one dose per day. Duration of treatment 4 weeks. If necessary, you can extend it for 2-4 weeks. Has contra-indications at pregnancy in the first trimester, during a lactemia, at an allergy on a preparation. Side effects are insignificant - rarely rashes on the body, diarrhea, constipation.

There are 5 generations of H2-histamine receptor blockers. These include cimetidine, ranitidine, famotidine, quamate, roxatidine, and others.

Kwamatel is a white powder and a transparent solvent for the preparation of injections. Introduced intravenously, at a dose of 20-40 mg suppresses the production of hydrochloric acid for 10-12 hours. It is recommended to stab twice a day for 20 mg. Contraindicated in case of hypersensitivity, pregnancy, breast-feeding, children, malignant neoplasms. When taking the drug may occur dry mouth, nausea, discomfort in the abdomen, increased fatigue, allergic manifestations.

Antacid preparations are presented on the pharmaceutical market with such preparations as alka-seltzer, almagel, gastal, gasterin, maalox, sodium hydrogen carbonate, renni, phosphalugel, etc.

Rennie - tablets, the effect of taking them comes in 3-5 minutes. In the mouth, chew or hold until completely dissolved. Single dose - 1-2 tablets, but not more than 16 per day. You can repeat the reception after 3 hours after the previous one. Not recommended for renal failure, hypercalcemia, hypersensitivity to the drug. There may be rare side effects in the form of rashes on the skin. For pregnant women is not a danger.

The task of cytoprotectors is to ensure the integrity of the gastric mucosa and its resistance against an aggressive environment. Such drugs are bismuth preparations: de-nol, sucralfate, misoprostol, pentoxifylline.

Sucralfate - is available in tablets, in gel form, in suspension. One-time is taken 0.5 g 4 times a day, you can make 2 receptions of 1 g. The duration of therapy is a month and a half. If necessary, prolonged to 3 months. Contraindicated in allergies to components, children under 4 years of age, with renal failure. The use of the drug may be accompanied by nausea, vomiting, dry mouth, headaches, skin allergies.

Vitamins

Congestive gastropathy often leads to inhibition of absorption of vitamin B12 (cyanocobalamin), resulting in a lack of it in the body. The role of cyanocobalamin in human life processes is very large: normalization of fat metabolism, hydrogen transfer, protein production, anabolic action, strengthening of immunity, regulation of hematopoiesis, normalization of pressure, support of reproductive function. Its deficiency leads to chronic fatigue, noise in the ears, dizziness, headaches, impaired vision, decreased mental ability, emotional depression. Vitamin can be administered subcutaneously, intramuscularly and intravenously once or twice a day. Single dose is 0.1-0.2 g. It is poorly absorbed, but simultaneous reception with folic acid improves this process. Vitamin B12 is found in products such as sea kale, liver, soy, milk, cheese, eggs, beef, poultry, fish. Parallel reception with a lot of vitamin C reduces its absorption from food.

Physiotherapeutic treatment

Physiotherapeutic treatment of congestive gastropathy should, first of all, include, physical exercises and respiratory gymnastics aimed at strengthening the muscular tissue of the internal digestive organs and abdominal muscles of the abdomen. Well toned the body, strengthen the motor and improve the blood supply of the stomach moderate physical load and dosed walking in the fresh air. In the presence of pain syndrome, electrophoresis with novocaine, papaverine is used. Thermal procedures in the presence of erosion, ulcer processes, polyps do not apply. Balneological procedures recommend mineral water inside and a bath of them. For treatment, great importance is the temperature of water and the time of reception with respect to food intake. Inside with congestive gastropathy is taken for half a glass of warm mineral water 1-1.5 hours before meals. When bleeding occurs, degenerated ulcers in malignant tumors, hydrotherapy is contraindicated.

Alternative treatment

Alternative treatment offers its own recipes for the treatment of congestive gastropathies, which are used in conjunction with basic treatment. One of them is a spoon of vegetable unrefined oil, better olive, on an empty stomach before eating. Also used is a mummy, dissolved in milk. Take up to a third of the glass before meals for 10 days. After a three-day break, you can repeat. Many alternative recipes mention honey. Here are a few: in a glass of warm broth of oats (1 glass of grains per liter of water, simmer for 2-2.5 hours on a slow fire), add a teaspoon of honey, take for 20 minutes. Before meals; in the juice of carrots add honey, drink ¼ cup 3 times a day before eating; in 100ml fresh potato juice stir a teaspoon of honey, take an empty stomach several times a day.

[40], [41],

Herbal Treatment

Using for the treatment of herbs, it is necessary to pay attention to the nature of their effect on the mucosa - inhibit the production of gastric juice or promote it. So, with reduced acidity apply ayr marsh: rhizome plants grind, a teaspoon is put in a glass of boiling water, insist for half an hour. They drink a third of the glass before meals. It is very popular in the treatment of gastritis and gastritis of aloe. This plant has a bactericidal, anti-inflammatory, immunostimulating effect. Has a good therapeutic effect with erosions, high acidity, heals inflammation of the mucous. To obtain juice, use the plant for at least 3 years. Fresh juice is drunk in 30 minutes. Before eating a teaspoon, you can add honey. A mild but strong positive effect on the organs of the gastrointestinal tract is provided by calendula. Infusion of calendula (2 tablespoons per liter of water) is drunk before meals 3-4 times a day. Combinations are possible with other herbs that help with congestive gastropathy: chamomile, yarrow, St. John's wort, the root of the althaea, etc.

Homeopathy

Homeopathy along with other conservative methods of treatment is used to combat stagnant gastropathy. In its armament, such drugs as gastricumel, gastro-gran, gastrokind, Iberogast, merkurid, yazbin, etc.

Gastro-gran has a wide spectrum of action on the pathology of the gastrointestinal tract. In the period of exacerbations, place 7 granules under the tongue 3-5 times a day. In the period of remission, it is enough to have 5 granules twice, for prophylaxis - 5 pieces once in the morning on an empty stomach. Side effects are not revealed, there are no contraindications.

Gastrokind - normalizes the work of the digestive organs, eliminates gravity in the stomach, nausea, flatulence. It is used in pediatrics. Children under 6 years are assigned one tablet under the tongue or in the crushed form up to 5 times a day for half an hour before or after eating, older - 2 tablets up to 6 times a day. Contraindicated in patients with hypersensitivity to the components of the drug and with lactase deficiency. At the initial stage of treatment, allergies can occur. In this case, you need to lower the dose.

Iberogast - normalizes peristalsis of the organs of the gastrointestinal tract, reduces symptoms of dyspepsia, spasms. Dose intake for children - 6-15 drops, depending on age, before meals 3 times a day; 20 drops for adults, with a small amount of water. Contraindication is an individual intolerance to the drug. Possible side effects in the form of nausea, vomiting, allergies.

Mercurid - is indicated for gastritis, ulcerous gastrointestinal tract, polyps. The recommended dose is for children 3 granules 3 times throughout the day, for adults - 7 pellets. The drug is taken 15 minutes before meals, or an hour after. The course of treatment is up to a month.

Yazbin - is made of ingredients of vegetable and animal origin with cytoprotective, anti-inflammatory action, stimulates the digestive process. It takes 15-20 minutes before meals 2 tablets 2 times a day. Rarely, a side effect can occur in the form of nausea, diarrhea, skin rashes. Contraindicated in children under 10 years, with ulcer bleeding, esophageal varices, pregnant and lactating.

Operative treatment

With congestive gastropathy, there are cases that require surgical intervention. Surgical treatment consists in removing the damaged areas of the stomach. A full-fledged operation can be performed or a laparoscopic method may be used. The latter is called a hybrid operation or manual assisted. Special devices are inserted inside through small incisions, the surgeon controls them, monitoring their actions on the monitor, performing the necessary manipulations, for example, on excising the ulcer or removing the tumor. Such operations are not yet very common, but are very effective, since they significantly reduce the duration and traumatism of the intervention.

Diet with congestive gastropathy

One of the important conditions for the successful treatment of congestive gastropathies is diet compliance. In this case, there is no need for strict restrictions on food, but it is necessary to refrain from eating foods that irritate the mucous, rough food. The main recipe is not to eat large amounts of food, making pauses between receptions 2-3 hours. From sharp, fat, strongly hot and cold it is necessary to abstain.

[42], [43],

Prevention

The best prevention of congestive gastropathy is a healthy lifestyle, eradicating bad habits. It is also important not to overload the stomach with food irritating the gastric mucosa. In a timely manner, eat, split portions, exclude dry-well.

[44], [45], [46], [47], [48]

Forecast

The prognosis of congestive gastropathy depends on the causes that caused them. So, if the disease is provoked by the intake of NSAIDs or other drugs, then if they are canceled or replaced with lighter ones and when the measures for eliminating the disease are applied, the prognosis is favorable. With the development of stagnant gastropathies against the background of tumors, cirrhosis, portal hypertension, the prognosis depends on the condition of the primary disease. The timeliness of revealing an ailment gives a chance for a speedy recovery.

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