Erosive gastritis

What is erosive gastritis?

Erosive gastritis – this is a kind of inflammatory processes of the gastric mucosa of acute and chronic origin, a distinctive feature of which is the formation of small defects (erosions) on its surface.

This means that erosive gastritis:

• It differs from simple gastritis in the presence of multiple eroded areas of the mucous membrane against the background of its hyperemia (redness) and inflammation. Sometimes they can spread over the entire surface of the stomach;

• It can occur both acutely when poor-quality food and toxic compounds enter the stomach cavity, or wear a chronic course in violation of the normal secretory-motor mechanisms of the digestive system;

• May be caused by Helicobacter pylori infection;

• Prone to protracted flow;

• It is treated longer and more difficult compared to other types of gastritis;

• May cause stomach bleeding of any severity. This feature can be a real problem if bleeding occurs simultaneously from the entire eroded surface of the stomach.

Pathogenetic mechanisms for the development of erosive gastritis can be:

• In acute erosive gastritis, mucosal damage occurs as a result of its direct contact with aggressive media (poor quality food, acids, alkalis, chemicals, drugs, etc.). In this case, a kind of burn occurs, which is accompanied by inflammation during its healing;

• At the heart of chronic erosive gastritis are disturbed secretory processes. They can be associated with both a violation of the nature of nutrition, and with internal failures of the body. In this case, there is a violation of microcirculatory processes, blood circulation in the stomach and an increased release of aggressive components of gastric juice. Naturally, the ischemic mucosa is not able to resist them, which leads to its inflammation with further ulceration and erosion.

Symptoms of erosive gastritis

It is extremely difficult to suspect the erosive form of gastritis only by clinical signs and complaints of the patient. The exception is those cases when, against the background of confirmed gastritis, gastric bleeding occurs. In such situations, the fact of erosion formation becomes obvious. All other symptoms are typical for any type of gastritis and can only indirectly indicate its erosive appearance with its strong severity and persistence.

Symptoms of erosive gastritis include:

• Pain in the projection of the stomach (epigastric region of the upper abdomen). With erosive gastritis, it may not be intense, but with a common process, even strong analgesics may be required to stop it;

• Heartburn. Most characteristic of chronic erosive gastritis with impaired gastric motility and reflux of acidic gastric contents into the lower esophagus;

• Dyspeptic disorders in the form of persistent heaviness in the stomach, sour and rotten belching, dryness and bitterness in the mouth, stool disorders;

• Strengthening or occurrence of pain after eating or on an empty stomach, when only gastric juice is present in the stomach cavity, irritating pain receptors at the bottom of erosions.

Any suspicion of erosive gastritis must be confirmed or refuted using additional research methods. For these purposes, a visual assessment of the gastric mucosa is used with fibrogastroduodenoscopy. This method allows you to reliably assess the degree of structural changes caused by the inflammatory process, determine its prevalence and, if necessary, make a biopsy. In this case, a fragment of the mucous membrane is taken along the edge of erosion for its examination under a microscope.

To assess the secretory activity of the stomach and acidity during endoscopic examination, appropriate studies and measurements are performed. With hyperacid erosive gastritis with high acidity, a test for Helicobacter pylori infection is performed, which affects the amount of therapeutic measures.

Erosive hemorrhagic gastritis

Due to its persistent and long course, erosive gastritis often ends in complications. One of them is gastric bleeding from the eroded mucosa. Such gastritis is called erosive-hemorrhagic. The mechanism of their development is associated with the size, depth and localization of erosion. Superficially located defects in the region of the anterior, posterior walls and fundus of the stomach bleed extremely rarely. The most dangerous in this regard are extensive and multiple erosions that extend to great depths. Their most dangerous localization is the region of lesser curvature due to the location of large vessels in this zone and the high intensity of the general blood flow.

For the transition of erosive gastritis to erosive-hemorrhagic erosion must reach the depth of the vascular bed. In each person, small vessels have different features of their branching, structure and level of pressure in them. Therefore, persons with the same diagnosis have a different degree of risk of erosive-hemorrhagic gastritis. To a greater extent, these are patients with any form of arterial hypertension and diseases of the blood coagulation system. The risk group also includes patients taking anticoagulant drugs (aspirin and its analogues, warfarin, heparin), non-steroidal painkillers and anti-inflammatory drugs (diclofenac, ibuprofen).

Symptoms of the transition of erosive gastritis to erosive-hemorrhagic are quite bright. All of them indicate the presence of gastric bleeding of varying severity.

These signs include:

• Reducing the intensity of the pain syndrome. This symptom is more pronounced, the more intense the bleeding. This phenomenon is due to the fact that erosion destroys sensitive receptors, behind which the vessels are located. Therefore, pain first decreases, then bleeding occurs;

• Vomiting is a mandatory sign of erosive-hemorrhagic gastritis. Its nature depends on the intensity of bleeding, the diameter and number of bleeding vessels. If the vomit is presented with bloody contents, this indicates active ongoing bleeding. The presence of brown contents in the vomit is evidence of blood leaking from the vessels into the stomach cavity or slight bleeding;

• Symptoms of anemia are a decrease in the amount of blood in the vascular space. Their severity depends on the amount of blood loss: skin pallor, dizziness, lowering blood pressure, accelerated heart rate;

• Dark color stool. Sometimes erosive-hemorrhagic gastritis is accompanied by so little bleeding that vomiting does not occur. But, destroyed by acid, blood elements, entering the intestines, cause a dark color of feces.

Treatment of erosive gastritis

The following directions in its treatment should help get rid of erosive gastritis:

• Elimination of excess secretion of gastric juice. It is achieved through the use of drugs with an antisecretory mechanism of action. These can be either histamine receptor blockers or proton pump blockers. From the first group, famotidine, ranitidine, kvamatel are most widely used. From the second – omez, lansoprazole, control, proxium;

• Neutralization of aggressive hydrochloric acid. For these purposes, antacids are shown: Renny, Maalox, Almagel, Phosphalugel, Venter. They not only eliminate excess acidity, but also form a protective film over the inflammatory mucosa and erosions. This contributes to their rapid healing;

• Relief of digestive processes in conditions of blocked gastric secretion. Different generations of enzyme preparations are used: creon, mezim, festal, panzinorm, pangrol;

• Restoration of normal motility of the stomach and duodenum. In most cases of erosive-hemorrhagic gastritis, its violation occurs. This pathogenetic component can be eliminated with the help of metoclopramide, cerucal, motilium, domperidone;

• Hemostatic drugs. Used only in case of erosive-hemorrhagic gastritis. It is better to administer intramuscularly or intravenously: etamsylate, dicynon, vikasol, thioctic acid;

• In case of confirmation of the Helicobacter pylori nature of erosive gastritis, anti-Helicobacter drugs are indicated: clarithromycin, metronidazole, ornidazole, amoxicillin, de-nol or ready-made combined preparations (pylobact neo, clatinol);

• Treatment with alkaline mineral waters. It is better to carry it out in the conditions of specialized sanatoriums.

Diet and menu for erosive gastritis

Acute and chronic erosive gastritis in the acute stage cannot be cured without following certain dietary recommendations. They must be adhered to for the prevention of the disease. In the active stage of the inflammatory process, diet No. 1 is prescribed. As it subsides, the patient is gradually transferred to the fifth dietary table. Their general characteristics are as follows:

• You can not eat food that increases gastric secretion and irritates the mucous membrane (spices, smoked meats, fried and fatty foods);

• Products must be fresh, steamed or boiled;

• Fractional and frequent meals. The advantage is given to small portions;

• Cooked meals should be warm, preferably in a liquid or mushy form. High and low temperatures are equally dangerous for the inflamed and eroded mucosa.

• As for specific products and the indicative menu, they should be as follows:

• Prohibited foods: fresh bread and buns made from butter flour, cookies, chocolates, fatty animal products (pork, lard, blood, homemade sausage with spices);

• Allowed products: stale white and black bread, crackers, bran, potatoes in the form of mashed potatoes or as part of a soup, various cereals from any cereals with the exception of wheat and barley, butter and a small amount of vegetable oil, dietary type meat (rabbit, chicken, fresh young beef), fish, dairy products.

An approximate daily menu and the correct distribution of dishes should look like this: