Exogenous:
Alimentary disorders
Smoking
Alcohol
Neuropsychiatric stress
Occupational hazard
Endogenous:
Chronic infection
Renal failure
Clinical syndromes
Pain
Gastric dyspepsia
Intestinal dyspepsia
Asthenic-neurotic
Laboratory studies:
complete blood count (deviation possible more prolonged chronic
disease with symptoms of atrophic gastritis, iron deficiency or B12
deficiency anemia);
urinalysis;
tests for Helicobaster pylory detection (fast urease test, breath test,
smear-mark);
ulcer
stomach cancer
diseases of the biliary tract
gastric polyposis
Drug treatment of autoimmune gastritis
(type A)
2. Etiology:
-HP - positive ulcer;
-HP - negative ulcer.
5. Complications:
-bleeding
-perforation
-penetration
-stenosis
-malignization
Variants of the course:
Light - periods of heightened at least once in 1-2
years, clinical manifestations expressed mild,
easily treatable;
Moderate - aggravation 1-2 times a year,
expressed clinical manifestations, in the
pathological process involved other organs of
digestion;
Severe - aggravation 3-4 times a year,
pronounced clinical signs, which are difficult to
treat, there are complications.
The role of
microorganisms
Helicobacter Pylori
Duodenal ulcer
gastric ulcer
erosive gastritis
Major syndromes of
gastric ulcer
Pain - is caused by irritation of the ulcer surface
aggressive content of gastric inflammation in ulcer
area, regional spasm of smooth muscle,
peryhastryt, peryduodenit.
Syndrome gastric dyspepsia, resulting heartburn,
belching, nausea, vomiting.
Syndrome of intestinal dyspepsia, which is a sign
of constipation, crampy pain in the gut .
Astenovegetativnogo, increased irritability,
emotional lability, sleep disorders.
Laboratory diagnosis
Omplete blood count (to exclude bleeding);
Biochemical analysis of blood (in the presence of anemia -
to investigate the level of Fe + in blood and Ferum-binding
ability of serum)
Blood (duodenum ulcers - most often in patients of group I,
gastric ulcer - 3-A blood group)
Fecal occult blood;
Cytological examination of bioptites (at least 5 fragments
from different parts of the stomach and duodenum;
Histological examination of the bioptites to exclude atypical
cells in the center;
Determination of microbial type of H. pylori (urease test,
cytology, histology)
Instrumental diagnosis
General principles
-Refusal of bad habits (smoking,
alcohol and coffee, cessation of
NSAIDs)
-Diet: health food, table number 1a-1.
Foods to eat 5 times a day, the last
time not later than 19:00.
Medication
1. Anticholinergic drugs (anticholinergics):
selective (Atropine, Methacin, Platifillin)
selective (Hastrotsypin, Pirenzepin)
2. Antacids (Almagel, Fosfalyugel, Maalox,
Haviskon, Helyusyl varnish, etc..)
3. H2-histamine receptors (Cimetidine,
Ranitidine, Famotidine, Roksatydyn);
4. Proton pump blockers (Omeprozol,
Lanzoprazol, Pantoprazole, esomeprazole);
5. Means, which form a protective film
(Sucralfate, De-nol, Smectite);
6. Helicobacter drugs: antibiotics (Amoxicillin,
Flemoksyn-Solutab, Clarithromycin,
Tetracycline, Metronidazole, De-nol);
7. Means that normalize gastric motor activity
(Reglan, Eglonil, Motilium);
8. Reparant (Hastrofarm, Solcoseryl,
Pentoxyl);
9. Means sedation (Amitriptyline,
Rhaponticum, Chinese Magnolia, Dalargin).
Schemes triple therapy for
the destruction HP
1. Pantoprazole 40 mg in the morning and 40
mg at night + Amoxicillin 500 mg 4 times a
day + Clarithromycin 250 mg 2 times a day.
Course 7 days, Eradication of HP 95%.
2. Pantoprazole 40 mg in the morning and 40
mg at night + Clarithromycin 250 mg 2 times
daily + Metronidazole 400 mg 2 times a day.
Course 7 days, Eradication of HP 95-97%.
4. Omeprazole 20 mg 2 times a day
+ Clarithromycin 250 mg 2 times a
day
+ Metronidazole 400 mg 2 times a
day.
5. Omeprazole 20 mg 2 times a day
+ Amoxicillin (flemoksyn-Solutab) to
1000 mg 2 times a day after meals
+ Metronidazole 400 mg 2 times a
day.
Scheme of kvadryterapy