Hemorrhagic gastritis is an inflammation of the gastric mucosa, accompanied by the formation of erosions and bleeding. This is a polyethological disease that can have an acute or chronic course. Patients complain of dull pain in the epigastric region associated with eating, dyspeptic disorders; in the case of acute gastric bleeding, symptoms of blood loss develop, vomiting in the form of “coffee grounds” and tar-like stools. Treatment includes a diet, the use of drugs to reduce acidity and restore the mucosa, hemostatic therapy. Sometimes surgical treatment is required.
Meaning
Hemorrhagic gastritis (erosive gastritis) is an inflammatory process in the gastric mucosa, accompanied by the formation of single or multiple bleeding surface erosions and flat ulceration. The tissue defect is formed only in the mucosa, does not affect the muscle membrane and heals without scar formation; the diameter of the erosions does not exceed 3 mm. The disease is often accompanied by gastric bleeding.
Hemorrhagic gastritis is one of the most severe inflammatory lesions of the gastric mucosa. Gastroenterologists consider this pathology to be quite common, but the least studied; according to WHO statistics, the number of registered cases of the disease has increased 10-fold over the past 10 years. In patients taking nonsteroidal anti-inflammatory drugs, corticosteroid hormones and alcoholism patients, the erosive process is detected in 50% of cases.
Causes of hemorrhagic gastritis
In modern gastroenterology, hemorrhagic gastritis is considered as a polyethological pathology. The most common cause of the disease is the uncontrolled use of certain medications (nonsteroidal anti-inflammatory drugs, glucocorticoids, analgesics), the use of substandard products. Helicobacteria, salmonella, Diphtheria bacillus can also cause erosive gastritis.
Errors in nutrition (irregular meals, spicy and spicy food, smoked meats) trigger the mechanism of formation of defects in the gastric mucosa; an important role is played by the action of high temperatures (too hot food). Quite often, mucosal defects are found in patients after suffering stress, especially against the background of chronic psychotrauma.
An important role in the development of hemorrhagic gastritis under the chronic action of damaging factors is played by a violation of vascular permeability and microcirculation, intracellular metabolic processes and the development of cellular degeneration. The occurrence of bleeding is directly due to the presence of multiple erosions, as well as the exudation of blood plasma and cellular elements into the lumen of the stomach.
Classification
Depending on the duration of the course, acute and chronic forms of the disease are distinguished: acute erosions heal in 4-10 days, and chronic ones can exist for quite a long time. There are also primary and secondary hemorrhagic gastritis. Primary develops in practically healthy people against the background of an intact (unaffected) mucous membrane, secondary – in people who already have stomach diseases. Depending on the localization of the pathological process, erosions of the bottom, body and antrum of the stomach are differentiated (the defeat of the antrum is more common).
Hemorrhagic gastritis symptoms
In most cases, the main signs of pathology are non-intensive dyspeptic complaints. In some cases, hemorrhagic gastritis can manifest immediately with gastric bleeding. Most often, patients complain of decreased appetite, dull pain in the epigastrium, a feeling of bursting and pressure in the stomach, nausea, heartburn, acid belching, an unpleasant, sometimes “metallic” taste in the mouth. Pain occurs immediately after eating. There may be vomiting of undigested food, diarrhea, followed by constipation.
Palpation of the abdomen determines soreness in the epigastric region, there are no symptoms of irritation of the peritoneum, however, in acute hemorrhagic gastritis, there may be a defiance (tension) of the abdominal muscles. Specific for hemorrhagic gastritis are signs of acute or chronic gastric bleeding. In the case of an acute process, patients complain of general weakness, dizziness, nausea. Vomiting of “coffee grounds” is characteristic (vomit becomes black due to blood entering the stomach and combining it with hydrochloric acid to form hematin hydrochloric acid).
With abundant blood loss, a violation of consciousness is possible. The skin and visible mucous membranes become pale, tachycardia and a decrease in blood pressure are determined. Black liquid fecal masses (“tar-like stool”) depart. Chronic bleeding is characterized by complaints of general weakness, headache, fatigue, dizziness, skin becomes pale, dry, nails dull, brittle. Posthemorrhagic iron deficiency anemia develops.
For hemorrhagic gastritis associated with taking medications, an almost asymptomatic course of the disease is typical. If the changes are provoked by other diseases of the internal organs, then the signs of gastritis are layered on the symptoms of the underlying disease (diabetes mellitus, myocardial infarction, thyrotoxicosis). With radiation sickness, signs of radiation enterocolitis and infectious complications are added.
Diagnostics
When examining the patient, the gastroenterologist reveals the pallor of the skin, the abdomen can be painful during palpation. The clinical blood test determines the changes characteristic of acute or chronic blood loss (anemia). In order to determine the acid-forming function of the stomach, pH–metry is performed, for the detection of helicobacteria – a respiratory urease test, PCR diagnostics.
The most informative diagnostic method is esophagogastroduodenoscopy, which allows you to visually assess the condition of the gastric mucosa, the localization of pathological changes, their prevalence and the source of bleeding. Against the background of an inflamed mucosa, numerous erosions, areas of hemorrhage and bleeding are determined. In the process of EGDS, a targeted biopsy is performed, which allows to exclude the oncological nature of the changes and determine the characteristic signs of inflammation.
Hemorrhagic gastritis treatment
Therapy can take place on an outpatient basis or in a hospital. Patients with signs of gastrointestinal bleeding are subject to mandatory hospitalization. Treatment begins with diet therapy: food should be frequent, fractional, in small portions, food is consumed in a pureed and semi-liquid form, warm. In the presence of bleeding, the Meilengracht diet is prescribed – mashed chilled food. Coffee, rich broths, spicy and fried dishes, smoked meats, alcoholic beverages and freshly squeezed juices are not recommended.
Pharmacotherapy is carried out individually, taking into account the peculiarities of the course of the disease. In accordance with the standards of treatment, acidity correctors are used (blockers of H2-histamine receptors – cimetidine, ranitidine; M-cholinolytics – pyrenzepine; proton pump inhibitors – omeprazole, pantoprazole; antacids – aluminum hydroxide + magnesium hydroxide, aluminum phosphate). Enveloping, astringent drugs (bismuth subcitrate, aluminum hydroxide + sucrose octasulfite), antibiotics (in the case of bacterial etiology of the disease), mucosants (licorice root extract, liquorazide + quercetin) and reparants (methyluracil, sea buckthorn oil) are also used.
In case of bleeding, hemostatic therapy is prescribed: inside, a solution of aminocaproic acid with adrenaline, tranexamic acid; vikasol and ethamzylate intramuscularly, intravenously. In hemorrhagic shock, blood loss is replenished with antishock blood substitutes, sometimes with drugs and blood components. It is advisable to use vegetable oils: sea buckthorn, carotene and rosehip oil. These drugs have anti-inflammatory and reparative effects. In remission, phytotherapy is indicated: a decoction of flax seeds, yarrow, plantain, St. John’s wort and chamomile inflorescences.
In some cases, surgical treatment is performed. To date, there is no consensus on what amount of surgery is optimal, so the operation is performed only when all the possibilities of conservative therapy and endoscopic treatment have been exhausted. The methods of endoscopic pricking with an alcohol-adrenaline mixture, irrigation with hemostatic solutions and electrocoagulation of the bleeding area, the method of prolonged hemostasis using a barium-thrombin mixture are quite effective.
Prognosis and prevention
The prognosis for life with hemorrhagic gastritis in most cases is favorable, for recovery – doubtful, since this disease is treated for a long time and often recurs even after surgical treatment.
Prevention is reduced to a healthy lifestyle, proper daily routine, regular nutrition and stress prevention, timely treatment of stomach diseases, exclusion of smoking and alcohol consumption. If symptoms of stomach damage appear, it is necessary to contact a gastroenterologist – timely treatment allows you to avoid the progression of the disease and the development of life-threatening complications.
Literature
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