Chronic gastritis

Chronic gastritis as degenerative and inflammatory process in the lining of the stomach is the most common gastrointestinal pathology. A special role in the disclosure of the nature and character of gastric lesions in chronic gastritis in recent years has played a method lifetime biopsy of the gastric mucosa. In the Soviet Union this method was first used P. A. Kanishchev (1963). The most detailed study of morphological essence of chronic gastritis held in led C. M RISCOM clinic of the Leningrad sanitary-hygienic medical Institute. Depending on the nature and depth of histopathological changes of the mucous membrane of the stomach are three main forms of chronic gastritis: surface, with the defeat glands without atrophy and atrophic.
One of the difficult issues to date is a clinical classification of chronic gastritis. Of the many classifications proposed at various times, a number of authors, in the resort
Practice the greatest recognition and widespread classification developed by O. L. Gordon. It distinguishes two basic forms of gastritis: gastritis with saved (or increased) secretion and gastritis with secretory insufficiency. Gastritis with stored secretion may be pain and dyspeptic, in its current distinguish the acute stage, decaying exacerbation and remission. There are also three stages of flow of gastritis: compensation (absence of clinical manifestations of the disease), subcompensation (the presence of pain and dyspeptic phenomena at a satisfactory General condition of the body) and decompensation (accession common violations of decline nutrition, anemia, weight, nutritional allergies and others).
Data lifetime of gastrobiopsy showed that chronic gastritis is an organic lesion of the stomach mainly dystrophic and partially inflammatory nature; leading is progressing defeat of gastric glands with outcomes in atrophy. Summarizing of work of its employees, S. M. RISS comes to the conclusion that morphological criteria are the most important and necessary for the proper understanding of chronic gastritis and its diagnosis. This view was reflected in the proposed new classification of chronic gastritis.
The basis of this classification is based on etiological, morphological, functional and clinical principles. Depending on the etiology of the disease gastritis are divided into exogenous and endogenous. According to the morphological characteristics of the author distinguishes between the superficial gastritis, defeat glands without atrophy, atrophic, antral and erosive. Atrophic gastritis in turn can be moderate, severe, with the phenomena of perestroika epithelium and atrophic-hyperplastic, and also include some rare form of the disease (without submucosal layer, with symptoms of fatty degeneration, with the formation of cysts). According to the functional feature the author identifies gastritis with normal secretory function, with moderate secretory insufficiency and with the acute secretory insufficiency.
Finally, the clinical course differ compensated and decompensated gastritis.
Chronic gastritis with normal secretory function of the stomach Spa treatment is indicated primarily in the phase of remission, and with gastritis with secretory insufficiency is in the stage of compensation and subcompensation. Treatment of patients in the resort, in all cases should be complex, but leading the importance of internal and external application of mineral waters and mud.
These medical factors are used in combination with diet therapy, physical therapy, methods of apparatus physiotherapy, medication, etc.
Method internal use of mineral waters choose depending on clinical forms of gastritis, intensity of the inflammatory lesions of the gastric mucosa, stage of disease and the nature of its current and so on (table. 5).
Chronic gastritis with normal or elevated secretion are mainly used water of low mineralization (2-7 g/l) with predominance of hydrocarbonate and sulfate ions, slightly carbon dioxide or not containing carbonic acid, which have a neutral or slightly alkaline reaction. In stage remission and decaying exacerbation from the beginning of the course appoint drinking treatment - drinking of mineral water in the form of heat for 200 ml for the 1 - 1.5 hours before meals 3 times a day. In the acute stage it is recommended to use water only low-mineralized (up to 5 g/l), water appoint not immediately but after some silence of pain and dyspeptic phenomena, approximately 4-5-th day of the treatment, and in reduced dosage - by 100-150 ml per reception 1-2 times a day with the subsequent increase in a single dose to 200 ml and number of techniques to 3 times a day. While dyspeptic gastritis additionally shown gastric lavage with mineral water in the morning on an empty stomach in a day just 6-8 procedures for the course. When pain gastritis (often neurogenic origin) shows absorption microclysters of 100-150 ml of mineral water temperature 38-39° at night before you sleep every day, only 10-12 procedures.
In connection with the often observed secondary (reflex) a dyskinesia of intestines in gastritis with normal or elevated secretion widely used rectally methods of introduction of mineral waters, often intestinal and soul siphon of enema. In remission and decaying exacerbation can be used underwater washing intestines, in the acute stage of gastritis this treatment should not be used.

Chronic gastritis with secretory insufficiency in stages of compensation and subcompensation shows water of medium mineralization with a predominance of bicarbonate ions, chlorine and sodium, mainly carbon dioxide average concentrations that have different reaction from acid to alkaline. In cases where chronic gastritis occurs with failure not only secretory, and motor functions of a stomach (hypotension, hypokinesis), the drinking cure is usually administered 1-2-th day of the treatment, the water is applied 200 ml for 15-30 minutes before meals 3 times a day.
Gastritis with secretory insufficiency in the stage of compensation, i.e. in the absence of clinical symptoms of gastritis, internal use of mineral waters is usually limited to drinking treatment in the use of other methods of introduction of mineral waters for the most part there is no need. Gastritis with secretory insufficiency in the stage of subcompensation additionally applied gastric lavage with mineral water, which is particularly indicated for the inhibition of motor function of the stomach and with a significant degree of inflammation in his mucosa (high gastric lacepedes, a large number of mucus and biuret products in the stomach). In addition, gastric lavage should assign and secondary lesions of the biliary tract and pancreas, as, according to the observations of A. G. Sahakyan (1959), in patients with chronic gastritis, gastric lavage with mineral water reflex increase the flow of bile and stimulates the exocrine function of the pancreas.
Chronic gastritis with secretory insufficiency of the decompensation treatment is not shown. If the patients still arrive at the resort, they prescribe gentle, health food and drugs acting on the principle of substitution therapy: pepsin, pankreatin, insulin, vitamins, anemia - iron, copper and other Internal use of mineral waters in such cases only with a gentle method. Recommended water of low mineralization, with a predominance of ions of hydrogen carbonate, sulfate and chloride, slavophilia (or without carbon dioxide), with slightly acidic, neutral or slightly alkaline.
One of the manifestations of the state of decompensation in gastritis with secretory insufficiency is anemia, which is gipomagniemii nature and its Genesis relates to the category of iron deficiency. In such cases it is advisable to apply for drinking water glandular, arsenic and with a high copper content.
Method internal use of mineral waters for chronic gastritis with secretory insufficiency of the decompensation should provide a sparing effect on their entire digestive system. In most cases, especially when there enterocolitis with a tendency to diarrhea, drinking treatment begins immediately, but after 5-6 days, mineral water prescribe the form of heat to 100-150 ml per reception 1-2 times a day with the subsequent increase in a single dose to 200 ml and number of techniques to 3 times a day.
Widely shown gastric lavage with mineral waters, especially when expressed inflammatory lesions of the mucous membrane of the stomach, oppression his tone and peristaltic function, as well as in secondary pathology of the biliary tract and pancreas. However, given the significant violations of the General condition of the body with decompensated gastritis (syndrome of General fatigue, lack of energy and power), as well as the tendency to diarrhea, stomach recommended infrequently - at the beginning of the course 1 time a week, in the future, with good endurance, 2-3 times a week.
In secondary colitis shows the various methods rectal insertion of mineral waters, with the exception of underwater irrigations. The latter are for patients with decompensated gastritis too much and can cause negative (inadequate) reactions, both General and local part of the digestive tract.