Hospital therapy. Diagnosis and treatment of chronic gastritis (the most important)

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Hospital therapy. Diagnosis and treatment of chronic gastritis (the most important)

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40. Diagnosis and treatment of chronic gastritis

Diagnostics. Chronic gastritis flows for a long time, with an increase in symptoms over time. Exacerbations are provoked by alimentary violations.

The physical picture of chronic gastritis is rather poor. In 80-90% of patients during an exacerbation of the disease, an objective study determines only local pain in the epigastric region. When chronic gastritis is combined with duodenitis, cholecystitis or pancreatitis, localization of pain that is not typical for gastritis, but characteristic of the pathology of another organ, can be determined.

An x-ray examination is more likely to exclude other diseases of the stomach (ulcer, cancer), help in the diagnosis of Menetrier's disease than to confirm the diagnosis of chronic gastritis.

Due to the paucity of clinical manifestations of the disease, as well as the non-specificity of laboratory tests, the diagnosis of chronic gastritis is based on the results of endoscopic and morphological studies. Endoscopy reveals changes in the gastric mucosa of varying severity: edema, erythema, mucosal vulnerability, exudate, flat erosions, raised erosions, hyperplasia or atrophy of the folds, visibility of the vascular pattern, submucosal hemorrhages.

Clinical manifestations characteristic of gastritis are also observed in other diseases of the digestive system, therefore, in the process of diagnosis, ultrasound of the abdominal cavity, a thorough endoscopic and morphological examination of the digestive organs are necessary.

Treatment. Patients with gastritis need general medical measures: regular balanced nutrition, normalization of the work and rest regime, leveling of stressful situations of the domestic and industrial plan.

Drug therapy is indicated only in the presence of clinical manifestations of chronic gastritis. Patients with gastritis associated with HP are treated according to the peptic ulcer program (see next lecture). Persons with autoimmune gastritis need vitamin B12 (500 mcg once a day subcutaneously for 1 days, followed by repeated courses of treatment), folic acid (30 mg per day), ascorbic acid (up to 5 g per day).

If necessary, substitution therapy is carried out with enzyme preparations (mezim-forte, festal, enzistal, creon, pancitrate, acidin-pepsin). The pain syndrome is usually stopped by the appointment of antacids (maalox, almagel, gastal) or H-histamine receptor blockers (ranitidine, famotidine) in medium therapeutic doses.

With special forms of gastritis, treatment of the underlying disease is necessary.

Forecast and prevention. The prognosis for life and work is favorable.

Prevention of gastritis is reduced to rational nutrition, compliance with the regime of work and rest, limiting the intake of NSAIDs.

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