Diseases of the digestive system occupy the third place in the morbidity structure of adults.
Chronic gastritis develops due to errors in the diet (when you eat rough and spicy foods), presence of Helicobacter pylori, bile acids in gastric contents, prolonged psychological stress, occupational hazards, Smoking and alcohol abuse. Currently, "chronic gastritis" is regarded as a concept which includes inflammatory and degenerative changes of the gastric mucosa. In practice, the diagnosis of chronic gastroduodenitis refers to endoscopic examination.
The main forms include superficial (catarrhal) and atrophic. This separation means the preservation or loss of the glands that have functional significance. Some classifications include an intermediate form is subatrophic, which means beginning atrophy of the glands.
Depending on the prevalence of mutated cells and the depth of penetration of inflammation in thickness of the mucosa non-atrophic gastritis is subdivided into mild, moderate and severe gastritis. The inflammatory process may involve the mucous membranes of the stomach, or some it Department, then there is a focal gastritis.
Atrophic gastritis is characterized by changes in the cells of degenerative nature, a decrease in the number of glands and inflammation of mucous the same as in patients with severe superficial gastritis. Depending on the reduction in the number of glands, moderate and severe degree of atrophy. In 50% of cases this form of gastritis combined with the restructuring of the mucosa (may be metaplasia in the fundus, intestinal metaplasia, dysplasia epithelium). True change is considered precancerous epithelial dysplasia, which is three degrees.
In addition to the main forms of gastritis secrete and its special forms: hyperplastic ("warty", polypoid), hypertrophic, granulomatous, hypertrophic, collagen and others. Focal hyperplasia of the mucosa is considered as the earliest form of a polyp. When casting bile into the stomach under the action of bile acids develop significant inflammation, metaplasia, atrophy of glands and focal hyperplasia.
Infection N. Pylori causes the most severe form of the disease. Thus, most infectious factor is manifested in erosive and hypertrophic form, somewhat less with subatrophic, atrophic and superficial gastritis. In individuals with a long history of the disease (17-20 years), more likely determined low level of acidity and a normal or increased acid production observed in less term.
Symptoms and treatment
Symptoms are nonspecific and varied. Patients worried about the pain and feeling of heaviness in the epigastrium, feeling of stretching and fullness or hunger after eating, burning sensation in the epigastric region and early satiety, bloating after eating, heartburn, belching, nausea, vomiting, salivation, regurgitation of food, loss of appetite.
Hemorrhagic gastritis is one of the most severe injuries, followed by the formation of multiple erosions and bleeding is evident. Patients there is vomiting "coffee grounds" and tarry stools. When heavy blood loss is loss of consciousness and develops anemia. The most common cause of this form of gastritis is the prolonged use of glucocorticoids and non-steroidal anti-inflammatory drugs.
Treatment of gastritis is aimed at the elimination of all factors that provoke worsening of the disease. In the first place are drugs that reduce the acidity of the stomach H2-blocker, but is currently widely used proton pump inhibitors, as they are more effective than H2-blockers in 3-10 times.
Upon detection of Helicobacter pylori exstirpatione is carried out by applying 3-component treatment regimen or proton pump inhibitors combined with two antibiotics). The ineffectiveness of these schemes is carried out, the Quad therapy.
In parallel to prevention of dysbiotic changes in the intestine prescribe a comprehensive probioticscontaining antibiotic resistant strains of microorganisms and colonize the intestine at various levels. Antacids have little impact on the level of pH, but are used as a coating means, which increase the resistance of the mucosa to the effects of hydrochloric acid and pepsin. For violation of motility and gastric emptying prokinetics are assigned.
When symptoms of gastritis treatment diet is of great importance as the food dry, irregular and poor nutrition, the use of excessively cold or hot food and large amounts of spices, cause a worsening of gastritis. For many decades, this disease are advised to follow a diet, as in ulcer.
Need a strict diet for gastritis? Despite the fact that in recent times depart from strict restrictions in the diet, even in peptic ulcer disease, however, food, especially in the period of exacerbation, should not contain irritating substances. It is recommended sparing diet, and the degree depends on the severity of exacerbation. In addition, the composition of supply depends on the condition and acid-forming function of the stomach.
For those who have gastritis with low acidity, suitable Diet number 2, which provides additional stimulation of the secretory function of the stomach and includes sokogonnym products and dishes. Resolved:
- Entrees on the low-fat meat/fish/mushroom broth, pickle with pureed vegetables and pickle cucumbers.
- Porridge on the water or in meat broth (no millet and barley cereals).
- Vegetables boiled and steamed potatoes, carrots, beets, zucchini, pumpkin, cauliflower and cabbage.
- Salads of ripe tomatoes, salads with cooked vegetables (excluding onions, sauerkraut and pickles), vegetable caviar, herring and mincemeat.
- Yogurt, yogurt, yogurt and other fermented milk drinks, cheese slices or grated cheese omelette.
- Heat treatment in the roasting, without formation of rough brown and fire that stimulates the production of gastric juice.
- Mature not pureed fruits. Oranges and lemons (in tea), tangerine, watermelon, grapes.
- The sauces on the meat soups, jellied dishes with broth.
- Tea with lemon, vegetable juices, coffee and cocoa, fruit juices (all juices in a diluted form).
When these gastritis also prescribed foods and dishes with choleretic action: vegetable oil, beet and beet juice, lemon and juice of lemon, melon, watermelon, avocado, turmeric, fresh herbs, rose hips, leaves and dandelion root. Constraint (pea, bean soup, okroshka, the soup of millet, fatty gross meat, salted, smoked fish, canned food, hard boiled eggs, corn, barley porridge, raw vegetables) is needed only in the period of exacerbation, and the improvement of and remission, the diet should be complete.
At the same time excludes: fresh bread, pastries, products from fancy pastry, beans, hash, soup, millet, fatty meats and poultry, smoked meats, fatty fish, salted and smoked fish, legumes, millet, corn, barley, barley groats, raw vegetables, pickled vegetables, onion, radish, radishes, cucumbers, rutabagas, sweet peppers, garlic, mushrooms, very spicy meals, mustard, pepper, horseradish.
When hyperacid gastritis (acidity) recommended Table No. 1 and its variants. Consistently assigned Diet 1A to 10 days, then 1B and №1 (up to two to three months). The ration include neutral foods: milk, egg, boiled meat and fish, porridge, sweet fruit juices. In addition, it is recommended that a fractional power in small portions. The lack in the food of strong stimuli, creates conditions for effective treatment. The basic principles are:
- The exclusion of foods that increase the secretion (spicy, pickled food, rich broth, mustard, alcoholic drinks, smoked and fried foods, coffee, tea, sodas).
- The exception of irritating products (cranberry, tomato, garlic, onion, citrus juices, acidic fruit juices, pepper, chocolate, turnip, radish, alcohol, ginger) and foods that increase flatulence (cabbage, beans, brew beer).
- Increasing protein intake and reducing fat in the diet (fatty pork, cream, butter, goose, duck, cakes and pastries with cream, animal fat, lamb).
- The decrease in the volume of food consumed (not more than 200 g per serving).
- Frequent meals (up to 6 times per day).
- Eating in the form of heat, eliminating cold food and overly hot, irritating the mucosa.
- The use of cooking, stewing and roasting in cooking.
- The exclusion of foods, which can not be combined (proteins and carbohydrates) to avoid rotting and fermentation.
- The inclusion in the diet of juice, potatoes, bananas, broth oats, sweet apples (first baked, later fresh).
Overall diet you need to stick to 1-3 months. Table No. 1 is complete and physiologically balanced (protein to 90-100 g, carbohydrates-300 g, fat per 100 grams). Gradually, the diet expands to normal for each person, but are explicitly excluded spice, spices, spicy food, pickles, smoked meat, canned food, fatty foods (meat and fish). The further course of gastritis depends on the attitude of the patient towards their health, compliance with preventive recommendations and discipline in relation to meals and medications.
In the period of exacerbation for patients with important dietary compliance, which excludes strong stimulators of secretions and irritants. It is therefore important to know the following.
Mechanical irritation cause:
- a rich meal;
- a large number of roughage — they contain radish, beans, turnips, radishes, bread with bran, gooseberries, grapes, currants, figs, raisins;
- meat with veins, cartilage, animals, leather birds and fish.
Chemicals cause irritation:
- acidic foods (kefir, whey, buttermilk), sour immature fruit;
- broth, broth of vegetables and mushrooms, spicy seasonings, canned food, fried foods, smoked meat and fish, pickled, salted and pickled vegetables, tomato sauce, stewed meat and fish, hard boiled eggs, rye bread, pastry, edible fats that have undergone heat treatment;
- strong tea, sodas, coffee, alcohol, raw vegetables (especially onions, garlic, radish, radish) and fruits.
Thermal effect causes a very cold or hot foods.
Gentle treatment in addition to elimination stimuli also provides for regular and smaller meals that facilitates the digestion and assimilation of food. Preferred cereal and liquid food.
Given all the above, the diet of the patient during an exacerbation should include a warm, non-coarse, pureed meals. These are milk, eggs, porridge, boiled fish, minced meat, steamed.
Is it possible to starve in this disease? There is no simple answer. The positive effect of this treatment is marked, but not always. Most food products have significantly enhanced the secretion of hydrochloric acid, even just getting food in the mouth causes a reflex production of gastric juice. Fasting is excluded from these two factors of influence on the acidity. Therefore, we can expect its decline. The digestive system not only reduces the production of gastric juice, saliva, bile, pancreatic enzymes. Peristaltic motion of the intestines is also reduced.
One of the signals about the necessity of unloading food is lack of appetite. The greatest effect of treatment noted in the period of exacerbation, when combined fasting for 3-5 days, followed by the use of light products. To achieve the effect of fasting combined with water treatments and daily enemas. The decay products and toxins leave the body faster. On the other hand, fasting reduces the vital resources of the body. It should not be used if anorexia and marked weight loss, on the background of antibacterial, eradication of H. pylori and pregnant.
Hunger must not start with a complete lack of food, you first need to switch to lighter products, such as kefir (during the day for 5 taking can you eat 900 ml of yogurt, 200 g of cottage cheese, one Apple). Such kefir fasting days spend 2-3 days in a row, and then move on to starvation.
It can be performed in two versions — dry fasting (forbidden technique even water). The second variant with application of mineral or boiled de-aerated water. Another day it is possible to use weak tea. So are 4-5 days. Power recovery starts from the consumption of rice broth and crackers from wheat flour. Then move on to liquid, well cooked oatmeal, rice and semolina porridge, which is cooked with water or with milk. It is possible during the day to eat cereal broths with soups and mucous soups. Prohibits the admission of fresh vegetables, fruits, juices.
Today among scientists there are those who advocate separate meals for gastritis and other gastrointestinal diseases. The discussion about the benefits and harms of continuing. The point is that food is broken down into three groups: proteins, fats and carbohydrates, which are used separately. The main prohibition — the combination in one meal starch (cereals, pasta, legumes, starchy vegetables) and animal proteins. Meat can only be combined with green vegetables without starch. Green vegetables, in turn, combine with many foods, fats, cereals and proteins. Sugar and confectionery products should be consumed separately from all other products, otherwise they cause fermentation, causing heartburn and belching. It's basically the principles of food combining.