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Erosive gastritis
Last reviewed: 23.04.2024
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Erosive gastritis - erosion of the gastric mucosa, caused by damage to the protective factor of the mucosa. This disease of the gastrointestinal tract is usually acute, complicated by bleeding, but may be subacute or chronic with unexpressed symptoms or lack of any signs. The diagnosis is made with endoscopy. Treatment of erosive gastritis is aimed at eliminating the cause of inflammation.
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To some patients of the DIC (eg, IVL, head trauma, burn injury, combined trauma) it is advisable to prevent the erosion of prescription drugs that suppress acidity.
[What causes an erosive gastritis?
Causes of erosive gastritis include non-steroidal anti-inflammatory drugs, alcohol, stress and, rarely, radiation, viral infection (eg, cytomegalovirus), vascular disorders and mucosal injury itself (eg, nasogastric sounding).
Erosive gastritis is characterized by surface erosion and point damage to the mucous membrane. They can develop 12 hours after the initial damage. Deep erosion, ulcers and sometimes perforation can occur in severe cases of the disease or in the absence of treatment. Damage is usually localized in the body of the stomach, but an antrum may also be involved in the process.
Acute stress gastritis as a form of erosive gastritis develops in approximately 5% of patients in critical condition. The likelihood of developing this form of gastritis increases with the duration of the patient's stay in the DIC and depends on the time that the patient does not receive enteral nutrition. Pathogenesis probably involves hypoperfusion of the gastrointestinal mucosa, leading to the destruction of the mucosal protective factor. In patients with craniocerebral trauma or burns, it is also possible to increase acid production.
Symptoms of erosive gastritis
Moderate erosive gastritis often occurs asymptomatically, although some patients complain of dyspepsia, nausea, or vomiting. Often, the first manifestation may be hematomesis, melena or blood in nasogastric probing, usually within 2-5 days after exposure to the etiologic factor. Bleeding is usually moderate, although it can be massive in case of deep ulceration, especially with acute gastritis as a result of stress.
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Treatment of erosive gastritis
In severe gastritis, bleeding therapy requires intravenous fluid transfusion and, according to indications, blood. Endoscopic hemostasis should be performed, surgical treatment (total gastrectomy) is indicated only as a last resort. Angiography is unlikely to be effective in stopping severe gastric bleeding due to the numerous collateral stomach. Suppression of acidity should be started immediately, if the patient did not receive this treatment.
With moderate gastritis, the elimination of the etiological factor and the use of medications that reduce gastric acidity may be sufficient.
Drugs
How to prevent erosive gastritis?
Prevention of erosive gastritis can neutralize the effect of stress on the development of acute gastritis. However, this mainly applies to high-risk patients requiring intensive care, including patients with severe burns, CNS trauma, coagulopathy, sepsis, shock, polytrauma, artificial ventilation for more than 48 hours, hepatic or renal insufficiency, multiple organ dysfunction and peptic ulcer or gastrointestinal -gravious hemorrhage in the anamnesis.
Erosive gastritis can be prevented if you follow the preventive measures that are aimed at increasing the pH of the stomach more than 4.0 and consists of intravenous injection of H 2 -blockers, proton pump inhibitors and oral antacids. Repeated pH measurement and changes in prescribed therapy are not required. Timely enteral nutrition can also reduce the chance of bleeding.
Suppression of acidity is not recommended in patients with single use of non-steroidal anti-inflammatory drugs or if there is no history of ulcer in the anamnesis.