Text: Evgeniya Skvortsova
It is difficult to find a person who would not have been diagnosed with gastritis at least once - many denote by this word any anxiety in the stomach. In fact, real gastritis - inflammation of the stomach wall - is not so common, and it can only be diagnosed by examining a piece of tissue under a microscope.
If such a tissue sample is not taken, then it is impossible to unequivocally speak of inflammation, even when the inner surface of the stomach was examined using gastroscopy and redness or erosion (superficial sores) was seen. Therefore, doctors use two different concepts: "gastritis" (actually inflammation) and "gastropathy" (a condition where the wall of the stomach is damaged, but there is no inflammation).
How to distinguish one condition from another and to be cured, we deal with doctors: candidate of medical sciences, gastroenterologist, general director of the evidence-based medicine clinic "Rassvet", author of the book "Intestine with comfort" Alexei Paramonov and candidate of medical sciences, gastroenterologist of the GMS Clinic medical center Alexei Golovenko …
Why does the stomach get inflamed?
The stomach contains an aggressive environment: gastric juice is hydrochloric acid and enzymes. At the same time, the organ does not digest itself: the acid does not have access to the stomach lining, which is protected by a layer of mucus. Only those areas where this layer is destroyed are exposed to the aggressive effect of gastric juice.
Painkillers (non-steroidal anti-inflammatory drugs) and alcohol are enemies of the protective layer. Their effects change the properties of mucus over time. As a result, the acid begins to affect the stomach - and gastropathy develops, and an ulcer may develop later. But the connection between spicy food, smoked meats, fibrous foods and damage to the gastric mucosa has not been proven by scientists.
In addition to external influences, internal factors can affect the condition of the stomach - for example, there is an autoimmune gastritis. Acute inflammation can develop from a viral infection and usually resolves quickly without requiring treatment.
Should you be afraid of Helicobacter pylori
The bacterium Helicobacter pylori (Helicobacter) is able to break down mucus, exposing the stomach wall. Its "goal" is to get to the latter and provoke constant inflammation or ulcers, and then cause a precancerous condition - metaplasia. It is interesting that most people have Helicobacter (for example, in Russia - 80% of the population) - and this has been going on for more than fifty thousand years.
To the question "why has humanity still not died out from stomach cancer?" the answer is simple: most carriers of the infection still do not develop inflammation. This is due to the fact that the immune system and Helicobacter reach "armed neutrality": bacteria interact with complex human immunity and win only sometimes. However, the risk still remains - and it is not difficult for microorganisms to access the stomach if you often drink painkillers or abuse alcohol.
Just a few years ago, it was believed that it was necessary to identify and destroy Helicobacter only in individual cases. Today, this is shown to almost all adult patients: experts are sure that the bacterium is the main provocateur of stomach cancer. According to the recommendations of the Kyoto Global Agreement on Helicobacter pylori-associated gastritis, it is necessary to be examined and treated from the age of twelve. European consensus recommendations are slightly different: everyone who lives in countries with a high risk of stomach cancer (in particular in Russia and Japan), patients who have a bad heredity, gastritis, peptic ulcer disease, any "stomach" complaints, iron deficiency should get rid of Helicobacter, vitamin B12 deficiency, as well as those taking pain relievers and anticoagulants.
Alexey Paramonov draws attention to the fact that the damage caused by Helicobacter is different for different people, but the risk of developing a malignant stomach tumor is increased for each carrier. According to the doctor, it is especially important to eliminate the bacteria for those who have to take anti-acid drugs for a long time (omeprazole, lansoprazole, esomeprazole).These drugs contribute to the development of atrophy of the gastric mucosa - and this is the first step to cancer, if the germs are not destroyed. But there is good news: timely methods of combating these bacteria allow the mucous membrane to fully recover.
What is easy to confuse gastritis with
According to gastroenterologist Aleksey Golovenko, most of the symptoms that many associate with "gastritis" have nothing to do with inflammation, stomach ulcers, or dangerous bacteria. A feeling of heaviness in the abdomen after eating, bloating in the stomach, nausea or severe weakness after fatty foods most often speak of functional dyspepsia - that is, a violation of the digestive process. First of all, we are talking about a violation of the motility (motor activity) of the digestive organs, which can be caused, for example, by stress. To improve the condition, it is usually enough to drink prokinetics (for example, domperidone or itopride) - drugs that stimulate the motility of the gastrointestinal tract. Psychotherapy and antidepressant medication can also work, but they must be prescribed by a doctor.
Alexey Paramonov emphasizes that it is not safe to use classic painkillers for any discomfort in the abdomen: most of them by themselves can lead to an ulcer. First aid for acute stomach pain is an antacid that neutralizes gastric acid. Another effective option is the so-called proton pump inhibitors, which also reduce acidity. But you still need to visit a doctor: it is important to understand the cause of the ailments and undergo treatment. For example, pregnant women often complain of so-called reflux disease or pregnancy heartburn, when acid from the stomach enters the esophagus. And if you do not need to follow a special diet with gastritis or dyspepsia (the benefits of Soviet "tables" have not been scientifically proven), then in this case the diet will have to be changed. Such a diet will not be rigid and will certainly not interfere with the development of the fetus.
If pain in the upper abdomen, heartburn, belching, nausea appeared for the first time and you are less than forty-five years old, there is no point in doing gastroscopy: dyspepsia treatment can be prescribed without looking into the stomach. According to the recommendations of the American College of Gastroenterology, gastroscopy is relevant when there is a possibility of detecting an ulcer, metaplasia or tumor. Symptoms of such conditions: discomfort when swallowing, iron deficiency anemia, frequent vomiting, unintentional weight loss by more than 5% in six months. Otherwise, it is sufficient to perform a Helicobacter breath test and eliminate bacteria, if any. Only if after this the state of health has not improved, you need to undergo a gastroscopy with a biopsy - the latter is required to confirm gastritis and allows you to assess the risk of developing stomach cancer in the future.
If you are over forty-five years old or one of your close relatives has had stomach cancer, then at the first "stomach" complaints the doctor will prescribe a gastroscopy. This examination allows you to detect not only gastritis, but also, for example, inflammation of the esophagus (esophagitis) or an ulcer. The unpleasant procedure has no alternative yet, but in order not to suffer, "swallowing the intestine", it is already now possible to be examined under anesthesia. There is progress in the treatment of peptic ulcer disease. Alexey Paramonov says that twenty years ago it was possible to cope with it by removing part of the stomach. Now surgeons recommend surgery only in an emergency, for example, in case of complications that have already arisen - and in other cases, the affected areas of the stomach are simply cauterized with a laser or radio waves.
What to do to prevent illness
In fact, getting rid of Helicobacter pylori, avoiding frequent use of painkillers, not overusing alcohol and not taking too long breaks between meals is the best prevention of gastritis.And in order to prevent functional dyspepsia (after all, it is she who most often causes stomach discomfort), Alexey Golovenko advises not to forget about training: regular physical activity reduces unpleasant symptoms. Learning to deal with stress more easily is also helpful - meditation can help.
Why folk remedies and dietary supplements will not help
Self-medication of gastritis or stomach ulcers with dietary supplements, as well as a decoction of plantain, sea buckthorn oil, badger fat and other "finds" of traditional medicine, even if they once helped your grandmother, according to experts, is useless and may even worsen the condition. Trying the "magic pill", you participate in the lottery: such drugs have not been tested in clinical trials, which means that one can only guess what the result will be.
Alexei Paramonov cites a case that happened to his patient: a man was diagnosed with three stomach ulcers, but instead of the prescribed treatment, he went to hunt a badger - he remembered that badger fat saves from an illness. As a result, fat for breakfast, lunch and dinner provoked severe bleeding from ulcers - the patient was saved at the last moment. And after the extermination of Helicobacter and a course of drugs that lower acidity, the person managed to fully recover in less than a month.