Biliary reflux gastritis

Reflux in medicine is the process of back-casting the contents. The mechanisms that allow the body to go against the established order may differ. But in any case, the disorder causes serious changes leading to the disease.

Biliary reflux-gastritis arises from the ingress of bile into the lower parts of the stomach. Before treating the disease, you need to understand the causes and try to restore normal digestion.

Prevalence of

In the International Classification, the disease is accounted for under code K29.6 in the "Other gastritis" group. Since there is no separate record of the disease, it is possible to focus on data on postoperative complications and studies on the appeal to polyclinics.

It is shown that duodenogastric reflux occurs in 52.6% of cases as a consequence of operations on the duodenum, and in connection with the removal of the gall bladder - in 15.5%.Symptoms similar to biliary reflux-gastritis reveal in 25-40% of adults.

Causes and factors provocateurs

To understand why the stomach gets bile, which should not be above the duodenum, you need to find out the causes of the pathology. The greatest value is given to functional disorders of the motility( peristalsis) of the stomach, its muscle tone, especially sphincters. They are manifested by accelerated output of content or delay. Accordingly, distinguish between hyper- and hypokinesia, hyper- and hypotension.

The most common spastic reduction of the gatekeeper. In addition to inflammatory diseases of the stomach and duodenum, it is observed with neuroses, mental tension, in people with hysteria, occupational intoxication. In case of decompensation, the stomach cavity expands. In differential diagnosis it is difficult to distinguish from a cicatricial stenosis of the pylorus.

Hypotension and hypokinesia of the stomach accompany the habitual overeating, copious drinking, eating fatty foods. Similar disorders are observed in gastritis, enteritis, colitis, cholecystitis, accompany many severe diseases of other organs, nervous system( toxic paralysis), postoperative complications.

The weakened peristalsis and the stomach tone( paresis) lead to the gaping of the gatekeeper, through it the contents can be thrown back from the duodenum.

Dyskinesia is a group of abnormalities in the coordination of the reduction of the sphincters of the stomach. They cause refluxes of gastric contents into the esophagus, which provokes reflux esophagitis, and from the duodenum to the stomach. In the first case, gastroesophageal reflux disease of the esophagus develops. In this case, the main damaging substance is the acid of gastric juice.

Duodenogastric reflux is characteristic of a hernia of the esophageal aperture of the diaphragm, peptic ulcer, duodenitis, pancreatitis, cholecystitis and inflammation of the bile ducts. Here the stomach suffers in connection with the action of irritating bile components.

In a healthy person, the contents from the lower parts can not get higher due to the work of special muscles of the stomach( sphincters) located on the boundaries of the organ. They are sufficiently compressed after the passage of food and do not allow reverse casting.

Biliary or bile reflux gastritis is caused by the combined effect of several factors:

• by the impaired contractile function of the pylorus;
• reduced sphincter tone at the border of the stomach and duodenum;
• a violation of the motility of the digestive system;
• chronic congestion of the secretion of the duodenum;
• consequences of operative intervention on the digestive organs( gastrectomy, pyloroplasty, gastroenterostomy, cholecystectomy);
• by irritable bowel syndrome;
• gastric emptying( gastroptosis);
• chronic hepatitis;
• peptic ulcers;
• by the use of non-hormonal anti-inflammatory drugs, antibiotics, analgesics, preparations containing iron and potassium, the action of drugs causes blocking of the synthesis of prostaglandins, then mucus in the stomach;
• with alcohol abuse;
• systemic disorders of the nervous and endocrine regulation.

Some medical scientists disagree with the leading role of duodenogastric reflux in the development of biliary inflammation of the stomach. Their position is based on the fact that the epithelium of the stomach is considered quite resistant to the action of bile. They refer the process to a physiological protective reaction, which allows to regulate the acidity with alkaline contents, in response to the enhancement of the synthesis of hydrochloric acid.

Smoking is one of the provoking factors of

pathology. The listed factors are able to supplement: food excesses, wearing tight clothes, smoking, stressful situations. Temporary biliary reflux occurs during pregnancy.

Which ingredients irritate the stomach during reflux?

The composition of the refluxed mass includes:

• duodenal juice;
• pancreatic enzymes;
• bile acids;
• lysolecithin.

How does the surface of the stomach change?

Morphological changes often occur after years. In the nearest section to the intestine - antral - the cells of the epithelium grow intensively, the mucous goblet glands disappear.

The surface becomes swollen, there is a cluster of basophilic leukocytes saturated with nucleic acids. They cause mild inflammation. A prolonged process leads to dystrophy of the cells, and then to necrobiosis. Formation of erosion, the development of protective mucus ceases.

First, a focal process develops. Possible coexistence of areas of mixed inflammation, alternating with normal mucosa. In the future, areas of atrophy are expanding. In the absence of treatment, it is possible to transform the epithelium into a malignant tumor with the development of a tumor.

Species

By the nature of the lesion, the localization of inflammation in the stomach, the following forms of biliary reflux gastritis are distinguished:

• superficial is a typical degeneration of the epithelium;
• catarrhal - joins edema, inflammation of the inner membrane;
• erosive - the deep layers are affected, the necrobiosis of cells forms erosion, there is such a sign as bleeding;
• antral - indicates the development of gastritis in the lower part of the organ( pyloric canal, antrum, sphincter of the pylorus), this zone is affected first and suffers most.

As there is no single classification, some authors singled out:

• acute biliary reflux-gastritis;
• fibrinous with the release of fibrinous-purulent exudate;
• necrotic;
• purulent.

Symptoms of

The disease develops gradually and differs in chronic course. The most common signs:

• pain in the epigastric region on an empty stomach, of a different nature and intensity( acute or persistent aching);
• feeling of heaviness in the upper abdomen;
• bloating( flatulence);
• belching eaten food and air;
• heartburn;
• nausea;
• occasionally vomiting with bile;
• unstable stool( alternating diarrhea and constipation);
• decreased appetite;
• weight loss.

Disturbance of digestion causes anemia and hypovitaminosis. They are manifested by increased fatigue, dizziness, dry skin, cracks in the corners of the lips.

The taste of bitterness in the mouth increases the nervousness of

patients Chronic reflux gastritis is characterized by a wavy course. There are asymptomatic cases that are detected in fibroadastroscopy. Expression is always a sign of a degree of lesion of the mucosa.

Diagnosis

Suspicion of the disease occurs with the doctor at close examination and clarification of the patient's complaints when the cause is identified. The special attitude to the persons who have undergone operative intervention. They are additionally inspected by a surgeon. Indirectly confirm the violation of digestion is possible by the analysis of blood, feces( coprology + hidden blood).

The basis of diagnostics is hardware research. In fibrogastroduodenoscopy, inflammatory foci in the antral part, swelling of the epithelium, expansion of the sphincter opening between the duodenum and pyloric stomach are revealed.

Modern treatment of gastritis requires evaluation of the mucosal state by a biopsy examination taken during fibroadastroduodenoscopy. In this way, the form of the disease is confirmed, the presence of metaplasia of the epithelium during the transition to cancer is checked.

If necessary, the daily pH-metry is performed with the device "Gastroscan"

Measurements of acidity at pH-metry, use of histamine test allow to study the influence of the level of acid formation in the stomach. X-ray of the stomach and intestines with the use of barium suspension helps to trace the movement of the contents of the stomach, to detect violations of contraction of the pyloric sphincter and reflux casting in the pictures. To check participation in the pathogenesis of other organs of the digestive tract, ultrasound of the abdominal cavity is performed.

Treatment of biliary reflux-gastritis

Therapy of the disease requires the patient to quit smoking, drinking alcohol, fatty, spicy and fried foods. Much more attention will have to be given to proper nutrition, compliance with the regime. It is not recommended intensive stress on the abdominal press. The muscle tension increases the pressure inside the peritoneum and promotes reflux movements.

To remove the negative effect of acidity, drugs and folk remedies with enveloping action are used: Maalox, Almagel, decoction of flax seeds, oat jelly. Almagel A simultaneously contains Anestezin, therefore it well pains the inflammation zone. At high acidity, blocking preparations of gastric juice secretion( omeprazole, rabeprazole), blockers of histamine receptors are shown.

Hydrotalcite - combined minerals( magnesium, aluminum), inhibiting acid secretion

Prokinetic group is prescribed to improve the tone of the pyloric sphincter and the muscular layer of the stomach( Primer, Motilium, Motilak).Prevent casting into the stomach Domperidone, Metoclopramide. In order to bind bile acids and improve the outflow of bile, ursodeoxycholic acid preparations( Ursofalk, Ursosan, Ursahol, Cholacide) are used.

In case of a long course of the disease, vitamins A, E, and group B are always prescribed. If during the examination the suspicion of erosive form and oncology is excluded, then physiotherapy courses are efficiently used:

• amplipulse therapy is a method of restoring gastric motility, normalizing secretory function;
• exposure to decimeter waves and ultra-high frequency - removes the swelling of the mucosa, pain, stimulates healing.

Folk remedies

Traditional recipes are popular in patients with mild biliary reflux gastritis. Reception of broths should be spent for a long time. Recommended:

• combined use of chamomile, St. John's wort and yarrow;
• syrup from dandelion and mint flowers.

Usually chamomile, plantain, calendula, dandelion are used with reduced acidity, but for the treatment of gastritis, their anti-inflammatory properties are necessary. Therefore, use in combination and mixtures is permitted.

Operative treatment

Surgical intervention with biliary gastritis is rarely used. Usually, they are operated on emergency indications( bleeding), in a planned manner, when non-healing ulcers, erosions, and tumor formations are detected.

To prevent reflux gastritis, it is necessary to exclude factors that provoke the disease. The control over the state of health after the transferred operations allows earlier to begin preventive treatment and to reveal complications. Therefore, patients should be examined at least once a year.