All about lymphocytic infiltration. Medical educational literature

Infiltration - what is it? Doctors distinguish several types of it - inflammatory, lymphoid, post-injection and others. The causes of infiltration are different, but all its types are characterized by the presence of unusual cellular elements in the tissue (or organ), its increased density, and increased volume.

Post-injection infiltrate

This kind pathological changes appears after injection as a result of penetration medicine in fabric. There are several reasons why post-injection infiltration occurs:

1. The rules of antiseptic treatment were not followed.

2. Short or blunt syringe needle.

3. Rapid administration of the drug.

4. The injection site is chosen incorrectly.

5. Repeated administration of the drug to the same place.

The appearance of post-injection infiltrate also depends on the individual characteristics of the human body. In some people it occurs extremely rarely, while in other patients it occurs after almost every injection.

Treatment of post-injection infiltrate

There is no infection in the infiltrated tissue, but the danger of this pathology after an injection is that there is a possible risk of an abscess. In this case, treatment can only take place under the supervision of a surgeon.

If no complications arise, then the infiltration after injections is treated with physiotherapeutic methods. It is also recommended to apply iodine mesh to the area of ​​tissue compaction several times a day and use Vishnevsky ointment.

Traditional medicine also offers several effective methods getting rid of “bumps” that appeared after injections. Honey, burdock or cabbage leaves, aloe, cranberries, cottage cheese, rice can help therapeutic effect if a similar problem occurs. For example, burdock or cabbage leaves should be taken fresh for treatment, applied to the sore spot for a long time. The “bump” can be lubricated with honey beforehand. A compress made from cottage cheese also helps get rid of old “bumps”.

No matter how good this or that method of treating this problem is, the final word should belong to the doctor, since it is he who will determine what to treat and whether it needs to be done.

Inflammatory infiltrate

This group of pathologies is divided into several types. Inflammatory infiltrate - what is it? The medical encyclopedia explains everything, which talks about the ways in which inflammation occurs and indicates the reasons for the appearance pathological reactions fabrics.

Medicine highlights a large number of varieties of infiltrates of the subgroup under consideration. Their presence may indicate problems with the immune system, congenital diseases, the presence of acute inflammation, chronic infectious disease, allergic reactions in organism.

The most common type of this pathological process- inflammatory infiltrate. What it is helps to understand the description of the characteristic features of this phenomenon. So, what should you pay attention to? Tissue compaction in the area of ​​inflammation. Painful sensations occur when pressed. With stronger pressure, a hole remains on the body, which levels out slowly, since the displaced cells of the infiltrate return to their original place only after a certain period of time.

Lymphoid infiltrate

One of the types of tissue pathology is lymphoid infiltrate. The Big Medical Dictionary allows you to understand what it is. It says that such pathology occurs in some chronic infectious diseases. The infiltrate contains lymphocytes. They can accumulate in different tissues of the body.

The presence of lymphoid infiltration indicates a malfunction of the immune system.

Postoperative infiltration

For what reason can a postoperative infiltrate form? What it is? Does it need to be treated? How to do it? These questions concern people who have had to face this problem.

The development of postoperative infiltration occurs gradually. Usually its detection occurs 4-6 or even 10-15 days after surgery. The patient's body temperature rises, aching pain appears in the abdominal area, and stool retention occurs. The presence of a painful lump is determined.

In some cases, it can be difficult to determine where the infiltrate is located - in the abdominal cavity or in its thickness. For this, the doctor uses special diagnostic methods.

The causes of infiltration after operations cannot always be accurately determined, but its therapy in most cases ends successfully. Antibiotics and various types of physical treatment give positive results.

Infiltration occurs very often postoperative scar. Sometimes it can appear several years after the surgical procedure. One of the reasons for its occurrence is the used suture material. Perhaps the infiltrate will resolve on its own. Although this happens rarely. Most often, the phenomenon is complicated by an abscess, which must be opened by a surgeon.

This is a dangerous pathology that requires immediate treatment. Using data X-ray studies and biopsies, doctors can detect pulmonary infiltration in the patient. What it is? Pulmonary infiltration must be distinguished from pulmonary edema. With this pathology, the patient experiences penetration and accumulation of fluids, chemical substances, cellular elements in the tissues of the internal organ.

Lung infiltration most often has an inflammatory origin. It can be complicated by suppuration processes, which leads to loss of organ function.

Moderate enlargement of the lung and compaction of its tissue are characteristic signs of infiltration. Helps to recognize them x-ray examination, in which darkening of the tissues of the internal organ is visible. What does this give? Based on the nature of the darkening, the doctor can determine the type of pathology in question and the degree of the disease.

Tumor infiltrate

The most common pathologies include tumor infiltrate. What it is? It most often consists of atypical tumor cells of different nature (cancer, sarcoma). The affected tissues change color, become dense, and sometimes painful. Manifests itself in tumor growth.

The likelihood of infiltration occurring is equally present in people of any age.

The results of the study showed that the cause of the disease can be various types of injuries and infectious diseases. They can be transmitted by contact, have a lymphogenous type of spread.

An infiltrate very often develops in the tissues of the perimaxillary region. What it is? How to distinguish it from other diseases? Only an experienced doctor can assess the patient’s condition and give an accurate answer to the questions posed. The causative agents of inflammation are staphylococci, streptococci and other representatives of the microflora of the oral cavity.

A complicated condition of acute appendicitis can also cause the development of infiltrate. It occurs due to untimely surgical intervention.

Symptoms of infiltration

As the disease develops, the patient may experience a slightly elevated temperature. It stays at a certain level for several days. Sometimes this indicator remains normal. The infiltrate spreads to one or more parts of the body. This is expressed in swelling and compaction of tissues with a clearly defined contour. All tissues are affected simultaneously - mucous membrane, skin, subcutaneous fat and muscle membranes.

The infiltrate, which develops against the background of a complication of appendicitis, is characterized by persistent pain in the lower abdomen, fever up to 39 degrees, and chills. In this case, the patient’s recovery is possible only with timely surgical intervention. The presence of this type of infiltrate is determined during examination by a doctor (does not require special diagnostic methods).

In other cases, only a differential approach makes it possible to accurately establish a diagnosis and prescribe the necessary treatment. Sometimes, to establish a diagnosis, data from the results of a puncture from the site of inflammation are taken into account.

Specialists examine materials taken from the inflamed area. The different nature of the cells making up the infiltrate has been established. It is this circumstance that allows doctors to classify the disease. As a rule, a large accumulation of yeast and filamentous fungi is found in the infiltrate. This indicates the presence of a condition such as dysbiosis.

The main goal of treating infiltration is to eliminate inflammatory foci. This is achieved conservative methods treatments, which include physiotherapy. The patient should not self-medicate and delay a visit to a specialist.

Thanks to physiotherapeutic treatment, resorption of the infiltrate is achieved by increasing blood flow. At this time, the elimination of stagnation occurs. There is also a reduction in swelling, removal pain. Electrophoresis of antibiotics and calcium is most often prescribed.

Physiotherapy is contraindicated if there are purulent forms diseases. Intense exposure to the affected area will only provoke the rapid development of infiltration and further spread of the lesion.

Choosing a treatment method for patients with rectal cancer

After finishing clinical examination both the nature and extent of the surgical intervention and the choice of the optimal treatment method are determined. The determining factor in choosing the nature of the surgical intervention is compliance with two fundamental provisions - ensuring maximum radicalism of the surgical intervention, i.e. removal of the tumor along with areas of regional metastasis in a single fascial capsule (block) and the desire to ensure maximum physiology of the operations performed. These two provisions constitute the main strategic direction in choosing the volume and nature of surgical intervention.

Among the numerous factors that determine the nature and volume of surgical interventions and, first of all, organ-preserving ones, the fundamental role belongs to the degree of local spread tumor process(stage of the disease) and the level of tumor localization in the rectum.

IN Department of Oncoproctology, Russian Scientific Research Center of the Russian Academy of Medical Sciences named after N.N. Blokhin The following classification of parts of the rectum is accepted

1) 4.1–7.0 cm – lower ampullary section

2) 7.1 – 10.0 cm – middle ampoule section

3) 10.1 – 13.0 cm – upper ampullary section

4) 13.1-16.0 cm – rectosigmoid region

According to this classification, in almost half of the patients (47.7%), the tumor was localized in the lower ampullary part of the rectum, in 29.5% in the middle ampullary part and in 22.8% in the upper ampullary and rectosigmoid part of the rectum.

Among the less significant factors influencing the choice of indications for various types of surgical interventions, a certain role is given to the patient’s age, the degree and severity of concomitant pathology, and the presence of complications from the tumor process.

Taking these factors into account, the entire range of surgical interventions on the rectum can be divided into two categories - with and without preservation of the sphincter apparatus of the rectum. Moreover, in recent years, everywhere in large oncoproctology clinics there has been a clear trend towards an increase in the number of organ-saving operations. A similar pattern is observed in the Russian Cancer Research Center named after. N.N. Blokhin, where in recent years the percentage of sphincter-preserving operations has increased to 70.1% (diagram)

Of course, the expansion of indications for organ-preserving operations should go in parallel with the development of clear criteria for their implementation based on a comparative analysis of long-term treatment results, the development and implementation of staplers, and the substantiation of indications for the use of combined and complex treatment programs that increase the ablasticity of surgical interventions.

Cancer of the superior ampullary and rectosigmoid rectum

For cancer of the upper ampullary and rectosigmoid rectum, according to the overwhelming majority of oncoproctologists, the method of choice is transabdominal (anterior) resection of the rectum. Thus, this operation is performed in more than 85%. Other types of surgical interventions (abdominoperineal extirpation of the rectum, Hartmann's operation, abdominal-anal resection) for this tumor location account for only 14 - 15% of operated patients. Moreover, these surgical interventions were performed, as a rule, in case of a complicated tumor process or severe concomitant somatic pathology of patients, when the formation of an interintestinal anastomosis is associated with a high risk of developing insufficiency of the anastomotic sutures.

In the case of an uncomplicated course of the tumor process, performing surgical interventions for cancer of the rectosigmoid and upper ampullary rectum does not present technical difficulties, and the possibility of carrying out full intraoperative visualization of the degree of local and lymphogenous spread of the tumor process allows one to fully comply with the principles of oncological radicalism (preliminary ligation of arteriovenous trunks, isolation tumors only sharp way, minimal contact with the tumor, i.e. compliance with the “no touch operation” principle, etc.).

When the tumor is localized at the level of the pelvic peritoneum, the latter is opened with a lyre-shaped incision in the presacral region and the rectum with pararectal tissue is mobilized in a single fascial-sheath capsule below the tumor 5-6 cm. At this level, the fascial capsule of the rectum is dissected and the intestinal wall is freed from pararectal tissue . In this case, the perirectal tissue is shifted towards the tumor and removed in a single block. It is important to emphasize that only complete and adequate mobilization of pararectal tissue distal to the tumor at least 5-6 cm and removal of the latter is the most important factor for the prevention of extraintestinal relapses (from pararectal lymph nodes).

Another important factor in the prevention of locoregional relapses is the implementation of a full lymph node dissection, taking into account the main routes of lymphatic drainage. Taking into account that the main route of lymphatic drainage from tumors of this section of the rectum is along the course of the upper rectal vessels, the latter should be ligated at the point where they originate from the inferior mesenteric artery (or from the sigmoid artery) and removed along with the tumor in a single block. If enlarged lymph nodes are detected along the inferior mesenteric artery, the latter is ligated at its origin from the aorta.

After removal of part of the intestine with the tumor, in most cases the continuity of the large intestine is restored - an interintestinal anastomosis is formed. When performing transabdominal (anterior) resection, the interintestinal anastomosis is formed either using stitching devices (domestic AKA-2 device for applying compression anastomoses, imported ETICON or JOHNSON&JOHNSON devices) or manually. The choice of method for forming an interintestinal anastomosis (manual or hardware) largely depends on the experience of using staplers, the qualifications of the operating surgeons, the setting of the clinic, etc.

Analyzing the results of surgical treatment of cancer of the upper ampullary rectum, it should be noted that local relapses occur in 11.2%, overall 5-year survival rate is 79.9%, 5-year relapse-free survival rate is 69.4% (data from the Russian Oncological Research Center)

This clinical situation prompts an urgent search for ways to increase the ablasticity of surgical interventions, using the capabilities of a combined method with the inclusion of preoperative large-fraction radiation therapy in the treatment program.

Using a combined treatment method in a total focal dose of 25 Gy. in patients with tumors exceeding 5 cm, it was possible to reduce the rate of locoregional relapses to 6.2% (with surgical treatment 11.2%), due to their reduction in patients with metastases of regional lymph nodes (from 15.1% to 5.8%).

The data obtained give grounds to believe that the most reasonable method of treatment for cancer of the upper ampullary and rectosigmoid rectum for tumors not exceeding 5 cm and in the absence of metastatic lesions of regional lymph nodes is surgical, and a combined method should be used if cancer is suspected. metastatic lesion regional lymph nodes. and (or) in patients where the size of the tumor process exceeds 5 cm.

Mid-ampullary rectal cancer

Surgery for mid-ampullary rectal cancer has a number of specific features due to the localization of the tumor process in the pelvis - under the pelvic peritoneum. Under these conditions, mobilization of the rectum with a tumor after dissection of the pelvic peritoneum occurs in the depths of the small pelvis in conditions of a surgical field limited by bone structures, creating certain difficulties in observing the basic principles of surgical ablastics. So, in case of cancer of the mid-ampullary section, if preliminary ligation of the upper rectal vessels does not present technical difficulties, then ligation, and especially separate ligation, of the middle rectal vessels passing in the depths of the small pelvis is impossible without preliminary mobilization of almost the entire rectum. Certain difficulties arise when trying to comply with the “no touch operation” principle, i.e. using the “no contact” technique with the tumor during surgery.

The desire to increase the radicalism of surgical interventions and at the same time preserve the sphincter apparatus for cancer of the mid-ampullary rectum encourages authors to use a wide variety of types of surgical interventions. The most performed surgical interventions for this localization of the tumor process are transabdominal (anterior) resection, abdominal-anal resection with reduction colon, Hartmann's operation, supranal resection, modification of Duhamel's operation, and abdominoperineal extirpation of the rectum.

For a long time, the question of the possibility of performing sphincter-preserving operations in the presence of such a prognostically unfavorable sign of local spread of the tumor process as germination of the intestinal wall by the tumor was not clearly resolved. This applies especially to circular tumors, with infiltration of perirectal tissue and possible defeat adjacent structures (posterior wall of the vagina, prostate, seminal vesicles), as well as for tumors of non-epithelial origin.

In these clinical situations, a number of authors strongly recommend performing abdominoperineal extirpation of the rectum. However, as subsequent clinical observations have shown, such characteristics of the tumor process as a circular growth pattern with germination into the perirectal tissue, in some cases, and into neighboring organs should not serve absolute contraindications to perform sphincter-preserving operations.

Contraindications to this kind of intervention are complicated forms of rectal cancer (perifocal inflammation, pararectal fistulas), as well as if the tumor is of a connective tissue nature. This approach made it possible to increase the percentage of combined and extended sphincter-preserving operations from 44.7% to 53.8%. , without worsening the long-term results of treatment compared with abdominoperineal extirpation of the rectum.

As with abdominal-perineal extirpation of the rectum, and with abdominal-anal resection, the rectum with the tumor is mobilized in its own fascial capsule to the pelvic floor muscles, followed by their removal in a single block. This volume of mobilization makes it possible to perform a total mesorectumectomy, which is a key point in the prevention of extraintestinal cancer relapses and allows you to retreat below the tumor at least 2-3 cm and thereby prevent the possibility of submucosal spread of tumor cells.

The differences between these two operations concern only the preservation of the levators and sphincter during abdominal-anal resection, the removal of which is not justified oncologically, due to the lack of their involvement in the tumor process. Thus, the desire to both perform and expand the indications for performing sphincter-preserving abdominal-anal resection of the rectum when the tumor is localized in the mid-ampullary section of the rectum, even when adjacent organs are involved in the tumor process, is justified and justified oncologically.

All of the above makes it possible to recommend in clinical practice the performance of organ-preserving operations for cancer of the mid-ampullary rectum only if two most important oncological requirements are met - removal of the mesorectum (i.e., performing a total mesorectumectomy) and resection of the intestine at least 2-3 cm below the distal border of the tumor.

Another aspect when choosing indications for implementation various types sphincter-sparing operations (transabdominal or abdominal-anal resection) for cancer of the mid-ampullary rectum is the possibility of performing a full (adequate) lymph node dissection, especially with regard to the removal of lymph nodes along the middle intestinal arteries.

Based on the experience in the treatment of mid-ampullary rectal cancer accumulated in the Department of Oncoproctology of the N.N. Blokhin Russian Cancer Research Center, the following indications for performing sphincter-preserving operations can be formulated:

At the same time, despite the observance of a differentiated approach to the selection of indications for performing sphincter-sparing operations, the frequency of relapses remains quite high. This gave reason to believe that the surgical method in the treatment, in particular, of cancer of the distal rectum, has reached its limit and further improvement of surgical technique is unlikely to lead to further improvement in long-term treatment results. In this regard, further progress in this direction is associated with the need to create a comprehensive program for the prevention of locoregional cancer relapses.

Based on radiobiological data on increasing the effectiveness of radiation exposure to tumors with large fractions, the Department of Oncoproctology of the N.N. Blokhin Russian Cancer Research Center has been using the technique of large-fraction preoperative irradiation with a total focal dose of 25 Gy for more than 20 years. with daily fractionation in single doses of 5 Gy.

The combined treatment method significantly reduced the relapse rate from 22.1% to 10.1% and increased the 5-year relapse-free survival rate by 15.1%.

Thus, the results of the study give grounds to assert that the combined method of treating cancer of the mid-ampullary rectum should be considered the method of choice, especially when sphincter-preserving operations are planned. The use of one surgical method for treating tumors of a given localization, due to high frequency the occurrence of locoregional cancer relapses should have limited use and be used only in cases of complicated course of the tumor process, when preoperative radiation therapy is impossible.

Cancer of the lower ampullary rectum

When cancer is localized in the lower ampullary part of the rectum for a long time, performing abdominoperineal extirpation of the rectum was the only justified operation from the standpoint of adherence to the principles of oncological radicalism. However, the long-term results of the surgical treatment of cancer of this localization when performing such a seemingly extensive surgical intervention remain disappointing. The frequency of locoregional cancer relapses ranges from 20 to 40% of operated patients, and relapse-free survival in cases of metastases affecting regional lymph nodes does not exceed 26.3%.

Previously (in the treatment of mid-ampullary rectal cancer), radiobiological data were presented to substantiate the program of preoperative large-fraction gamma therapy and a treatment method was given. The more advanced the tumor process, specifically for cancer of the lower ampullary rectum (advanced stages include those classified as T3N0 and T2-3N1), the less significant the role of preoperative radiation therapy in improving long-term treatment results.

At the present stage of development of oncology, further successes in the development of radiation therapy, and consequently the combined method of treatment, are associated with the development of selective effects on the radiosensitivity of tumor and normal tissues. Among the factors that selectively increase the sensitivity of a tumor to the action of ionizing radiation, one should first of all include the use of local hyperthermia, which has become increasingly popular in recent years. wide application. However, only recently has this technique received sufficient scientific basis. The use of hyperthermia is based on the fact that due to the high heating of the tumor compared to normal surrounding tissues, due to the peculiarities of the blood supply in them, there is an increased thermal damage to tumor cells. It was found that thermal radiation directly destroys primarily cells in the DNA synthesis (S) phase and in a state of hypoxia. Overheating causes sharp pronounced violation, up to the cessation of microcirculation, and to a decrease in the supply of cells with oxygen and other necessary metabolites. This effect cannot be achieved by any of the techniques alternative to hyperthermia.

All of the above, as well as the negative results of the combined method of treating cancer of the lower ampullary rectum using one preoperative gamma therapy, served as the basis for creating, together with the department of radiation therapy of the N.N. Blokhin Russian Cancer Research Center, a combined treatment program with the inclusion of local microwave hyperthermia as a neoadjuvant component of radiation therapy.

Intracavitary hyperthermia is carried out in microwave radio wave mode on domestic devices Yalik, Yakhta-3, Yakhta-4 with a frequency of electromagnetic oscillations of 915 and 460 MHz. For this purpose, special emitter antennas were used, which were inserted into the intestinal lumen. The temperature in the tumor was maintained at 42.5-43 degrees for 60 minutes. In case of severe tumor stenosis (lumen less than 1 cm), large tumor sizes (more than 10 cm), heating is applied through the sacrum using Ekran-2, Yagel, Yakhta-2 devices operating in radio wave mode with a frequency of electromagnetic oscillations of 40 MHz. Local microwave hyperthermia is carried out starting from the third session of preoperative radiation therapy over the next three days. Surgery is performed over the next three days.

The use of local microwave hyperthermia is a powerful radiosensitizing agent of radiation therapy, significantly (more than 4 times) reducing the rate of locoregional relapses for the entire group compared with surgical treatment alone. Moreover, this pattern can be observed in the treatment of locally advanced (resectable) tumor lesions of the rectum and especially in metastatic lesions of regional lymph nodes, where the frequency of cancer relapses decreases by more than five times (22.7% with surgical and 4.4% with thermoradiation treatment) . The consequence of this was a significant increase in 5-year relapse-free survival with combined treatment with a thermoradiation component in patients with metastases of regional lymph nodes, compared with radiation and surgical treatment alone.

Thus, the fundamental possibility of increasing the effectiveness of the radiation component of the combined method of treating lower ampullary rectal cancer using a radiomodifier of tissue sensitivity - local microwave hyperthermia - has been shown.

Cmodern strategy for choosing a treatment method for patients with rectal cancer (algorithm for choosing a treatment method)

Based on the results of treatment of more than 900 patients with rectal cancer, the following indications for choosing the optimal treatment method can be formulated, taking into account the main prognostic factors (localization and degree of local spread of the tumor process):

1) Cancer of the rectosigmoid and upper ampullary rectum:

2) Cancer of the mid-ampullary rectum:

The method of choice for any degree of local spread of the tumor process is combined treatment with preoperative radiation therapy. The use of a combined treatment method is especially indicated when planning sphincter-preserving operations.

3) Cancer of the inferior ampulla:

for any degree of local spread of the tumor process, the use of preoperative thermoradiotherapy in terms of combined treatment is indicated. Surgical treatment should have limited application and be performed only in case of complicated tumor process.

Prognosis factors for rectal cancer

The criterion for assessing the effectiveness of a method of treating oncological diseases is considered to be 5-year survival rate. This figure for the surgical treatment of rectal cancer has not changed over the past decades and is 50-63%. Assessment of long-term treatment results should be carried out taking into account the size of the tumor, its location, the depth of tumor invasion into the intestinal wall, the presence or absence of metastatic lesions of regional lymph nodes, the degree of differentiation of tumor cells and a number of other factors. Only like this comprehensive analysis, which characterizes the degree of spread of the tumor process, is necessary for objectivity and allows one to judge the prognosis for each specific group of patients with the presence of a certain set of prognostic signs.

Factors such as the gender of patients, duration of medical history, volume of blood transfusion during surgery, according to most authors, do not have important prognostic significance. The young age of the patient is a factor that aggravates the prognosis. However, it has been established that in young patients the frequency of metastatic lesions of regional lymph nodes is significantly higher than in patients of other age groups, and therefore a more unfavorable prognosis in patients in this category is due precisely to this circumstance, and the patient’s age itself is a secondary prognostic factor.

One of the most negative prognostic factors is large tumor size. Based on a study of the prognostic value of the extent of the tumor, which most often occupies more than half the circumference of the intestinal tube, it is clearly established that this factor almost always correlates with the depth of invasion of the intestinal wall and therefore rarely has an independent prognostic value.

A thorough analysis of clinical and morphological observations shows that the most important have data from pathomorphological examination of removed specimens: depth of intestinal wall invasion, presence or absence of regional metastases, histological structure of the tumor.

It is known that the deeper the invasion of the intestinal wall, the worse prognosis: 88.4% of patients whose tumor infiltration did not extend beyond the mucous-submucosal layer live for more than 5 years, 67% - when the tumor spreads to the muscle layer, 49.6% - with invasion of perirectal tissue. However, it should be noted that the degree of spread of the tumor deep into the intestinal wall has independent prognostic significance only in the absence of regional metastases; if they do occur, then the depth of invasion has practically no effect on 5-year survival.

In fact, the only prognostic factor for rectal cancer, the role of which is not discussed in the literature, but is unanimously accepted, is metastatic damage to regional lymph nodes. At the same time, the difference in life expectancy of patients with metastases to regional lymph nodes increases every 5 years of observation.

The basis for the analysis of prognostic value histological structure Rectal cancer is based on the International Classification of Intestinal Tumors (Morson et al., 1976), which distinguishes the following forms:

well-differentiated, moderately differentiated, poorly differentiated, mucinous adenocarcinoma and signet ring cell carcinoma. A comparatively more favorable clinical form with relatively satisfactory long-term results is characteristic of highly and moderately differentiated adenocarcinoma, while poorly differentiated, mucous and signet ring cell carcinoma, characterized by pronounced structural and cellular anaplasia, is characterized by a more aggressive course and a worse prognosis.

It can be assumed that the variability in the results of treatment of rectal cancer to a certain extent varying degrees differentiation of neoplasm cells, which is associated with growth rates, and therefore the depth of wall invasion, and the tendency to metastasize. It is these factors that determine the prognosis. Thus, regional metastases in poorly differentiated forms of rectal cancer are detected 3 times more often than in highly differentiated ones.

One of the manifestations of the body’s ability to respond to the development of a neoplastic process with protective reactions is the immunological activity of regional lymph nodes. V.I. Ulyanov (1985), who studied in detail the significance of these factors, believes that they can explain the discrepancy between unfavorable clinical tests and a successful treatment outcome. A five-year period is experienced by 72.8% of patients with hyperplasia of the lymphoid tissue of regional lymph nodes and 58.2% of those in whom it was not expressed.

Very important in prognostic terms is the question of the level of rectal resection, i.e. the distance from the line of intersection of the intestinal wall to the distal border of the neoplasm. Among patients in whom this distance was less than 2 cm, 55% survived the 5-year period, and when it was greater - 70%; Moreover, according to such cardinal indicators as the frequency of regional metastases and the depth of invasion, both groups were identical. It can be assumed that in the case where the resection line is close to the tumor margin, worst results are caused not only by tumor infiltration of the intestinal wall, but also by insufficient radical removal at the same time fiber with lymph nodes.

Of undoubted interest is information about long-term results, depending on the type of operation, which is mainly determined by the location of the tumor. The highest 5-year survival rate (69.6%) was observed among patients who underwent transabdominal resection of the rectum, usually performed when the tumor is localized in the upper ampullary and rectosigmoid sections of the intestine.

It should be noted that none of the listed factors allows us to explain why, even with similar clinical and morphological signs, as well as the volume and nature of surgical intervention, the effectiveness of treatment is different: some patients live 5 or more years, while others die in the early stages after treatment for disease progression. An attempt to explain this fact prompted the study of the finer structure of tumor cells and its connection with the prognosis of the disease.

The work of N.T. Raikhlin, N.A. Kraevsky, A.G. Perevoshchikov showed that in human cancer cells ultrastructural features characteristic of the original cells homologous to the given tumor are preserved.

For the epithelium of the colon mucosa, these are several types of cells, which can only be differentiated using an electron microscope:

1) bordered enterocytes that perform the function of absorption;

2) goblet enterocytes producing mucus;

3) endocrine cells that carry the function of humoral regulation,

4) oncocytes, the role of which has not been established;

5) cells squamous epithelium, apparently the result of metaplasia.

All of these cells are derived from the general population of intestinal crypt stem cells. Depending on the identification of the specified ultrastructural signs of specific differentiation in cancer cells, it became possible to divide the cell population of colon cancer into 2 groups: the so-called differentiated tumor cells– the 5 types listed above (1st group), retaining the ultrastructural signs of a certain prototype of the normal epithelium of the colon mucosa, and undifferentiated – without ultrastructural signs of organ specificity (2nd group).

The ultrastructural classification of colon tumors contains the concept of a tumor variant depending on the ratio of the ultrastructure of differentiated and undifferentiated cells: Option I - more than 50% differentiated, Option II - an equal number, Option III - more than 50% undifferentiated, Option IV - only undifferentiated cells.

It should be especially emphasized that the criterion for the degree of differentiation at the light-optical level is the similarity of the microscopic structure of the tumor with the normal epithelium of the colon mucosa, and at the ultrastructural level - the ratio of ultrastructurally differentiated and undifferentiated elements of the tumor, defined as one of four structural options. Therefore, regardless of the light-optical differentiation of adenocarcinoma, its cellular composition could be dominated by both ultrastructurally differentiated and undifferentiated cells. This fact allows us to some extent explain the reason for the different prognosis for the same histological form of tumors.

Lymphocytic (microscopic) colitis is an inflammatory disease of the colon, accompanied by lymphocytic infiltration of the mucous membrane. This type of colitis is characterized by recurrent diarrhea with a long course.

Collagen colitis differs from lymphocytic colitis and is characterized by hypertrophy of collagen tissue in the subepithelial layer of the colon.

Causes of lymphocytic colitis

Collagen and lymphocytic colitis are rare forms of pathology. The causes of the disease are not known.

The occurrence of the disease is associated with immunological disorders in the colon mucosa.

It is known that similar types of colitis are observed, as a rule, in patients with Sjögren's syndrome, rheumatoid arthritis and celiac enteropathy, i.e. diseases associated with HLA A1 and HLA AZ antigens. A pathogenic effect on the differentiation and formation of fibroblasts of the intestinal microbial flora is also suspected.

The function of colonocytes is significantly impaired due to the presence of a large amount of connective tissue. As a result, the absorption of electrolytes and water in the colon is disrupted, which leads to chronic, predominantly secretory diarrhea. The depth of the haustra and the height of the semilunar folds decrease, and the motor-evacuation function of the intestine also decreases. The large intestine takes on the appearance of a tube with smooth walls in collagenous colitis.

Stage I of the disease (lymphocytic or microscopic colitis) is characterized by a nonspecific inflammatory reaction, which can be manifested by pronounced infiltration of the intestinal wall with lymphoid cells.

Stage II of the disease (collagenous colitis) differs from the previous one in that a collagen layer is found under the basement membrane of epithelial cells.

Symptoms of lymphocytic colitis

• diarrhea (4-6 times a day), which has an intermittent, periodic nature with periods of remission
• cramping abdominal pain
• weight loss (anemia rarely develops)

Treatment of lymphocytic colitis

For the treatment of mild forms of lymphocytic colitis, antidiarrheal, anti-inflammatory, antibacterial drugs with a duration of use of up to 2 months (smecta, bismuth, tannalbine).

The main treatment is budesonide (budenofalk). The drug is not systemic, therefore it is concentrated as much as possible at the site of inflammation and has a small number of side effects.

Among non-medicinal means, various herbal decoctions are used with high content tannins.

A decoction of burnet rhizome rhizome and fireweed root is used 1 tablespoon 5–6 times a day, a decoction of bloodroot rhizome is 1 tablespoon 3 times a day, a decoction of bird cherry fruit is half a glass 2–3 times a day, an infusion of fruits alder (1:20) - 1 tablespoon 3-4 times a day, decoction of oak bark or blueberry fruit - 2 tablespoons 3 times a day.

Nutrition for lymphocytic colitis

During periods of severe diarrhea, diet No. 4a is prescribed with fractional meals up to 6 times a day. Diet No. 4b is prescribed after the cessation of profuse diarrhea. During the period of remission of the disease, with normalization of stool - diet No. 4.

Also excluded are dishes that increase fermentation. Food is consumed boiled and baked. Fruits - only baked. You can drink milk, and if you are intolerant, you can drink low-fat kefir, cottage cheese, and mild cheeses.

Products that increase intestinal motility are excluded: chocolate, strong coffee, alcohol, baked goods, fresh fruits and vegetables, fatty fish and meat, cakes, carbonated drinks, concentrated juices, cereals (millet, pearl barley, barley), milk, full-fat sour cream.

Diagnosis of abdominal infiltration - what is it?

When a doctor diagnoses abdominal infiltration, what it is is of interest to any patient. This is the name for a condition when biological fluids (blood, lymph) or tissue cells accumulate in the organs of the cavity or in the cavity itself, causing a pathological compaction to form. It is important to promptly eliminate the infiltrate so that it does not cause the formation of an abscess, fistula or bleeding. With adequate treatment, the effusion resolves completely, leaving no traces.

Most often, this is a consequence of many different diseases, primarily inflammatory ones. The accumulation of biological fluids - effusion (exudate) - is a sign of such processes or excess blood, lymph in internal organs. These fluids may contain blood elements, proteins, minerals, dead cells, as well as pathogens, which, in fact, cause inflammation. Depending on the composition, hemorrhagic (bloody), serous (from blood serum), fibrinous (mainly from leukocytes localized in some organ), putrefactive, purulent effusions are diagnosed. It is necessary to distinguish exudate from transudate, when water accumulates in the cavities during swelling.

According to medical statistics, an inflammatory infiltrate develops with effusion from blood vessels in 23% of cases as a result of various infections (staphylococci, streptococci, candida, etc.), and in 37% as a result of injuries. It happens that with appendicitis a tumor forms with an inflamed appendage inside if the latter is not removed in a timely manner. Sometimes during surgical interventions, postoperative infiltration of the abdominal organs is detected after a few weeks. The causes of seals in them include anesthetic drugs, antibiotics, alcohol, and foreign bodies. Due to poor-quality surgical threads, scar infiltration may form, even several years after surgery. If it causes the development of an abscess (severe suppuration of tissues with their disintegration), it must be eliminated surgically.

When malignant cells multiply, tissues grow and increase in volume, forming a tumor infiltrate that causes pain. Lymphoid compactions of the abdominal organs with a predominance of lymphocytes appear in chronic infectious diseases and weakened immunity.

Post-injection infiltrates often form if the injections were given unsuccessfully or in violation of the rules of medical manipulation.

Manifestations of pathology

Its main symptoms are:

• mild aching pain in the abdominal cavity;
• more distinct pain and dent formation when pressed;
• redness, swelling of the peritoneum, visually visible compaction under the skin;
• normal body temperature or slight increase(with appendicitis significant, up to 39°C);
• digestive disorders - constipation, diarrhea, flatulence.

Additionally, the distinctive signs of infiltration may include mild manifestations such as slight redness or a shiny appearance of the skin. Symptoms that occur when there is air in the abdominal cavity are important for diagnosing acute peritonitis - a total inflammation that is life-threatening. When purulent foci delimited by muscles are detected, increased signs of inflammation are essential for the prognosis of the development of the disease. For this purpose, they are monitored and repeated palpation of the abdominal organs.

To determine the composition of the exudate, a biopsy method is used - sampling a liquid sample from the peritoneum with a special needle. The latter is subjected to histological analysis, which allows a final diagnosis to be made. If an inflammatory infiltrate is suspected, differential diagnosis is necessary, taking into account the cause of the pathology, its duration and the conditions under which it arose.

Identify the structure of the infiltrate, the presence of an abscess or cystic neoplasms, in which water accumulates, can be done using echography. To determine the location and exact size of the compaction, an ultrasound of the abdominal organs is performed. In complex cases, a CT scan is required.

The main goal is to eliminate infiltration. Often this is achieved using only conservative treatment methods. General principles The treatments for this pathology are:

• bed rest;
• local hypothermia;
• taking antibiotics;
• physiotherapy.

Local hypothermia - cold applied to the peritoneal area - constricts blood vessels, inhibits metabolic processes, reduces the production of enzymes and thus helps stabilize the inflammatory process, preventing it further dissemination. A course of antibacterial treatment is usually prescribed for a period of 5-7 days. The most commonly used antibiotics are Amoxicillin, Ampicillin, Ceftriaxone, Metronidazole, etc. They are taken simultaneously with drugs that restore beneficial microflora intestines, for example Linex or Bifiform.

Sanitation of the abdominal cavity in the absence of suppuration and tumors using physiotherapy is very effective. Thanks to electrophoresis with antibiotics, calcium chloride, sessions of laser, electromagnetic or ultraviolet irradiation relieve pain, swelling subsides, local blood circulation improves and the seal gradually resolves. However, if conservative treatment fails, abscess formation or signs of peritonitis, surgical intervention is required. The abscess is removed using laparoscopic surgery under ultrasound guidance, during which the purulent focus is drained. In case of peritonitis, extensive abdominal surgery cannot be avoided.

After removal of the purulent focus, the abdominal cavity is sanitized with antiseptic solutions of sodium hypochlorite and chlorhexidine. One of the most important conditions for successful treatment is drainage of the abdominal cavity. To do this, several tubes are installed in the latter, through which the exudate flows out (on average 100-300 ml per day). Drains reduce the degree of intoxication of the body and provide early diagnosis of possible postoperative complications: dehiscence of surgical sutures, perforation of organs, bleeding.

Timely drainage of the abdominal cavity, drug and physiotherapeutic treatment of the infiltrate, used in combination, lead to rapid resorption of the formation and provide a favorable prognosis for the patient.

What do we know about hemorrhoids?

In a special section of our website you will learn a lot of necessary and useful information about the disease “hemorrhoids”. The widespread belief that “everyone” suffers from hemorrhoids is incorrect; nevertheless, hemorrhoids are the most common proctological disease. People aged 45 to 65 years are most susceptible to hemorrhoids. Both men and women suffer from hemorrhoids equally often. Many patients prefer to exercise self-treatment, or hemorrhoids are not treated at all. As a result, advanced cases of hemorrhoids are, unfortunately, quite common. Specialists at the Diagnostic and Treatment Center for Coloproctology strongly do not recommend postponing the treatment of hemorrhoids, because hemorrhoids cannot go away on their own. We also recommend you products for hemorrhoids on the website vitamins.com.ua. Always up-to-date prices, original products and fast delivery throughout Ukraine. For any questions, please contact the Contacts section on the website vitamins.com.ua.

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Symptoms of proctological diseases

Here are the symptoms of hemorrhoids and other diseases of the colon: pain in the anus, rectal bleeding, discharge of mucus and pus from anus, constipation, colon obstruction, bloating, diarrhea.

Diseases of the colon and anal canal

Diagnostic methods used in proctology

You will be calmer and more comfortable at an appointment with a proctologist if you know and understand the features and purposes of the examinations he conducts or prescribes for the diagnosis of hemorrhoids and other diseases.

Articles and publications about the problems of coloproctology

Various articles and publications on the problems of coloproctology are divided into topics: “General coloproctology” (including the problems of treating hemorrhoids), “Colon tumors”, “Non-tumor diseases of the colon”, “Colitis”. The section is periodically updated with new materials.

NEW IN UKRAINE: Painless treatment of hemorrhoids.

Transanal dearterialization of hemorrhoids. THD technique. Presentation of the methodology. Video.

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Lymphocytic gastritis is a rare type of ordinary chronic gastritis of unknown origin. The disease is characterized by nonspecific clinical manifestations and endoscopic signs. It most often affects older people after 60-65 years of age, but sometimes infants up to 1 year of age. Adult women get sick 3 times more often than representatives of the stronger sex.

The disease manifests itself in severe infiltration of the gastric epithelium. In this condition, small lymphocytes (or T-lymphocytes) are located in the gastric pits on the surface of the mucosa and there is infiltration of the membrane with plasma cells. Lymphocytic gastritis, if left untreated, in most cases leads to serious complications.

Causes of lymphocytic gastritis

The causes of this type of gastritis have not been fully elucidated by medical scientists to this day.

But the most plausible assumptions are::

1. The onset of the disease begins with the development of celiac disease (celiac disease). It is characterized by intolerance to gluten, a protein found in most grains, especially rye, barley, wheat and oats. For the body of people with celiac disease, gluten is foreign, so immune cells begin to block it already in the stomach. But at the same time with this protein, they also injure healthy cells of the surface layer of the mucosa.
2. The development of this form of gastritis is caused by infection of the gastric and duodenal mucosa with pathogenic microorganisms Helicobacter pylori. Proof of this theory are specific changes in the tissues of the mucous membrane, typical of the bacterial form of the disease.

In addition, in the area increased risk There are people whose menu is dominated by smoked, pickled, spicy, fried, fatty and salty dishes, as well as those who are overly addicted to alcoholic beverages and smoking.

There are no special signs indicating lymphocytic gastritis. The disease can be completely asymptomatic, in other cases it manifests itself with symptoms similar to those of bacterial gastritis caused by Helicobacter pylori microorganisms. The main manifestation of the disease is epigastric pain, which appears in the morning on an empty stomach or 1 hour after eating.

Moreover, pain sensations can be of different types.:

• pulling;
• aching;
• cramping:
• cutting;
• baking

Moreover, most often the pain intensifies after eating rough and hard food, which can quickly irritate the damaged mucous membrane. With gastritis with increased acid production, pain is accompanied by nausea, heartburn and belching. A dense whitish coating forms on the tongue.

With lymphocytic gastritis with reduced acid secretion, patients are bothered by a feeling of fullness in the stomach, rumbling and a feeling of transfusion in it, belching with a sharp heavy odor, flatulence, diarrhea or constipation. The tongue in this case is dry. If the patient's condition worsens, they begin to severe vomiting acidic masses mixed with blood. If the disease lasts a long time, patients lose weight, but their appetite does not decrease.

Since the disease does not have specific symptoms, the presence of it in a person can only be confirmed through diagnostics.

To do this, the following diagnostic procedures are prescribed::

1. General blood analysis. It allows you to detect inflammation in tissues by reducing the number of red blood cells and hemoglobin protein and increasing ESR. They indicate the development of anemia as a result of the chronic course of the inflammatory process.
2. Detailed blood test. It makes it possible to detect deviations much more accurately metabolic processes from the norm.
3. Stool test to determine occult blood.
4. Fibrogastroduodenoscopy. This is a method of visual examination of the esophagus, stomach and duodenum using a flexible optical probe. It allows you to examine the walls of the affected organs and take a tissue sample for microbiological study.
5. Histological examination. This method makes it possible to determine the degree of damage to cells in inflamed tissues.

Fibrogastroduodenoscopy is the main and most informative method for diagnosing lymphocytic gastritis, therefore, it is on the basis of its results that conclusions are drawn about the presence or absence of the disease.

Features of tissue damage in lymphocytic gastritis

During an endoscopic examination, granular accumulations characteristic of this type of gastritis, which resemble papillae or small nodules, are found on the surface of the stomach affected by inflammation. One more typical sign This disease causes damage to the epithelium in the form of small erosions with necrotic tissues of their upper part.

The gastric mucosa with lymphocytic gastritis is pale, thickened and swollen, and there is a large amount of mucus on the surface of the membrane. Gastric dimples are elongated and widened; pinpoint hemorrhages (small hemorrhages) and cysts (cavities with thin walls and semi-liquid contents) can form on the mucosal epithelium.

Treatment of lymphocytic gastritis

The disease is treated with the following medications:

1. Histamine receptor blockers (Famotidine and Ranitidine).
2. Proton pump inhibitors (Omeprazole, Pariet).
3. Antacid medications (Almagel, Gastal, Maalox).
4. Agents that have a protective effect on the mucous surface of the diseased organ (De-nol).
5. Antibiotics if Helicobacter pylori is found in the stomach cavity (Amoxicillin, Amoxiclav, Azithromycin and Clarithromycin).
6. Regulators of motility of the digestive system (Lactiol, Linaclotide, Motilium, Itomed).
7. Enzyme medications (Mezima, Festala, Panzinorm, Enzistala, Abomina).
8. Combined drugs that combine antacid, antispasmodic, laxative and astringent effects (Rothera, Vikalina).
9. Antiemetics (Cisapride, Cerucal, Domperidone).

The effectiveness of treatment of lymphocytic gastritis depends on the degree of neglect of the disease, therefore, at the first suspicious symptoms, you should contact a gastroenterologist for an immediate examination and prescription of appropriate treatment.

Diet for lymphocytic gastritis

During the treatment of this type of gastritis, patients must follow a strict diet to reduce the activity of inflammation of the stomach tissue and speed up the healing of erosions on its mucosa.

They need to exclude from their diet all foods containing a large amount of fiber, as well as too:

• sour;
• spicy;
• spicy;
• fried;
• salty

dishes, rich meat and fish broths, baked goods. You should not drink carbonated drinks, fresh milk and coffee, or alcohol of any strength. You need to eat prepared food warm, not cold, but not hot either. Meals should be fractional (up to 6 times throughout the day).

With lymphocytic gastritis, food should be boiled, baked, stewed or steamed and eaten grated, mushy or semi-solid. You should also quit smoking, move more, and spend more time in the fresh air.

The gastric mucosa consists of several layers. The upper layer of the mucosa - the epithelium - is loose fabric lining the inner surface of the stomach.

It consists of special proteins and protects the walls of the stomach from self-digestion by pepsins - enzymes of gastric juice.

Pepsins are capable of breaking long protein molecules into short fragments - amino acids, which the body can absorb.

If there is no epithelium, then pepsins will destroy the walls of the stomach in the same way as any piece of meat that enters this organ along with food.

Underneath the epithelium lies connective tissue, between the fibers of which there are glands that open into the stomach cavity. The glands produce gastric juice.

Anatomically, connective tissue and glands are also included in the gastric mucosa.

It is clear that the integrity and thickness of the epithelium is extremely important for the health of the stomach.

When the epithelium is thinned or damaged, the mucous membrane ceases to cope with its functions, which leads to the appearance of unpleasant symptoms:

1. belching, heartburn;
2. nausea and vomiting;
3. burning sensation in the stomach, worsening after eating and secretion of gastric juice.

Alcohol and some medications, such as Aspirin, easily “break through” the epithelial barrier. In a healthy and young body, such damage heals within 24 hours.

But the situation changes if the body is weakened, there is inflammation or infection in the gastrointestinal tract, or the metabolism is disturbed.

In this case, the restoration of the epithelium is slow, it gradually becomes thinner, and in some areas disappears altogether.

Then we can talk about mucosal atrophy. Mucosal atrophy is a dangerous pathology that leads to cancer.

Atrophy of the epithelial tissue of the stomach and intestines is caused by:

• Helicobacter pylori infection;
• uncontrolled reception medicines, especially antibiotics;
• excessive consumption of alcohol and unhealthy food;
• nervous experiences;
• deficiency of B vitamins;
• chronic and acute inflammation of the intestines and other gastrointestinal organs: colitis, pancreatitis, cholecystitis.

It is impossible to restore the mucous membrane without eliminating factors that irritate the epithelium. The organ needs to be given rest, and after a little time the mucous membrane will recover.

The process is accelerated by taking medications and dietary supplements, but this can only be done after consultation with a gastroenterologist.

Drugs for epithelial restoration

Drugs that can restore the mucous membrane belong to different pharmacological groups, but the principle of their action is the same - they improve blood supply to the walls of the organ and thus accelerate the regeneration of the epithelial layer and the tissues underlying it.

Cymed is a preparation that contains copper, zinc, a casein (milk protein) hydrolyser and an extract from sea buckthorn berries.

In addition, the drug has a beneficial effect on blood vessels and muscles - it will relieve pain after physical activity, can serve prophylactic for atherosclerosis, helps get rid of migraine attacks.

The medicine is available in tablets. Tsimed is taken twice a day: morning and evening. Duration of treatment is 30 days. There are 60 tablets in a package, so one package is just enough for a full course.

Regesol - contains extracts of medicinal plants, has a healing effect on the entire body.

Helps restore the mucous membrane of the stomach, esophagus, small and large intestines, duodenum, and oral mucosa.

The drug can be taken for inflammation of the gums, gastritis, including atrophic, gastric and duodenal ulcers, colitis, cystitis, reflux, pancreatitis, hepatitis, acute respiratory diseases.

The medicine can be used to reduce the aftereffect of anticancer therapy and to accelerate the healing of wounds of the skin and mucous membranes.

Regesol suppresses inflammation, has an antimicrobial effect, and has a mild analgesic effect. The release form and method of application for Regesol are the same as for Tsimed.

Venter is a drug based on sucralfate, a substance that breaks down into aluminum and sulfur salt in the stomach.

Aluminum has a special effect on the protein that makes up the mucus that covers the walls of the stomach and upper intestines.

Sulfur salt fixes mucus on the walls of the stomach in those places where the epithelium is destroyed. This protection for the affected areas lasts for 6 hours.

Venter and similar drugs are used for stomach ulcers, gastritis with high acidity, including atrophic gastritis, reflux disease, and heartburn.

The drug can be used to prevent seasonal exacerbations of gastric ulcers and during increased psycho-emotional stress, to protect the mucous membrane of the stomach and upper intestines from erosion.

Restoration of mucous membranes using traditional medicine methods

To restore the mucous membrane, you need to exclude fatty, fried, spicy and sour foods from the menu. Products are boiled, baked, stewed or steamed.

Solid foods need to be well ground: do chopped meat, fruit and vegetable purees. The basis of the diet should be rice, oatmeal and buckwheat - these grains contribute to the formation of mucus.

There are quite effective folk remedies that help restore the mucous membrane.

Sea buckthorn oil helps heal ulcers and erosions. You need to drink it before bed, one teaspoon at a time, mixing with the same amount of olive oil.

With normal and increased acidity You can restore the shell using folk remedies using plantain leaves.

This plant has enveloping, wound-healing and analgesic properties. Plantain extract is included in many drugs and dietary supplements intended for the treatment and restoration of the gastrointestinal tract (Plantaglucid, etc.).

For chronic gastritis and other internal inflammations, drink the juice of freshly picked plantain leaves.

Juice is squeezed out of two types of plantain - P. major and P. flea - and mixed equally. Drink this mixture one tablespoon three times a day, 20 minutes before meals.

Before taking, dilute a tablespoon of juice in 50 ml of water.

After an exacerbation of gastritis, you can restore the inner lining of the stomach with the help of this herbal tea:

• chamomile flowers;
• St. John's wort leaves;
• marshmallow root.

20 g of dried raw materials are poured into a glass of boiling water and kept in a bathhouse for 20 minutes, then the container with the infusion is removed from the water and allowed to stand at room temperature for 10 minutes.

Strain, squeeze out the herb and bring the volume to 200 ml with boiled water. Drink half a glass 4 times a day.

Flax seed has good enveloping properties.

To restore damaged epithelial tissue, jelly is prepared from flaxseed:

1. A tablespoon of seeds is poured into a mixer and poured with a glass of hot water, beat for 5 minutes;
2. Add a pinch of ground chicory and beat for another 1 minute.

Kissel is drunk freshly prepared, one glass at a time, a few minutes before meals. If you are not allergic to bee products, you can add a little honey to the drink.

Another way to restore epithelial tissue is to drink a teaspoon of bioactivated aloe juice, half mixed with honey, before meals.

The wound-healing properties of aloe are well known to everyone, and honey is added to improve the taste.

So, it is possible to restore the inner lining of the stomach and intestines. The body itself strives to regenerate damaged areas; it just needs not to be disturbed.

The patient’s task will be to eliminate factors interfering with digestion and use medications or folk remedies recommended by the doctor.

Symptoms and treatment of inflammation of the gastric mucosa

Inflammation may appear suddenly (acute gastritis) or develop slowly ( chronic gastritis). In some cases, this process can lead to ulcers and increase the risk of stomach cancer. The gastric mucosa contains special cells that produce acid and enzymes that begin to digest food. This acid can potentially break down the lining itself, so other cells produce mucus that protects the stomach wall.

Inflammation and irritation of the mucous membrane develops when this protective barrier of mucus is disrupted - with increased acidity, due to the action of the bacterium H. pylori, after overuse alcohol. For most people, this inflammation is not severe and goes away quickly without treatment. But sometimes it can last for years.

What are the symptoms of inflammation of the gastric mucosa?

Inflammatory diseases of the mucous membrane can cause:

• aching or burning pain in the abdomen;
• nausea and vomiting;
• feeling of heaviness in the stomach after eating.

If the mucous membrane is damaged, this is considered erosive gastritis. Areas of damaged gastric mucosa that are not protected by mucus are exposed to acid. This can cause pain, lead to ulcers and increase the risk of bleeding.

If symptoms appear suddenly and last difficult character, these are considered signs of acute gastritis. If they last a long time, this is chronic gastritis, which is most often caused by a bacterial infection.

What factors can cause inflammation in the stomach?

The causes of the inflammatory process in the mucous membrane can be:

Complications

If left untreated, the inflammatory process can lead to the formation of ulcers and bleeding. In rare cases, certain forms of chronic gastritis can increase the risk of stomach cancer, especially if inflammation causes the lining to thicken and change its cells.

How is the presence of inflammation in the mucous membrane detected?

To detect inflammation of the gastric mucosa, it is necessary to perform an endoscopy. A thin and flexible endoscope is inserted down the throat into the esophagus and stomach. With its help, you can detect the presence of inflammation and take small particles of tissue from the mucous membrane for examination in the laboratory (biopsy). Carrying out a histological examination of tissue under a microscope in the laboratory is the main method of confirming the presence of an inflammatory process in the gastric mucosa.

An alternative to endoscopy is a barium X-ray examination of the stomach, which can detect gastritis or stomach ulcers. However, this method is much less accurate than endoscopy. Tests to detect H. pylori infection can be done to determine the cause of the inflammation.

How to treat inflammation of the gastric mucosa?

Treatment of gastritis depends on the specific cause of inflammation of the mucous membrane. Acute inflammation caused by NSAIDs or alcohol can be relieved by stopping the use of these substances. Chronic inflammation caused by H. pylori is treated with antibiotics.

In most cases, the patient's treatment also aims to reduce the amount of acid in the stomach, which relieves symptoms and allows the stomach lining to heal. Depending on the cause and severity of gastritis, the patient may be able to treat it at home.

Symptom relief

• Antacids – These medications neutralize acid in the stomach, providing quick pain relief.
• H2-histamine receptor blockers (Famotidine, Ranitidine) - these drugs reduce acid production.
• Proton pump inhibitors (Omeprazole, Pantoprazole) – these drugs reduce acid production more effectively than histamine H2 receptor blockers.

Treatment of Helicobacter pylori infection

If a patient with gastritis is found to have this microorganism, he needs eradication (elimination) of H. pylori. There are several schemes for such treatment. The basic regimen consists of a proton pump inhibitor and two antibiotics.

How to relieve inflammation at home?

The patient can relieve symptoms and promote mucosal recovery by following these tips:

• You need to eat in smaller portions, but more often.
• Irritating foods (spicy, fried, fatty and sour foods) and alcoholic beverages should be avoided.
• You can try to switch from taking NSAID painkillers to taking Paracetamoa (but you need to talk to your doctor about this).
• Stress needs to be controlled.

Herbal medicine can reduce inflammation and irritation of the stomach lining. It is believed that four herbs are particularly effective in treating inflammatory diseases digestive tract and restoration of mucous membranes:

• liquorice root;
• red elm;
• peppermint;
• chamomile.

The health of the human body depends on nutrition. An unhealthy stomach causes many diseases. How to restore the gastric mucosa?

This question is asked very often when pain appears in the stomach area and discomfort is felt. The process of restoring the gastric mucosa is quite complex, sometimes lasting a very long time. Treatment should be started as early as possible so that the disease does not become critical.

How to start treatment

First of all, you need to forget about cigarettes and stop drinking alcohol. The renunciation of such bad habits must be complete, without any exceptions. These habits equally affect digestion; they are terrible enemies of the gastric mucosa.

You definitely need to work out your own menu to restore the gastric mucosa. Eating should be frequent, but in limited quantities. Coffee should be drunk only before meals, this should not be done after it. Spicy, fried and fatty foods are excluded from the diet.

Poorly digested in the body:

• cabbage;
• greenery;
• mushrooms;
• raw vegetables.

Food does not need to be taken very hot; slightly warmed dishes are considered the best option.

In order for the gastric mucosa to be restored, medications are used to help eliminate those elements that create conditions for the development of gastritis and its exacerbation. Medicines help restore the mucous membrane and start restorative processes.

When treatment is carried out, the patient eats strictly according to his schedule. A diet is prescribed, usually only plant-based. It is agreed upon with a doctor, who, depending on the type of gastritis and the amount of acidity, prescribes its form.

Drug treatment

Doctors, to highlight of hydrochloric acid, to obtain pepsin, prescribed special drugs. They are taken before meals. If it is difficult to take medications, hydrochloric acid is sometimes delivered to the stomach directly through the esophagus using a thin tube. This way the tooth enamel is not damaged.

The use of medications must be carried out in conjunction with the elimination of all causes that provoked acute gastritis. To reduce stomach acidity, use:

• Almagel;
• Maalox.

These drugs have a protective function. The antacids they contain cover the entire surface of the stomach, preventing acid from penetrating inside, thus blocking the entry of acid.

When restoring the mucous membrane, they also use hormonal drugs. Cytotec helps reduce the effect of hydrochloric acid. As a result, stomach protection is created. However, apart from positive qualities, the drug has some contraindications. Pregnant women should not take this medicine. It can cause premature birth.

Some types of medications protect the lining of the stomach. This group includes Venter, Pepto-Bismol.

When they enter the body, the effect of hydrochloric acid on the gastric mucosa is blocked.

Medicines

In gastroenterology, in order to restore the mucosa and when increasing cell regeneration takes place, the following drugs are used:

Prostaglandin E and its varieties:

• Misoprostol;
• Cytotech.

Herbal medicines:

• sea ​​buckthorn oil;
• aloe.

Preparations of animal origin: Solcoseryl and Actovegin.

Antisecretory drugs include:

• Omeprazole;
• Lansoprazole.

To normalize the intestinal microflora, the following are prescribed:

• Bifiform;
• Lactobacterin.

Basically, in order to restore the gastric mucosa, it is necessary to know exactly the cause of its damage. In the absence of clinical manifestations, appropriate treatment is still required, because complications can have very serious consequences.

Restoration of the mucosa during treatment with antibiotics

Of course, antibiotics help restore the membrane, but they also have side effects. To neutralize them, certain actions are performed.

The doctor prescribes medications that act similarly to “beneficial” prostaglandins.
Drugs are used to speed up the healing process. They are especially needed when an ulcer is detected.

The acidity value is determined and adjusted.

For increased acidity, antisecretory drugs are used. If it is low, replacement therapy is used.

To monitor the effectiveness of the measures taken, a control fibrogastroduodenoscopy is performed. This makes it possible to see the mucous membrane after inserting the endoscope into the patient’s stomach.

In addition, laboratory tests are carried out to rule out Helicobacter infection. If a Helicobacter pylori infection is detected, the classic treatment regimen should be applied.

When treating the stomach, it is often used ethnoscience. People use folk remedies only if they know exactly what diagnosis was made by the doctor. The method of treatment also depends on this.

What if you have chronic gastritis? Basically, this is inflammation of the stomach, which has passed into the chronic phase. This is the most common disease on earth affecting the digestive tract and its organs.

When the disease occurs, inflammation of the mucous membrane occurs, regeneration is impaired, and atrophy occurs. glandular epithelium. The form of the disease gradually becomes chronic.

Symptoms of gastritis include:

• heartburn;
• nausea;
• weakness;
• bloating;
• frequent constipation;
• diarrhea;
• pain when eating;
• headache;
• dizziness;
• heat
• sweating;
• tachycardia.

Treatment methods, auxiliary diets

The most important thing in treating the stomach traditional medicine and folk remedies is a certain diet. Special diets are prescribed and the appropriate set of products is selected.

When gastritis begins, it is very important to monitor the condition of the body and prevent the transition of the acute form of the disease to chronic gastritis. In this regard, special food is selected that will not irritate the mucous membrane. Food should be taken in small portions, but very often throughout the day. This blocks the aggressive effect of gastric juice on the walls of the stomach.

Food that has been left in the refrigerator for a long time should be excluded from the diet. It is forbidden to eat fast food. Only food that was prepared several hours before eating, and only from natural, fresh products, can be considered safe. It will not cause poisoning, no negative effects will follow from it.

They fight gastritis using proven folk remedies:

• flax seeds;
• potato juice;
• yarrow;
• St. John's wort;
• celandine;
• chamomile;
• cabbage juice;
• parsley;
• plantain.

In any case, the most important treatment for full recovery The mucous membrane needs good rest, walking and eating small portions.

5.14. Lymphocytic (“Varioloform”;, “Chronic erosive”;) gastritis

Lymphocytic gastritis is characterized by a number of features that make it possible to distinguish it in special shape gastritis (178). Its main symptom is pronounced lymphocytic infiltration of the epithelium. It is known that an increase in the content of MEL is observed in all gastritis, but infiltration of the epithelium is combined with infiltration of the lamina propria of the mucous membrane. With lymphocytic gastritis, there is a selective or predominant infiltration of the epithelium; There are relatively few lymphocytes and plasma cells in the lamina propria, including in areas of erosion.

Lymphocytes with a characteristic light rim are located in groups only on the ridges (Fig. 5.88) and the superficial part of the pits; they are not present in the deeper sections. We can speak of lymphocytic gastritis when the number of lymphocytes exceeds 30/100 epithelial cells.

Endoscopic examination of such patients reveals nodules, thickened folds and erosions. The constant presence of nodules with an ulcerated surface determined the designation of this type of gastritis as varioloform. In the latest edition of the manual by R. Whitehead (1990), it is included in the group of “chronic erosive gastritis”; (14).

In the classification of the German Society of Pathologists “lymphocytic gastritis”; listed as a special pathogenetic form of gastritis, “on equal terms”; with autoimmune, bacterial and reflux gastritis. As for the term “erosive gastritis”, it has been removed from the German and Sydney classifications. The presence and characteristics of erosions in these classifications are indicated in the diagnosis, but as a “suffix”; (16,18). Nevertheless, we consider it possible in this section to discuss the connection between gastritis and erosions.

Nodular mucous membrane with lymphocytic gastritis is found in 68% of patients, with “nonspecific gastritis”; in 16%, thickened folds in 38 and 2%, respectively (178).

The localization of lymphocytic gastritis also differs from “nonspecific” gastritis. In 76% it is pangastritis, in 18% it is fundic and only in 6% it is antral. "Non-specific"; gastritis is antral in 91%, fundic in 3% and total in 6% (178).

Lymphocytic gastritis accounts for about 4.5% of all gastritis (179).

Etiology and pathogenesis of this “new”; (178) The forms of gastritis are unknown.

It can be assumed that we are talking about an immune reaction to the local influence of some antigens. Such antigens could be HP or food ingredients. Indeed, HP was found in 41% of patients, but much less frequently than in patients with chronic active gastritis in the control group, where HP was detected in 91% (179). At the same time, serological signs of HP infection were so common that this gave reason to consider HP to be the antigen that is responsible for the occurrence of lymphocytic gastritis (179). However, not all researchers agree with this (180). It should be noted that immuno-morphological changes differ from those observed in type B gastritis: in the nodularly changed mucous membrane the content of IgM plasma cells is reduced, but the number of IgG and IgE cells is increased (178).

Infiltration of the epithelium in lymphocytic gastritis is surprisingly reminiscent of the patterns that are constantly observed in the small intestine of patients with celiac disease (Fig. 5.89). In this regard, it has even been suggested that lymphocytic gastritis is a manifestation of celiac disease (181). Indeed, lymphocytic gastritis was found in 45% of patients with celiac disease, which is 10 times more common than among patients with all forms of chronic gastritis. The MEL content in the small intestine was almost the same as in the stomach (47.2 and 46.5/100 epithelial cells) (180,181). At the same time, there are no macroscopic signs of lymphocytic gastritis (“varioloformity” of the mucous membrane) in celiac disease (180).

The superficial localization of lymphocytes is associated with the action of gluten. It is possible that gluten can be passively absorbed by the gastric mucosa of gluten-sensitive patients and cause an immune reaction, the expression of which is lymphocytic gastritis (181). This assumption is not contradicted by the fact that the mucous membrane of the stomach, unlike the mucous membrane of the small intestine, is intended not for absorption, but for the secretion of mucus. As is known, the rectum also secretes mucus, but the introduction of gluten into it leads to a significant increase in the number of MEL (182 ).

Lymphocytic gastritis, as a rule, is accompanied by erosions of the gastric mucosa and on this basis is included in the group of chronic erosive gastritis.

R. Whitehead (1990) believes that there are at least 2 forms of chronic erosive gastritis (14).

One is related to Helicobacter gastritis B and is combined with peptic ulcer disease, perhaps even preceding it. This gastritis is localized mainly in the antrum.

It can be assumed that inflammation of the mucous membrane, reducing its resistance

resistance to various damaging factors predisposes to the development of erosions. Such erosions have the appearance of superficial necrosis infected with leukocytes (Fig. 5.90). Surrounding them is a picture of chronic active gastritis. Such erosions are acute.

The second form of chronic erosive gastritis is characterized by the presence of chronic erosions, the bottom of which is formed by necrotic masses, fibrinoid, and a thin unstable layer of granulation tissue (Fig. 5.91). They are surrounded by hyperplastic, elongated, convoluted and branching pits, often lined with immature epithelial cells. There are many MEL in the surrounding mucosa. The muscular plate is either intact or hyperplastic.

Moreover, HP is found in 99% of patients with chronic erosions. The intensity of HP contamination and the activity of gastritis were significantly higher than in patients with chronic Helicobacter pylori gastritis, but without erosions. On this basis, it has been suggested that Helicobacter pylori gastritis plays a leading role in the pathogenesis of chronic erosions. This is due to the high cytotoxicity of microorganisms, which initially cause superficial microerosions. HCL penetrates through the mucous barrier destroyed due to this, it damages the underlying tissue, which, moreover, in these areas is relatively poorly supplied with blood. These topographical features against the background of severe gastritis complicate reparative regeneration and erosion becomes chronic (183).

The concept of the role of HP in the pathogenesis of chronic erosions allows us to understand the origin of the so-called distant leukocytosis (38). We are talking about the constant detection at some distance of erosions of areas of leukocyte infiltration of the lamina propria and epithelium. There is every reason to classify them as foci of active Helicobacter pylori gastritis; their subsequent manifestation ensures the recurrent nature of the erosions.

Judgments about the pathogenesis and morphogenesis of erosions are complicated by the fact that the erosions that the endoscopist sees are not always found in histological preparations. A multicentric European study (184) showed that surface epithelial defects in biopsies were found in only 42% of patients with endoscopically diagnosed erosions. In most biopsies, only areas of acute inflammation, intestinal metaplasia, and subepithelial hyperemia were visible.

5.15. Pseudolymphoma.

Pseudolymphomas are characterized by pronounced hyperplasia of lymphoid tissue, with infiltration of not only the mucous membrane, as in all types of chronic gastritis, but also the submucosa. Nevertheless, they are classified as chronic gastri

there (1.158), using as a synonym the term lymphatic (lymphoblastoid) gastritis, proposed back in the 30s by R. Schindler (1937) and G.H. Konjetzny (1938).

Usually, pseudolymphomas are combined with peptic ulcer disease, and less often they are independent.

Most pseudolymphomas are localized in a place typical for chronic gastritis - in the pyloric antrapium, mainly on its lesser curvature.

Gastroscopy reveals diffuse polypoid hyperplasia of the folds, sometimes the mucous membrane has the appearance of a cobblestone pavement. Similar changes are usually visible in the circumference of gastric ulcers.

The mucous membrane is abundantly infiltrated with mature small lymphocytes, always with an admixture of plasma cells and macrophages (Fig. 5.92). Eosinophils are also often found. The infiltrate expands the glands and can penetrate through the muscular plate into the submucosa (Fig. 5.93). Less commonly, infiltrates are found in one’s own muscle layer(Fig. 5.94).

Pseudolymphomas are characterized by the presence of lymph nodes (follicles) with large light (germinal) centers (Fig. 5.95a). They are located, like all follicles, mainly in the basal part of the mucous membrane, but due to their size, their groups can occupy almost its entire thickness. Follicles are also common in the submucosa (Fig. 5.956). The infiltrate seems to push apart the pre-existing network of argyrophilic fibers; their new formation is not observed (Fig. 5.96).

Three subtypes of gastric pseudolymphomas have been identified (186).

1. Ulcerations surrounded by abundant lymphocytic infiltrate. Apparently, these pictures should be regarded as a reactive process.

2. Nodular lymphoid hyperplasia. Ulcerations and post-ulcerative fibrosis are absent in these cases. There are large superficially located lymphatic aggregates that deform the gastric fields. In such patients, hypogammaglobulinemia and giardiasis are noted.

3. Angiofollicular lymphoid hyperplasia. This subtype is rare and differs markedly from the previous two. By histological structure there are monomorphic cell, polymorphic cell and mixed variants (187).

The infiltrate in the monomorphic cellular variant of pseudolymphoma is formed mainly by mature lymphocytes, but there is always an admixture of plasma cells and eosinophils, so it is “monomorphic”; here, in contrast to the “true”; lymphoma is not complete. Therefore, it is better to talk about “predominantly monomorphic pseudolymphoma”;.

In the polymorphic cellular variant, along with lymphocytes, there are many plasma cells, eosinophils, and lymphoblasts. With this option, deeper infiltration of the stomach wall was noted.

Table 5.5. Differential diagnosis between malignant lymphomas and pseudolymphomas of the stomach (1 each).

The mixed variant is characterized by the fact that monomorphic cellular areas alternate with polymorphic cellular ones.

Pseudolymphoma can be diagnosed using gastrobiopsy, but the pathologist's conclusion can only be speculative due to the small size of the biopsy.

The main thing with a biopsy is the differential diagnosis between pseudolymphoma and malignant lymphoma. It should be taken into account that the picture of pseudolim-

Foma in a superficially excised biopsy does not exclude the presence of lymphoma in deeper areas. In addition, lymphoid cell infiltration may be a reaction to malignant lymphoma. It also cannot be ruled out that if lymphoma originates from preexisting reactive elements, then those changes that are regarded as pseudolymphoma may turn out to be an early stage of the tumor (14), or “pretumor” (186). It has even been suggested that the so-called pseudolymphoma is a lymphoma, but of a low grade (188). It has been found that primary B-cell lymphoma of the stomach can remain a local process for a long time, the lymph nodes may not be involved, and the long-term results of surgical treatment are very favorable (189).

Some criteria differential diagnosis between pseudolymphomas and malignant lymphomas are given in Table 5.5.

When studying biopsy material, lymphoma should be suspected in the presence of dense infiltration of the mucous membrane that has retained its structure without signs of ulceration (14). Lymphoma is characterized by the phenomenon of epithelial tropism of tumor cells with the formation of so-called lymphoepithelial lesions with progressive destruction of the epithelium (189). These pictures are easy to distinguish from active gastritis, in which the epithelium is destroyed by leukocytes and non-lymphocytes. Unlike interepithelial lymphocytes, they do not have a characteristic light rim and form large clusters that protrude into the lumen.

With pseudolymphomas, there is often damage to the surface epithelium in the form of severe dystrophy (Fig. 5.97), necrobiosainecrosis with the formation of erosions. These processes are apparently caused by impaired microcirculation due to abundant infiltration of the mucous membrane. This can be explained by the presence of long-term non-healing erosions in many patients.

Pseudolymphoma can be combined with gastric cancer (Fig. 5.98). Two possibilities are accepted: first, pseudolymphoma represents a reaction to cancer, and second, pseudolymphoma stimulates the development of adenocarcinoma (190). It cannot be ruled out that the long-term existence of a defect in the mucous membrane leads to constant stimulation of the proliferative activity of the epithelium, which creates certain preconditions for malignancy due to impaired reparative regeneration caused by altered tissue trophism (191).

Chronic gastritis, L.I. Aruin, 1993

Gastritis is a disease in which there is inflammation of the gastric mucosa. With gastritis, food in the stomach will be digested with some difficulty, which means much more time will be spent on digesting food. Currently, there are several types of the disease and here are the main ones:

• Surface;
• Atrophic.

Superficial active gastritis

Active superficial gastritis is a harbinger of atrophic inflammation of the stomach and an early stage of chronic inflammation. It is characterized by minimal damage to the gastric mucosa and few clinical symptoms. The disease is diagnosed using endoscopy.

Superficial active gastritis is characterized by the following symptoms:

• Metabolic disorders;
• Discomfort in the upper abdomen that occurs on an empty stomach and after eating;
• Disturbance of the digestive process.

As a rule, superficial active gastritis does not have pronounced symptoms, but if you find any of the above symptoms in yourself, you should immediately contact a gastroenterologist. Otherwise, the disease will develop into a more severe form and then its treatment will require much more effort. Treatment must take place after consultation with a gastroenterologist, since the recovery process requires various therapeutic approaches.

Treatment for this form of gastritis usually involves taking antibiotics and medications that reduce the level of acidity in the stomach. In addition, when treating the superficial form of active gastritis, not only regular medication is required, but also adherence to a strict diet. The diet requires excluding the following foods from the diet:

• roast;
• salty;
• spicy;
• fat;
• smoked;
• soda;
• products with various dyes;
• coffee and alcoholic drinks.

Active chronic gastritis is accompanied by various inflammatory processes, which in turn lead to damage to the lower region of the stomach. In this case, the basic functions of the stomach will not be affected, but a prolonged course of the disease may have a bad effect on the condition of the gastric cells, which can lead to a pathological decrease in its functionality.

Symptoms of active chronic gastritis may begin to develop due to a decrease in the level of acid in the gastric juice. The disease is diagnosed on the basis of a physical examination, and differentiation is carried out on the basis of laboratory, instrumental and functional abilities. Of particular importance in this case is endoscopy, as well as biotite examination. Results may be affected by:

• low secretory activity of the glands of the gastric mucosa;
• wide gastric pits;
• thinned stomach walls;
• vacuolization of stomach cells;
• moderate infiltration of leukocytes outside the vessels.

Chronic active atrophic gastritis may be accompanied by bleeding in the stomach, peptic ulcer disease duodenum, as well as stomach cancer. A patient with a chronic form of the disease must undergo not only drug treatment, but also follow a strict diet, which must be selected individually. When creating a diet, you must take into account the course of the disease. Patients who suffer from this disease should be under constant supervision of a gastroenterologist.

Chronic atrophic gastritis must be treated for a week. In addition, in most cases, atrophic active gastritis worsens due to frequent stressful situations. It is because of this that quite often gastroenterologists, in addition to prescribing certain medications and diet, write out a referral to a psychologist to provide psychological assistance.

Chronic gastritis is a disease based on chronic inflammation of the gastric mucosa, prone to progression and leading to digestive disorders and metabolic disorders.

One of the key elements of treatment remains diet for chronic gastritis. Without proper diet the effectiveness of therapy decreases sharply and full recovery becomes impossible. About who and what menu is prescribed, what and how you can eat, what dishes you need to exclude from your diet, and also a little about recipes ─ later in this article.

Principles of therapeutic nutrition

Nutrition for chronic gastritis is based on several principles:

• You need to eat mechanically, temperature and chemically neutral food.
• You need to eat often, but in small portions.
• The menu should contain enough vitamins and microelements and have the necessary energy value.
• You should exclude or significantly limit foods high in fiber, meat dishes, alcohol, fried and mushroom dishes, baked goods, coffee and strong teas, chocolate, chewing gum and carbonated drinks. These restrictions are especially strict for those who have concomitant diseases (cholecystitis, pancreatitis).

What determines the choice of diet?

What does a doctor focus on when giving advice on his patient’s menu? Depending on the form of the disease and the presence of concomitant diseases (cholecystitis, pancreatitis), therapeutic nutrition for chronic gastritis will be different. Next, a little about anatomy, which will help to better understand the differences in prescribed diets.

Depending on the morphological changes in the stomach wall, gastritis occurs:

• nutrition for chronic gastritis with high acidity
• what to eat for acute gastritis
• what to take for chronic gastritis

• Surface. It is characterized by disruption of the processes of nutrition and restoration of the gastric epithelium, the gastric mucosa is inflamed. Although the gland cells are changed, their function is not significantly impaired. This form of the disease occurs most often with normal and high acidity.
• Atrophic. Chronic atrophic gastritis is manifested by the same structural changes that occur with superficial gastritis, but here the inflammatory infiltration of the gastric mucosa is already continuous, and the number is also reduced - in fact, atrophy of the glands. As a result of the above processes, there are signs of gastritis with low acidity. What else can this type of gastritis be associated with and who gets it? Often occurs in patients with cholecystitis, pancreatitis. Low acidity in in this case may be caused by the reflux of duodenal contents into the stomach (since it has an alkaline reaction).

The diet for chronic gastritis depends mainly on the above classification: on whether the disease occurs with low, normal or high acidity, as well as on what phase it is in - exacerbation or remission.

The most strict diet is prescribed in the acute phase. For those patients whose condition improves, its menu is gradually expanded.

Diet during an exacerbation

There is only one diet during an exacerbation, regardless of acidity. Food should be as gentle as possible on the gastric mucosa, which will reduce inflammation and stimulate its recovery. In the hospital, patients with exacerbations are prescribed diet number 1, namely its subtype number 1a. All dishes are prepared in water or steamed, taken in grated form, and the use of table salt is limited. You need to eat 6 times a day. The diet is observed especially strictly if there is also pancreatitis or cholecystitis.

• On the first day of an exacerbation, it is recommended to abstain from food, drinking is allowed, for example, sweet tea with lemon.
• From the second day you can eat liquid food, add jelly, jelly, meat soufflé.
• On the third day, you can eat crackers, steamed cutlets, lean meat broth, and compotes.

Diet without exacerbation

When the acute period subsides, switch from diet number 1a (the first 5–7 days) to diet number 1b (up to 10–15 days).

The principle of sparing the gastric mucosa remains, but it is not as radical as in acute period. Foods and dishes that stimulate the secretion of gastric juice are limited. The amount of salt is still limited. Meals six times a day.

Features depend on acidity:

• Patients with increased acidity of gastric juice are not recommended to eat fatty broths, fruits, or drink juices. Dairy products and cereals are shown.
• In the diet of patients with low acidity of gastric juice, meat soups and broths, vegetable salads, juices, and fermented milk products are used.

For gastritis with reduced secretion, diet number 2 can also be prescribed. According to this diet, you should not eat spicy foods, snacks and spices, and fatty meats. Avoid foods containing large amounts of fiber, whole milk, and flour products.

Outside of an exacerbation, you need to stick to basic diet number 1 or number 5.

Concomitant pathology

Gastritis rarely occurs on its own. If it is combined with diseases of the liver, gall bladder, biliary tract, for example, cholecystitis, it is advisable, especially during an exacerbation, to adhere to diet number 5.

About drinking

An adequate amount of water is no less necessary for the successful treatment of chronic gastritis than any other diet. There are several rules according to which:

• What matters is what kind of water you drink ─ it’s better to boil tap water or buy bottled water.
• You can drink water during the day as the need arises, the total volume can reach 2 liters per day.
• It is important to drink a small amount of water 30 minutes before meals ─ this will prepare the stomach for eating.
• During an exacerbation, it is prohibited; outside of it, it is extremely undesirable to drink cold or hot water. This once again irritates the gastric mucosa and worsens the condition.
• It is necessary to reduce the intake of coffee and strong tea to a minimum; during an exacerbation, they should not be taken at all.
• Give up carbonated drinks!

The main treatment for gastritis can be supplemented with mineral water. But it should be remembered that to be effective, the course of treatment must be at least 1–1.5 months.

With high acidity, the choice usually stops at Essentuki-1 or Borjomi.

There are features of taking mineral water in this case:

• Drink 250 ml of warm mineral water 3 times a day 1 hour - 1 hour 30 minutes before meals.
• The specified volume is drunk at once, quickly evacuated from the stomach and reflexively reduces increased secretion.

With reduced secretion, preference is given to Essentuki-4 and 17. Features of administration:

• Water can be taken warm, with a volume of about 250 ml, 3 times a day, 15-20 minutes before meals.
• Drink in small sips ─ this will lengthen the time of contact of mineral water with the gastric mucosa and normalize reduced secretion.

Fruits and berries

If acidity is high, sour fruits and berries are prohibited; if acidity is low, you can eat them little by little; melons and grapes are not recommended. You should also not take risks by trying exotic things: avocado, papaya.

But you can afford such a tasty berry as watermelon even with gastritis.

After all, especially in the summer, many patients are interested in whether it is possible to include watermelons in their menu. It is allowed to eat watermelons, but you should not abuse them either, this will provoke another exacerbation. If you eat a few small slices of watermelon, you can do this every day.

Although fresh fruit is strictly limited, you can bake it! Recipe books are filled with a huge number of delicious and healthy recipes.

Recipe for apples baked with cottage cheese and raisins.

• The apples are washed and cored.
• The pureed cottage cheese is mixed with sugar and raw egg and vanilla.
• The apples are filled with the resulting mass and placed in the oven, preheated to 180°C for 10 minutes.

A recipe for apples filled with a mixture of cottage cheese and raisins will allow you to diversify your menu.

Illness and pleasure from eating

It may seem that therapeutic diet for gastritis contains too many restrictions. Many foods must be completely excluded from the diet, many dishes the patient cannot eat at all, and what remains is completely impossible to eat. But this is not true.

If you search, you will find many recipes for dishes that you can and should please yourself with, even if you have chronic gastritis and need to eat according to a diet and cannot eat a lot of things.

Gastric biopsy - procedure, risks

A biopsy is the removal of a small fragment of material from the gastric mucosa for subsequent analysis in a laboratory.

The procedure is usually performed with classical fibrogastroscopy.

The technique reliably confirms the existence of atrophic changes and makes it possible to judge with relative confidence the benign or malignant nature of neoplasms in the stomach. When detecting Helicobacter Pylori, its sensitivity and specificity is at least 90% (1).

Procedure technology: how and why is a biopsy performed during FGDS?

The study of gastrobiopsy specimens became a routine diagnostic technique only in the mid-twentieth century.

It was then that the first special probes began to be widely used. Initially, the collection of a tiny piece of tissue was not done precisely, without visual control.

Modern endoscopes are equipped with fairly advanced optical equipment.

They are good because they allow you to combine sample collection and visual examination of the stomach.

Nowadays, not only devices are in use that mechanically cut off material, but also electromagnetic retracting devices of a fairly advanced level. The patient does not have to worry that a medical specialist will blindly damage his mucous membrane.

A targeted biopsy is prescribed when it comes to:

• confirmation of Helicobacter pylori infection;
• various focal gastritis;
• suspected polyposis;
• identification of individual ulcerative formations;
• suspected cancer.

The standard process of fibrogastroscopy is not too lengthened by taking a sample - in total, the process requires 7-10 minutes.

The number of samples and the site from which they are obtained are determined taking into account the acceptable diagnosis. In cases where infection with Helicobacter bacteria is suspected, material is studied at least from the antrum, and ideally from the antrum and body of the stomach.

Having discovered a picture characteristic of polyposis, a piece of the polyp is examined directly.

Suspecting a ulcer, they take 5-6 fragments from the edges and bottom of the ulcer: it is important to capture the possible focus of degeneration. Laboratory research gastrobiopsy data allows you to exclude (and sometimes, alas, detect) cancer.

If there are already signs indicating oncological changes, 6-8 samples are taken, sometimes in two doses. As noted in the “Clinical Guidelines for the Diagnosis and Treatment of Patients with Gastric Cancer” (2),

With submucosal infiltrative tumor growth, a false negative result is possible, which requires a repeat deep biopsy.

Radiography helps to draw final conclusions about the presence or absence of a diffuse-infiltrative malignant process in the stomach, but it is not performed in the early stages of the development of such cancer due to its low information content.

Preparing for the biopsy procedure follows the standard procedure for FGDS.

Isn't this harmful to the organ?

The question is logical. It’s unpleasant to imagine that something will be cut off from the stomach lining.

Professionals say that the risk is almost zero. The instruments are miniature.

The muscle wall is not affected; the tissue is taken strictly from the mucous membrane. There should be no subsequent pain, much less full-blown bleeding. Standing up almost immediately after taking a tissue sample is usually not dangerous. The examined person will be able to go home calmly.

Then, naturally, you will have to consult a doctor again - he will explain what the answer he received means. "Bad" biopsy - serious reason for concern.

If alarming laboratory data is received, the patient may well be referred for surgery.

Contraindications for biopsy

1. suspected erosive or phlegmonous gastritis;
2. physiologically determined probability of a sharp narrowing of the esophagus;
3. lack of preparedness at the top respiratory tract(roughly speaking, a stuffy nose that forces you to breathe through your mouth);
4. the presence of an additional disease that is infectious in nature;
5. row cardiovascular pathologies(from high blood pressure to heart attack).

In addition, a gastroscope tube should not be inserted into neurasthenics or patients with severe mental disorders. They may react inadequately to the sore sensation in the throat that accompanies the introduction of a foreign body.

Literature:

1. L.D.Firsova, A.A.Masharova, D.S.Bordin, O.B.Yanova, “Diseases of the stomach and duodenum”, Moscow, “Planida”, 2011
2. “Clinical guidelines for the diagnosis and treatment of patients with stomach cancer”, project of the All-Russian Union of Public Associations “Association of Oncologists of Russia”, Moscow, 2014

gastritis diagnosis cancer diagnosis ulcer diagnosis