1. Chronic gastritis and peptic ulcer disease

2. gastritis
Gastritis - a focal or diffuse inflammation of the gastric mucosa in response to its damage with disorders of the secretory, motor, and sometimes inkretory functions.

3. types of gastritis acute; chronic; specific forms of gastritis :
hypertrophic;
lymphocytic;
eosinophilic;
granulomatous;
reactive.

4. International Classification of gastritis (Houston, 1994)
Nontrofic (type B)
Atrophic, autoimmune (type A)
Specific forms:
-Chemical (reflux gastritis, type C) -Radiative -Lymphocytic -Noninfectious granulomatous -Eosinophilic -Some infections

5. Etiologic factors Exogenous: Alimentary disorders Smoking Alcohol
Neuropsychiatric stress
Occupational hazard
The uncontrolled use of drugs

6. Etiologic factors Endogenous: Chronic infection
Diseases of the nervous and endocrine
systems
Cardiovascular and respiratory systems
Renal failure

7. Clinical syndromes Pain Gastric dyspepsia Intestinal dyspepsia
Asthenic-neurotic

8. Laboratory studies:
complete blood count (deviation possible more prolonged chronic disease with symptoms of atrophic gastritis, iron deficiency or B12 deficiency anemia);
urinalysis;
fecal occult blood worms and eggs;
cytology of byoptites (during the first endoscopy, the dynamics - if necessary, after the end of treatment);
histological examination of biopsy samples (if necessary – in dynamics);
tests for Helicobaster pylory detection (fast urease test, breath test, smear-mark);
total protein and protein fractions of blood serum;
determination of glucose in blood and urine.

9. Instrumental study:
esophagogastroduodenoscopy with mandatory biopsy and brush cytology;
ultrasound of the abdomen;
X-ray examination: X-ray examination of esophagus, stomach, duodenum and other parts of the intestine, if necessary - radiography of these bodies.

10. Differential diagnosis
ulcer
stomach cancer
diseases of the biliary tract
gastric polyposis

11. Drug treatment of autoimmune gastritis (type A)
1. Drugs that stimulate the secretory function of the stomach (Lymontar, Pentagastrin, Calcium Gluconate). 2. Replacement therapy (gastric juice pepsydyl, pepsin, pepsin-atsydyn, Abomin, Panzinorm, Hydrochloric Acid). 3. In the presence of pain and frustration Dyspepcyc - Cerukal, Eglonil, Nospanum, Halidor. 4. Anti-inflammatory therapy (plantain leaves, Plantahlyutsyd, Venter). 5. Enzymes (Solizym, Oraz, Festal, Mezim forte). 6. Mineral water ("Mirgorodskaya", "Slov'yanivska" - in the form of heat for minutes before meals, in small sips to 1/2-1 cup 2-3 times a day).

12. ulcer
Peptic ulcer disease - a chronic disease with cyclic flow and a tendency to progression, which is characterized by the formation of a defect in the lining of the stomach or duodenum due to the reduction of its security properties or increasing aggressiveness of gastric juice.

13. Classification of peptic ulcer
1. Localization ulcer: -ulcer -duodenal ulcer (bulbar, postbulbar) -combined gastric and duodenal ulcers; -hastroyeyunal ulcer (ulcer anastamoses).
2. Etiology: -HP - positive ulcer; -HP - negative ulcer.
3. Phase ulcerative process: -active (acute, fresh); -scarring; -stage of scar; -prolonged absence of scarring.

14. 4. Accompanying morphological changes: -localization and activity of gastritis and duodenitis; -the presence and severity of mucosal atrophy -the presence of intestinal metaplasia; -erosions, polyps; -availability gastroezofagal or duodenogastric reflux.
5. Complications: -bleeding -perforation -penetration -stenosis -malignization

15. Variants of the course:
Light - periods of heightened at least once in 1-2 years, clinical manifestations expressed mild, easily treatable;
Moderate - aggravation 1-2 times a year, expressed clinical manifestations, in the pathological process involved other organs of digestion;
Severe - aggravation 3-4 times a year, pronounced clinical signs, which are difficult to treat, there are complications.

17. The role of microorganisms Helicobacter Pylori

18. Duodenal ulcer

19. gastric ulcer

20. erosive gastritis

21. Major syndromes of gastric ulcer
Pain - is caused by irritation of the ulcer surface aggressive content of gastric inflammation in ulcer area, regional spasm of smooth muscle, peryhastryt, peryduodenit.
Syndrome gastric dyspepsia, resulting heartburn, belching, nausea, vomiting.
Syndrome of intestinal dyspepsia, which is a sign of constipation, crampy pain in the gut.
Astenovegetativnogo, increased irritability, emotional lability, sleep disorders.

22. Laboratory diagnosis Omplete blood count (to exclude bleeding);
Biochemical analysis of blood (in the presence of anemia - to investigate the level of Fe + in blood and Ferum-binding ability of serum)
Blood (duodenum ulcers - most often in patients of group I, gastric ulcer - 3-A blood group)
Fecal occult blood;
Cytological examination of bioptites (at least 5 fragments from different parts of the stomach and duodenum;
Histological examination of the bioptites to exclude atypical cells in the center;
Determination of microbial type of H. pylori (urease test, cytology, histology)

23. Instrumental diagnosis
pH-metric study hastritis;
Endoscopy (at the first examination, the dynamics at the end of treatment);
Ultrasonography of the abdomen; X-ray study of the stomach, duodenum and intestines if indicated.

24. Differential diagnosis
Cancer of the stomach;
Diseases of the bile ducts;
Chronic pancreatitis;
Symptomatic ulcers;
Myocardial infarction (abdominal form).

25. Treatment
General principles -Refusal of bad habits (smoking, alcohol and coffee, cessation of NSAIDs) -Diet: health food, table number 1a-1. Foods to eat 5 times a day, the last time not later than 19:00.

26. Medication
Anticholinergic drugs (anticholinergics): selective (Atropine, Methacin, Platifillin) selective (Hastrotsypin, Pirenzepin)
Antacids (Almagel, Fosfalyugel, Maalox, Haviskon, Helyusyl varnish, etc..)
H2-histamine receptors (Cimetidine, Ranitidine, Famotidine, Roksatydyn);
Proton pump blockers (Omeprozol, Lanzoprazol, Pantoprazole, esomeprazole);

27. Means, which form a protective film (Sucralfate, De-nol, Smectite);
Helicobacter drugs: antibiotics (Amoxicillin, Flemoksyn-Solutab, Clarithromycin, Tetracycline, Metronidazole, De-nol);
Means that normalize gastric motor activity (Reglan, Eglonil, Motilium);
Reparant (Hastrofarm, Solcoseryl, Pentoxyl);
Means sedation (Amitriptyline, Rhaponticum, Chinese Magnolia, Dalargin).

28. Schemes triple therapy for the destruction HP
Pantoprazole 40 mg in the morning and 40 mg at night + Amoxicillin 500 mg 4 times a day + Clarithromycin 250 mg 2 times a day. Course 7 days, Eradication of HP 95%.
Pantoprazole 40 mg in the morning and 40 mg at night + Clarithromycin 250 mg 2 times daily + Metronidazole 400 mg 2 times a day. Course 7 days, Eradication of HP 95-97%.

29. 4. Omeprazole 20 mg 2 times a day + Clarithromycin 250 mg 2 times a day + Metronidazole 400 mg 2 times a day.
5. Omeprazole 20 mg 2 times a day + Amoxicillin (flemoksyn-Solutab) to 1000 mg 2 times a day after meals + Metronidazole 400 mg 2 times a day.

30. Scheme of kvadryterapy
Pantoprazole 40 mg 2 times daily + Tetracycline 500 mg 4 times a day + De-nol 120 mg 3 times for 30 minutes before a meal and 4 th time in 2 hours after dinner + Metranidazol 400 mg 4 times a day.

31. Physiotherapy treatment
For uncomplicated ulceral disease in acute phase fading: paraffin, ozokerytni, mud baths on the epigastric area, diathermy, inductothermy UHF therapy elektoforez and acupuncture.

32. Thanks for your attension!