Clinical features

The signs of chronic gastritis are difficult to describe because the course and symptomatology of the disease are quite variable. Some patients do not complain of anything during remissions; the disease may also develop for a long time without any manifestations and it is therefore difficult to establish the time of its onset.

The main syndrome of chronic gastritis is gastric dyspepsia: heaviness in abdomen after the meal, earlier saturation, deterioration of appetite, nausea, eructation and vomiting. It may combine with intestinal dyspepsia characterized by meteorism, rumbling sounds in the abdomen, constipation, and diarrhoea.

Objective examination. General patient’s condition is usually from satisfactory to moderate grave. The consciousness is clear, the posture active. The color of the skin and visible mucosa has corporeal color.

The data of inspection, palpation, percussion and auscultation of respiratory and cardiovascular systems are without peculiarities.

Palpation of the epigastrium is in most cases painless or may be distinguish moderate pain in epigastrium and umbilical regions.

Additional methods of examination

Gastric secretory function. The acid secretion may remain normal or it may decrease. Free hydrochloric acid may be absent from the gastric juice (achlorhydria).

Roentgenography is but of little use in the diagnosis of chronic gastritis.

Gastroscopy can give valuable diagnostic information, especially if it is combined with sighting biopsy.

Biopsy is important for the study of patients with chronic gastritis.

Detecting of Helicobacter pylori.

Peptic ulcer disease (Gastric and Duodenal Ulcer)

Peptic ulcer is a general chronic and relapsing disease characterized by seasonal exacerbations with ulceration of the stomach wall or the duodenum. Approximately 10% of all adults have peptic ulcer at some time in their lives. Duodenal ulcer is more common 4 times than gastric ulcer. The male to female ratio for duodenal ulcer varies from 4:1 or 2:1. Gastric ulcer is more common in the older (over 50 year), and duodenal ulcer in those from 30-60 year. Duodenal ulcer is more common in male at age 30-55 years. 90-95% of duodenal ulcers occur in the first portion of duodenum. More than 90% of gastric ulcers occur in the lesser curvature.

Etiology

- associated with Helicobacter pylori;

- influence of drugs;

- results of pathological hypersecretion;

- mixed etiology.

Many ulcers are caused by a bacterium called Helicobacter pylori (H. pylori). Around 90% of duodenal ulcer patients and 70% of gastric ulcer patients are infected with H. pylori. Peptic ulcers frequently also can be caused by daily use of pain relievers called non-steroidal anti-inflammatory drugs (NSAIDs). The remaining 30% of gastric ulcers are due NSAIDs.

Having a close relative with peptic ulcer disease also increases your risk, as does smoking and alcohol use.

Pathogenesis

An ulcer forms when there is an imbalance between aggressive factors and defense factors. Aggressive factors: H. pylori infection, NSAIDs, acid and pepsin, smoking, alcohol and other factors. Defense factors: gastric mucosa, gastroprotective prostaglandins, mucus layer on epithelial cells, bicarbonate secreted by epithelial cells and adequate blood supply of gastric mucosa.