This article is intended for everyone who considers himself indispensable at work so much that he lives for many years with discomfort, or even with real pain, and does not go to give up to the doctor. It is especially aimed at young men at the take-off of their careers, when there is not a single free minute, and pharmacy over-the-counter to relieve any kind of discomfort is bought up by bags.
Each of us at least once in our lives, and most of us more than once, have faced discomfort, or even real pain in the epigastric region, heartburn, nausea and all that is often and unreasonably called gastritis. And we connected it with anything – I ate, drank or drank the wrong way, the work is nervous and also a sea of all sorts of self-soothing excuses, convincing myself not to go to the doctor, so as not to swallow the terrible “gut”, sorry, undergo the procedure of fibrogastroduodenoscopy (FGDS). Yes, and television advertising helps this a lot, confidentially slipping antacids and all kinds of motor regulators, but completely not solving the main problem. Why it is not necessary to succumb to such provocations and engage in complacency, we will talk today.
In order to understand the importance of today’s discussion, we will first go on a short historical excursion.
For decades, it was believed that gastritis and ulcers in the stomach and duodenum are associated with non–infectious causes – stress, poor nutrition (a favorite until recently lack of hot first courses in the diet), changes in acidity in the stomach, etc., etc. It was all treated accordingly – diets, prescriptions of secretory and antisecretory drugs, at one time even hydrochloric acid was swallowed with gastritis with low acidity, then becoming clients of dental prosthetic offices, and everything ended up on the surgeon’s operating table and the deprivation of part of the affected organs, or even organs completely.
And so it would have continued for who knows how long, if in 1983 an article by two Australian authors, B. Marshall and R. Warren, had not appeared in one of the most authoritative medical periodicals, The Lancet, who suggested and described a possible connection between an “unidentified curved wand” and chronic gastritis. So quietly, in the form of a small note, another revolution took place in medicine – Helicobacter pylori was discovered.
Marshall and Warren were not the discoverers of Helicobacter. It was first described in 1875 by Botcher and Lettul inside an ulcer defect.
But then this discovery was “forgotten”, until Australian researchers made an assumption about the probable infectious cause of damage to the gastric mucosa. And this gave such a significant impetus to the study of the microorganism that in 1987 the European Group for the Study of the pathogen was created. In 1990, the Sydney Classification of Gastritis was adopted at the International Congress of Gastroenterologists, in which helicobacter is recognized as one of the five main diagnostic criteria. And in 1994, that is, 25 years ago, the International Agency for Research on Cancer classified Helicobacter as a type I carcinogen, equating the risk of stomach cancer when infected with Helicobacter pylori to the risk of lung cancer when smoking. In the same year, 1994, the conciliation commission of the National Institute of Health recognized the leading role of helicobacter in the development of peptic ulcer disease. And from that moment, global programs for the diagnosis and treatment of these pathologies begin to be developed, taking into account the identified pathogen – the EU countries adopt the “Maastricht Consensus”, which has been updated several times, and now its fifth edition is in effect, on which our gastroenterological Association for the diagnosis and treatment of Helicobacter pylori infection in adults” from 2018. Therefore, when you come to the doctor with complaints of stomach pain, you now know, based on which documents and with what history behind them, the doctor will diagnose and treat.
A minute of epidemiology or how we get infected with helicobacter
It is believed that at least 50% of the world’s population is infected with helicobacter, although the differences in prevalence depend very much on the region of residence, as well as the level of economic development of the country of residence – about 35% are infected in economically developed countries, almost 70% in countries with depressed economies. In the EU, this indicator ranges from 25%, with the exception of Italy, where in some regions the figures reach 60%, and in the USA the fluctuations range from 15% to 80%, depending on the state. The highest infection rate is in Asia, Africa and South America – up to 93% of the population.
Who is at risk regardless of the region and country of residence:
children under 5 years
old members of the same family
medical staff of endoscopic departments
The ways of transmission of infection are still not fully understood, although it is known that Helicobacter is very contagious. It is assumed that the main role is played by the fecal-oral route of infection, that is, through poorly washed and processed food and water. In addition, there is an assumption about the oral-oral method of transmission, both by contact and through food (it is not necessary to finish eating for others what they have bitten, or use someone else’s toothbrushes!), as well as gastro-oral and gastro-gastric, that is, through medical equipment that has not undergone a normal procedure disinfection.
What happens after infection?
When Helicobacter infects the mucous membrane of the stomach or small intestine, it causes inflammation at the site of its introduction, which further enhances the secretion of hydrochloric acid and thereby accelerates and enhances the development of ulcers, increasing their size.
The main manifestations of helicobacter infection are:
gastritis (defeat of the gastric mucosa)
gastric ulcer and duodenal ulcer
duodenitis (inflammation of the duodenum)
cancer as a consequence of ongoing chronic inflammation in the stomach wall
In what situations should you stop self-medicating and immediately run to the doctor? What symptoms indicate that there may be a helicobacter lesion?
nausea,
vomiting of partially digested food,
pain in the epigastric region,
flatulence,
heartburn or frequent belching,
bad breath,
lack of appetite,
heaviness and pain in the stomach even when eating small portions of food,
stool disorders,
allergies, especially if it occurred for the first time against the background of other signs of the disease
If any of the above, especially in combination with epigastric pain, is familiar to you – take a ticket to the doctor. No, stalling is not the best idea – if you have an ulcer, then it may be able to close thanks to pills from advertising, but as it closed, it will open again, because its cause has not been eliminated. In addition, scar tissue changes may begin, strictures may form and patency between the stomach and small intestine may be disrupted, and, in the worst, but, unfortunately, not a rare scenario, stomach cancer may develop (in those infected with helicobacter, it develops 3-6 times more often than uninfected) – an extremely serious disease with a very poor prognosis in case of late treatment.
We do not even mention such formidable complications as gastric bleeding or perforation of an ulcer into the abdominal cavity, which still often end in death.
In general, it is now clear that it is necessary to go to the doctor.
What diagnostic methods will be used to identify the cause
Of course, it is necessary to do a fibrogastroduodenoscopy. No options. If it is very scary, you can do it with sedation or anesthesia, but it must be done. Firstly, there is no substitute for a visual examination, secondly, the doctor will take a piece of suspicious tissue for a subsequent biopsy, and, thirdly, it will be possible to conduct a urease test directly on the gastric mucosa.
In addition, there are respiratory urease tests and determination of the antigen to the helicobacter in the feces. But they do not cancel the FGDS. I want to note right away, in the absence of symptoms, there is no practical benefit from conducting these tests, so you can not waste either time or money.
What will you be treated with?
Since the disease has an infectious nature, it will be treated with antibacterial therapy. Several schemes have been developed, the use of which will depend on whether you have any drug intolerance. The most important thing to understand is that the course of antibiotics should be completely drunk, it is absolutely impossible to save in this case, since at best you will have a relapse, at worst the relapse will be caused by a helicobacter that has managed to acquire drug resistance, and you will spend three times more money on its destruction.
In addition to antibiotics, the doctor will prescribe antisecretory drugs and a diet that will reduce the level of mucosal injury in the ulcer area, which are also mandatory. The result is most often a complete cure, and I would like to note that after anti-helicobacter therapy appeared, the number of disabling surgical interventions, as well as interventions in general, decreased tenfold, and treatment ceased to be long and painful (for example, FGDS began to be carried out no more than 2 times – before treatment and after that, to control the result).
In an ideal situation, after a disease, rehabilitation in a resort is necessary, but the real world is such that it is not always possible to leave even on sick leave, and therefore I would like to urge you to be less nervous, walk more before going to bed, give up salty-fatty-fried and try to create at least some kind of regime. work and rest.
