AKHILIYA OF THE STOMACH

From Big Medical Encyclopedia

AKHILIYA OF THE STOMACH (achylia gastrica; grech, and - otritsa. + chylos juice) — total absence in a gastric juice salt to - you and enzymes. In clinical practice the term «akhilichesky syndrome» for designation of set of the signs connected with oppression of gastric secretion remains (3. Marzhatka, 1967). And. it is necessary to distinguish from an achlorhydria (see), at a cut in a gastric juice is absent only free salt to - that.

Studying And. it is connected with detection of a mucosal atrophy of a stomach. The English doctor Fenvik (S. Fenwick, 1877) described 4 cases of a mucosal atrophy of a stomach confirmed on autopsy. Many researchers note that they at a mucosal atrophy of a stomach are absent salt to - that and enzymes. However Eyngorn (M. of Einhorn, 1892) showed that And. it is observed also without atrophic changes of a mucous membrane of a stomach, it can be a consequence of nervous breakdowns. Martsius (F. Martius, 1892) who described a so-called idiopathic akhiliya in a basis a cut as he believed adhered to this point of view, inborn functional weakness of the secretory device of a stomach lies.

The large contribution to studying of various parties of department of a gastric juice was made by I. P. Pavlov and his pupils (K. M. Bykov, 1947; And. M. Kurtsin, 1953; Yu. M. Lazovsky, 1948; I. P. Razenkov, 1948; Ya. P. Sklyarov, 1961; B. P. Babkin, 1960). Disclosure of the main patterns of neurohumoral regulation and cyclic activity of gastric glands had huge value for development of normal and pathological physiology of a stomach, including and in studying of problem A.

It is accepted to distinguish two main types And. — functional and organic.

At functional akhiliya the ferruterous device of a stomach is kept, but owing to negative mental and other moments salt to - that and pepsin do not separate.

From the point of view of the doctrine of I. P. Pavlov and his pupils, functional And. is explained by braking of secretory function of gastric glands owing to disturbance of cortical dynamics, failures of conditioned-reflex activity occurring at a nervous tension, intoxications, long mental traumatization. Functional And. can be a consequence of disturbance of food, insufficiency in a diet of protein, some types of avitaminosis or a hypovitaminosis (a scurvy, a pellagra, to a spr). Decrease in secretory activity of gastric glands can be observed during the overheating of an organism.

One of manifestations of a functional akhiliya is the geterokhiliya when at the same person on the same trial irritant at a repeated research various conditions of the secretory device of a stomach can come to light: akhiliya, hypochylia and hyperchylia. According to a number of authors (e.g., A. G. Ghukasyan), the geterokhiliya is more often observed at persons with functional frustration of a nervous system, especially at young age. Other authors (M. P. Konchalovsky, 1911; G. L. Levin, 1968; A.S. Belousov, 1969) consider that increase and reduction of gastric secretion is not a resistant symptom and therefore the accepted standards of acidity have only relative value.

Organic akhiliya (anadeniya) is a consequence of irreversible damages of the ferruterous device of a stomach with the termination of secretion of hydrochloric acid and pepsin. Irreversible morphological changes of a mucous membrane can be display of primary disease of the ferruterous device of a stomach (atrophic gastritis), and then speak about primary organic And. Secondary organic And. meets at new growths, intoxications, hron, diseases of a liver and bilious ways, endocrine diseases (a diabetes mellitus, a hypothyroidism, a diffusion toxic craw, an addisonovy disease).

Clinical picture

Clinical picture functional And. long time can not be shown, especially at good compensatory function of a pancreas and intestines. Complaints of the patient are not specific: uncertain pains in an anticardium, especially after reception of large numbers of food; bystry fatigue; acrimony. And. in such cases comes to light accidentally.

At organic And. there is a number of the objective symptoms connected with change of functions of a stomach and involvement in pathological process of a liver and bilious ways. Disturbances in system of bilious ways together with insufficiency of a pancreas are shown by a steatorrhea, a creatorrhea and polyexcrements, cause intestinal dyspepsia, strengthen fermentative and putrefactive processes. In the absence of salt to - you and pepsin the exogenous infection gets into intestines, dysbacteriosis and infectious diseases develop. Pain in an anticardium can explain with a circulatory disturbance in a wall of a stomach in the form of venous staz preferential in the field of an arrangement intragastralny nervous gangliyev (P. N. Stepanov). Disturbance of hydrolytic processes, the strengthened absorption in the inflamed small bowel of large fragments of proteinaceous molecules at the lowered barrier function of a liver lead to development of a sensitization of an organism (O. L. Gordon); perhaps, the intolerance of eggs, fishes, crayfish, milk and some other foodstuff is also explained by it. And. quite often is followed by weight loss, decrease in body resistance, anemia owing to disturbance of digestion of B12 vitamin, iron and copper. Due to the disturbance of digestion of vitamins and mineral salts the pellagra, osteoporosis, an ariboflavinosis can develop.

The diagnosis

the Diagnosis is made on the basis of laboratory and tool researches. It is important to define a condition of secretory function of gastric glands (existence or absence salt to - you and pepsin), a look And. At organic And. it is necessary to reveal whether it is primary or the investigation of another, time of a serious illness. For diagnosis functional and organic And. apply methods of a multimoment research of gastric secretion, radio telemetric definition of pH and enzymatic activity of contents of a stomach, especially against the background of the submaximum and maximum stimulation of the secretory device of a stomach a histamine (see. Histamine test ). Comparison of these these analyses to results of a research of basal secretion allows to judge a role of functional and organic factors in secretory disturbances of a stomach (Yu. I. Fishzon-Ryss). Identification And. in the middle age, and furthermore in elderly (senile And.), guards concerning a possible precancerous state or a carcinoma of the stomach.

Great value in diagnosis functional and organic And. the gastrofibroskopiya has (see. Gastroscopy ) with an aim or so-called linear biopsy of a mucous membrane of a stomach [Kimura, Takemoto (K. Kimura, T. Takemoto), 1970], with carrying out histochemical and enzimologichesky researches of biopsy material. Radiological at organic And. note a rough relief of a mucous membrane and a considerable smoothness of contours of a stomach, the accelerated evacuation and existence of single or multiple polyps is frequent.

The forecast

the Forecast depends on a type of an akhiliya. Functional And. proceed more favorably. Forecast organic And. it is serious, at secondary organic — the forecast depends on a basic disease.

Treatment

At compensated, especially functional, And. patients do not need special treatment. It is necessary to exclude the dishes which are individually causing a digestive disturbance from food. For stimulation of the neuroferruterous device of a stomach include foodstuff with strong sokogonny action in a diet: meat and vegetable gains, low-fat meat, fish in the fried or baked look, low-fat ham, a herring, black caviar, not strong cheeses, greens, vegetables and fruit, stale white loaf, crackers, cookies, eggs and egg dishes, cream, creamy and melted butter, kefir, acidophilus milk, curdled milk, cottage cheese, porridge, juice, jam. The patient shall eat food of 4 — 5 times a day. When there occurs permanent improvement, there is no need to strictly keep to a diet.

At the akhiliya caused by inflammatory process in a mucous membrane of a stomach, the diet shall be most sparing and it is not enough differ from a diet at a peptic ulcer.

If And. is followed by intestinal frustration, to the patient introduce the corresponding dietary restrictions. At fermentative dyspepsia it is necessary to limit administration of carbohydrates for the short period. Food shall contain the increased amount of vitamins. Vegetable juice, especially cabbage, grape, melons and apricots is contraindicated. Exclude from a diet also peas, beans, haricot, cabbage, black bread, sweets, limit salt. At putrefactive dyspepsia temporarily limit proteins, in addition appoint vitamins of group B, enter days of food apples, acidophilic paste. Approximately with 10 — the 12th day when the condition of the patient improves and normalized a chair, in food recover normal protein content.

From pharmaceuticals active coal, Almagel, broths or officinal herbs infusions (a St. John's Wort, a camomile, a valerian root, a yarrow) is recommended. At ponosa are shown Pancreatinum (on 1 g 3 — 4 times a day), Enteroseptolum (on 1 — 2 tablets 2 — 3 times a day), Mexaformum or Mexasum (on 1 — 2 tablets 2 — 3 times a day). Apply divorced salt to - that and pepsin or a natural gastric juice. At the phenomena of heavy dyspepsia antibiotics and antifungal means are shown. At a combination And. with hypochromia anemia it is necessary to include the products rich with iron (crude vegetables, vegetable and fruit juice) in a diet, appoint iron preparations; at a combination to hyperchromic anemia — drugs of a liver.

Apply gastric lavages isotonic solution of sodium chloride or warm water (M. G. Solovey). Beneficial influence on patients And. renders sanatorium treatment — balneal (Yessentuki, Truskavets, etc.) and climatic.

Patients with functional, and especially organic, And. are subject to dispensary observation.

See also Stomach , motive and secretory frustration.


Bibliography: Belousov A. S. Sketches of functional diagnosis of diseases of a gullet and stomach, M., 1969; B e-lousov A. S. and N. I. Endoradiozondirovaniye's Hawk in gastroenterologies, Kiev, 1972; Ghukasyan A. G. Disturbances of gastric acidity at diseases of some internals and systems, a yew., M. — JI., 1941; Konchalovsky M. P. Gastric akhiliya (Achylia gastrica), M., 1911; JI e-in and G.'s N of JI. Sketches of gastric pathology, M., 1968; Marzhatka 3. Practical gastroenterology, the lane from Czeches., page 134, etc., Prague, 1967; Menshikov F. K. Dietotherapy, page 90, M., 1972; Molchanov N. S., Fishzon-Ryss Yu. I. and Timakov of V. A. Radiotelemetriya as method of clinical studying of gastric secretion. Sov. medical, No. 3, page 3, 1969; Fishzon-Ryss Yu. I. Modern methods of a research of gastric secretion, JI., 1972; Ginesta J. R. Hipoclorhidria, aclor-hldria at aquilia en clinica mgdica, Pren. m6d. argent., v. 56, p. 134, 1969; Katsch G. u. Pickert H. Die Krankheb ten des Magens, Handb. inn. Med., hrsg. v. G. Bergmann u. a., Bd 3, T. 1, S. 431, B. u. a., 1953, Bibliogr.; Martius F. Achylia gastrica, Lpz. — Wien, 1897.

A.S. Belousov.

Яндекс.Метрика