EROSION of the STOMACH (Latin erosio corrosion) — the surface defect of a mucous membrane of a stomach which is not reaching a muscular plate and beginning to live without formation of a hem.
J. Morganji in 1756 Mr.
Karvonen is for the first time described (A. L. Karvonen, 1981) at endoscopy of a stomach revealed erosion at 10,5% of patients. Martinoli and Gantner (E, Martinoli, J. Gant-ner, 1970) on section material found acute erosion in a stomach and a duodenum in 6,1% of all cases of openings.
In the majority of the existing classifications E. it is accepted to divide depending on features of a current and morfol. signs on acute and chronic. Century of X. Vasilenko with sotr. (1978) includes in the concept «erosion of a stomach» also the defects of a mucous membrane arising at malignant or system patol. processes (a carcinoma of the stomach, a lymphoma of a stomach, a disease Krone, etc.), however this opinion is shared not by all researchers.
The etiology and pathogeny of erosion of a stomach are studied insufficiently. They are often diagnosed at shock, burns, sepsis, after various operations (so-called stressful damages). Emergence E. it can be connected with reception of medicines (acetylsalicylic acid, Brufenum, indometacin, corticosteroids, etc.)*. Sometimes erosive damages of a stomach (is more often than antral department) can be an early stage of a peptic ulcer (see). Quite often E. accompany tumors of a large intestine, hron. to diseases of a liver, diseases of cardiovascular system, respiratory organs, blood (secondary erosion). Thus, erosion represent heterogeneous damage of a mucous membrane of a stomach and are result of its same reaction on various (the general or local) patol. influences.
According to modern representations, major importance in development E. the ischemia of a mucous membrane of a stomach resulting various patol has. influences and leading to increase in its permeability. Owing to disturbance of permeability of a mucous membrane of a stomach back diffusion of hydrogen ions amplifies that promotes release of a histamine and pepsin, developing of hypostasis of a mucous membrane, increase in permeability of capillaries. Damages of type of erosion and ulcers are result of these changes. There is an assumption that hypersecretion salt to - you and pepsin, a reflux of bile (see the Reflux), and also strengthening of autoimmune processes promote transition of process to chronic.
The pathologist and h e with-to and I am a picture. AA. represents small (to 10 — 15 mm in the diameter) the defect of a mucous membrane of a stomach of rounded, gear or triangular shape which is not reaching a muscular plate. AA. can be single (1 — 3) and multiple (more than three in different departments of a stomach). Damage of a mucous membrane of all stomach or its most part classify as ero-zivno-hemorrhagic gastritis.
Acute erosion are located in the field of a bottom and a body of a stomach more often. Lack of a superficial epithelium is characteristic of them; in the field of a bottom of defect — moderate infiltration by lymphocytes and imposings of fibrin; in the field of edges — flattening of epithelial cells and a hyperchromia of their kernels, existence in kernels of a large amount of DNA.
Hron. erosion are localized more often in antral department (a cave of the gatekeeper, T.) stomach. At gistol. a research reveal granulyatsionny fabric, vasodilatation in the field of a bottom, dystrophic changes and an atrophy of peloric glands in the field of a bottom and edges of an erosion, and also a focal hyperplasia of a superficial epithelium in the field of its edges. Besides, in a zone of acute and chronic erosion the expressed cellular reaction of own plate of a mucous membrane of preferential lymphoplasma character is noted. At erozivnogemorragichesky gastritis in a mucous membrane along with erosion note multiple hemorrhages with rejection of a superficial epithelium.
Clinical picture E. it is more often shown yazvennopodobny or hemorrhagic by syndromes. The Yazvennopodobny syndrome can be observed at persons with acute or chronic erosion. Patients are disturbed by the pains in epigastric area connected with meal, sometimes «hungry», nausea, an eructation, heartburn. The hemorrhagic syndrome is observed more often at patients with acute erosion and erosive hemorrhagic gastritis, shown by gastric bleedings and posthemorrhagic anemia (see). Quite often the asymptomatic course of process meets, at secondary erosion symptoms of a basic disease can prevail.
Diagnosis. The leading diagnostic method is gastroscopy (see). At an endoscopic research acute erosion represent surface defects of a mucous membrane (flat erosion) covered with blood, a hemorrhagic or fibrinous plaque. In
2 — 4 weeks there is their full healing by epithelization without formation of hems. In some cases acute erosion pass into chronic. Hron. erosion look as small protrusions with deepening in the center («full» erosion). Their outcome is the focal hyperplasia of a mucous membrane, sometimes — polyps (see the Stomach, tumors). Question of transition hron. erosion of a stomach in hron. an ulcer or cancer remains disputable. For an exception of a malignant tumor of a stomach at infiltration, a hyperemia, change of a relief of a mucous membrane of a stomach around an erosion carry out an aim biopsy.
At detection E. it is necessary to conduct comprehensive examination of the patient and to carry out behind it observation for the purpose of early detection of a basic disease (more often than a tumor of a large intestine, hron. disease of a liver).
Treatment is similar to treatment of a peptic ulcer (see). The patient appoint the corresponding mode, a sparing diet, antiacid means (salts of calcium, magnesium, Almagelum) enveloping means (drugs of bismuth, etc.); cholinolytics (atropine), and also the metronidazole (see) promoting healing of defects of a mucous membrane of a stomach. Have good effect a neuroleptic Cimetidinum (Belometum, Tagametum), and also gastrozepin, reducing secretion of a gastric juice dogmatit (Sulpiridum, eglonyl), H2 blocker of a histamine.
At E., proceeding with a hemorrhagic syndrome that meets at acute E more often., treatment in surgical department of a hospital is shown. Transfuse to patients blood and plasma, intravenously enter aminocaproic to - that, fibrinogen, intramusculary — Vikasolum, wash out a stomach a cold water or cold isotonic solution of sodium chloride. In case of inefficiency of conservative treatment by means of gastroscopy make diathermocoagulation (see) or laser photocoagulation of the bleeding vessels. At severe bleedings sometimes resort to an operative measure up to a resection of a stomach (see the Stomach, operations). At hron. erosion in case of inefficiency of other means and in connection with a possibility of formation of polyps apply diathermocoagulation.
Forecast, as a rule, favorable; at patients with secondary erosion it depends on a basic disease.
Prevention is same, as at a peptic ulcer: a balanced diet, the sparing mode, an exception of alcohol and smoking. For the purpose of the prevention of a recurrence for the patient within 2 — 3 years establish dispensary observation. Bibliography: Vasilenko V. of X. and
Grebenev A. L. Diseases sheludka and duodenum, page 65, M., 1981; V. I. pods, etc. Gastrointestinal bleedings and fibro - endoscopy, page 154, M., 1977; Atlas of diseases of the upper gastrointestinal tract, ed. by R. Ottenjann a. K. Elster, Philadelphia, 1980; P r a n z i n G. o. Chronic erosions of the stomach, Endoscopy, v. 16, p. 1, 1984; R about e s with h W. Erosions of the upper gastrointestinal tract, Clin^ Gastroent., v. 7, p. 623, 1978.
V. D. Vodolagin.