GASTRITIS (gastritis; grech, gaster a stomach + - itis) — damage of a mucous membrane of a stomach with preferential inflammatory changes at acute development of process and the phenomena of a disregeneration, restructuring with its progressing atrophy at hron, a current, followed by disturbance of functions of a stomach and other systems of an organism.
Ideas of G. changed depending on the level of development of medical science. References of functional and organic disturbances of a stomach can be found in Hippocrates's works, Galen, Strike, Ibn-Sina, etc. The beginning of studying of G. is connected with a name of the fr. doctor F. B of Ruse (1803) who considered G. the most widespread disease and connected with it development of heart diseases, a brain, lungs. Since introduction to a wedge, practice of a method of sounding of a stomach [A. Kussmaul, 1867] was considered by G. as a functional disease. However this point of view was reconsidered in the 2nd half of 19 century — the beginning of 20 century on the basis of new data patol, anatomy, surgery of an abdominal cavity, rentgenol. a method, I. P. Pavlov's researches and his school in the field of physiology of a digestive tract.
Introduction to a wedge, practice of methods of gastroscopy and especially aspiration gastrobiopsiya led to expansion of ideas of. The big contribution to development of the doctrine about G. was made by the Soviet scientists Yu. M. Lazovsky, N. I. Leporsky, O. L. Gordon, I. P. Razenkov, S. M. Ryss.
Distinguish acute and hron.
- 1 Acute gastritis
- 2 Chronic gastritis
- 3 Gastritis at advanced and senile age
- 4 Experimental gastritis
- 5 Clinicodiagnostic characteristic of some clinical forms of chronic gastritis
is Distinguished by the following forms of acute G.: simple (banal, catarral), korrozivny, fibrinous, phlegmonous.
The pathogeny of acute gastritis
the Pathogeny of acute gastritis comes down to development of inflammatory process of various degree of manifestation — from superficial changes to deep inflammatory and necrotic. The pathogeny a wedge, signs is caused, on the one hand, by disturbance of secretory and motor function of a stomach (vomiting, spastic pain, etc.), depth and expressiveness of inflammatory changes in a stomach (a leukocytosis, the accelerated ROE, elevated temperature of a body, pain as a result of irritation of nerve terminations in a wall of a stomach), with another — involvement in patol, process of other bodies, systems of an organism and some parties of a metabolism (a collapse, dehydration of an organism, a pachemia, etc.).
The pathological anatomy of acute gastritis
Pathological anatomy of acute gastritis is characterized by inflammatory changes of a mucous membrane of a stomach. Distinguish catarral, korrozivny, phlegmonous and fibrinous.
At catarral The mucous membrane of an infiltrirovan leukocytes (tsvetn, the tab. of fig. 1 — 3) which are located as well between cells of an epithelium, is noted a peristatic hyperemia, dystrophic and necrobiotic changes of an epithelium.
At korrozivny Are observed necrotic - inflammatory changes in a wall of a stomach (tsvetn. fig. 9).
At phlegmonous (tsvetn. fig. 10) is observed diffusion leukocytic infiltration of all layers of a wall of a stomach, but hl. obr. submucosa. Phlegmonous G. is followed perigastritis (see) can also end with peritonitis.
Fibrinous It is characterized by a diphtheritic inflammation of a mucous membrane.
Simple gastritis (banal, catarral) — the most frequent form. Meets at all age and irrespective of a floor. Errors in food, an infection, especially food toxicoinfections are the frequent reason of simple G. (see. Toxicoinfections food ). Irritant action of some drugs is known (salicylates, Butadionum, bromides, iodine, a foxglove, antibiotics, streptocides, etc.). G.'s development from reception of small amounts of medicines and under the influence of some types of food (eggs, a wild strawberry, crabs, etc.) can testify to the allergic mechanism of injury of a mucous membrane of a stomach.
Wedge, picture of simple. (caused by the most frequent reasons — errors in food and food toxicoinfections) develops usually in 4 — 8 hours after influence etiol, a factor. Patients note pains, feeling of weight and completeness in an anticardium, nausea, weakness, dizziness, vomiting, sometimes a diarrhea, hypersalivation or, on the contrary, strong dryness in a mouth. Language is laid over by a grayish-white plaque. At a palpation of an abdominal wall — morbidity in epigastric area. Pulse is usually frequent, by the ABP it is a little lowered. Fervescence, in peripheral blood — a neutrophylic leukocytosis is possible. In urine there can be an albuminuria, an oliguria, a cylindruria, i.e. the changes characteristic of toxic damage of kidneys. In gastric contents there is a lot of slime; secretory and kislotoobrazovatelny functions can be oppressed or strengthened. Motor frustration are shown pylorospasm (see), hypotonia and even atony of a stomach (see). Duration of the acute period of a disease at timely begun treatment — 2 — 3 days.
Complications at simple G. are rare. The general intoxication, disturbances in cardiovascular system can develop.
Diagnosis simple G. is based on a wedge, a picture. At temperature increase and disorder of activity of intestines it is possible to assume gastroenterocolitis (see), it is also necessary to differentiate G. with salmonelloses (cm). Crucial importance at the same time is attached bacterial, and serol, to researches.
Treatment simple G. it is necessary to begin with clarification of a stomach and intestines and purpose of antibacterial drugs (Enteroseptolum on 0,25 — 0,5 g 3 times a day, levomycetinum to 2 g a day, etc.) and absorbents (active coal, clay, etc.). At the expressed pain syndrome enter atropine (0,5 — 1 ml of 0,1% of solution subcutaneously), Platyphyllinum (1 ml of 0,2% of solution subcutaneously), a papaverine (1 ml of 2% of solution subcutaneously). At development of dehydration enter subcutaneously fiziol, solution, 5% solution of glucose. At acute cardiovascular insufficiency — caffeine, a phenylephine hydrochloride, noradrenaline. It is necessary to appoint to lay down. food. The first 1 — 2 day it is necessary to abstain from meal, drink is allowed in the small portions (strong tea, borzhy). On 2 — the 3rd day — low-fat broth, mucous soup, the semolina and wiped rice porridges, kissels. For the 4th day — a beef-infusion and fish broth, boiled chicken, fish, steam cutlets, mashed potatoes, crackers, the white dried loaf. Then to the patient appoint a table No. 1 (see. Clinical nutrition ), and in 6 — 8 days — usual food.
Forecast at simple G. in case of timely begun treatment favorable. If action etiol, factors repeats, then acute G. can pass in hron.
Prevention simple G. the dignity comes down to a balanced diet, observance. - a gigabyte. actions in life and at catering establishments, a dignity. - a gleam, work.
Korrozivny gastritis develops owing to hit in a stomach of such substances as strong to - you, alkalis, salts of heavy metals, the high-concentrated alcohol.
Wedge, picture of korrozivny. depends on a damage rate of a mucous membrane of a mouth, a gullet and a stomach, character and resorptive effect of the substances which were the reason of korrozivny, Patients usually complain of mouth pains, behind a breast and in epigastric area, repeated painful vomiting; in emetic masses — blood, slime, sometimes fragments of fabrics. On lips, a mucous membrane of a mouth, a pharynx and a throat there are signs of a burn — hypostasis, a hyperemia, ulcerations. Sometimes on the nature of change of mucous membranes it is possible to establish the reason of a burn: from sulfuric and salt to - t appear grayish-white spots, from nitric — yellow and chartreuse crusts, from chromic — brownish-red crusts, from carbolic — the bright white plaque reminding lime from acetic — superficial belovatosery burns. In hard cases can develop collapse (see). The stomach is blown usually up, at a palpation in an anticardium is painful, signs of irritation of a peritoneum sometimes come to light. At some patients during the first hours after poisoning there occurs acute perforation of a wall of a stomach, signs of toxic damage of kidneys are noted (in urine — protein, cylinders) up to development of an acute renal failure.
Complication at korrozivny G. can come during the first hours from the moment of influence etiol, a factor and it is shown by perforation of a wall of a stomach with development peritonitis (see) and a penetration in the next bodies.
Diagnosis korrozivny G. the wedge, signs is based on data of the anamnesis (including the nature of changes of a mucous membrane of a mouth, pharynx and throat).
Treatment it is necessary to begin with a gastric lavage with a large amount of water via the probe oiled vegetable. Contraindications to introduction of the probe are a collapse and, obviously, heavy destruction of a gullet.
At poisoning to-tami add milk, lime water or magnesia usta to water; at defeat by alkalis — divorced lemon and acetic to - you, enter antidotes. At severe pains enter morphine, Promedolum, fentanyl, Droperidolum; at a collapse, besides — caffeine, Cordiaminum, a phenylephine hydrochloride, noradrenaline, strophanthin (subcutaneously or intravenously with krovezamenyayushchy liquids, glucose, fiziol. solution, etc.). During the first days starvation, parenteral administration fiziol, solution and 5% of solution of glucose is necessary. At impossibility of food through a mouth within several days — parenteral administration of plasma and protein hydrolyzates. At perforation of a stomach urgent operational treatment is shown.
Forecast korrozivny G. depends on weight of inflammatory and destructive changes and therapeutic tactics during the first hours and days of a disease; death can come from shock, bleeding or peritonitis. Korrozivny G.' outcome usually are cicatricial changes of a stomach, is more often in peloric and cardial departments.
Fibrinous gastritis meets seldom, develops at serious infectious diseases (smallpox, scarlet fever, sepsis, etc.), and also poisonings with corrosive sublimate, acids, etc., as defines a wedge, a picture, treatment and the forecast.
Phlegmonous gastritis arises, as a rule, initially owing to hit of an infection directly in a wall of a stomach. Is caused by a streptococcus, is more often hemolitic, it is frequent in combination with colibacillus, is more rare staphylococcus, a pneumococcus, Proteus, etc. Sometimes develops as a complication of an ulcer or the breaking-up carcinoma of the stomach, at an injury of a stomach owing to injury of a mucous membrane of a stomach. Phlegmonous G. can develop for the second time at some infections — sepsis, a typhoid, etc.
Wedge, picture of phlegmonous. it is characterized by the acute beginning, fervescence, a fever, a sharp adynamia and pains in an upper half of a stomach which are usually amplifying at a palpation, nausea and vomiting. The general state sharply worsens. Patients refuse food and drink; quickly there comes exhaustion. In peripheral blood — a neutrophylic leukocytosis, toxicogenic granularity in granulocytes, the accelerated sedimentation of erythrocytes, change of a ratio of protein fractions and other reactions.
Complications at phlegmonous G.: purulent diseases of a thorax — mediastinitis (see), purulent pleurisy (see) and an abdominal cavity — subphrenic abscess (see), thrombophlebitis of large vessels (see. Thrombophlebitis ), abscess liver (see), etc.
Diagnosis phlegmonous G. before operation it is put very seldom.
Quite often it is distinguished on the operating table or at autopsy.
Treatment phlegmonous G. consists in the basic in parenteral administration of antibiotics of a broad spectrum of activity in high doses. At inefficiency of conservative treatment surgical intervention is shown.
Forecast phlegmonous G. it is serious. After treatment there can be permanent organic changes in a stomach.
Hron. Makes the most part of diseases of a stomach. Quite often it is combined with other diseases of the digestive system.
Hron. — a concept a wedge. - morfol., it is shown a wedge, signs, functional and morfol, changes in various combinations and can proceed with various disturbances of secretion, but reduction of gastric secretion is more characteristic. Function of a kislotoobrazovaniye at hron. It is broken earlier and more often than fermentoobrazovatelny and excretory.
There are many various classifications hron. G. Privoditsya classification by Ryss (1966).
I. On an etiological sign
1. Exogenous gastritises: long disturbances of food — qualitative and quantitative structure of food; alcohol abuse and nicotine; action thermal, chemical, fur. and other agents; influence of profvrednost — systematic testing of the spiced crude meat (the canning industry), swallowing alkaline vapors and fat to - t (the soap, margaric and candle factories), inhalation of cotton, coal, metal dust, work in hot workshops, etc.
2. Endogenous gastritises: neuroreflex (patol, reflex influence from other struck bodies — intestines, a gall bladder, a pancreas); connected with disturbances in century of N page and endocrine organs; hematogenous G. (hron, infections, disbolism); hypoxemic G. (hron, circulatory unefficiency, pneumosclerosis, emphysema of lungs, pulmonary heart); allergic G. (allergic diseases).
II. On a morphological feature
2. Gastritis with an adenosis without atrophy.
3. Atrophic: a) moderate; b) expressed; c) with the phenomena of reorganization of an epithelium; d) atrophic - hyperplastic; other rare forms atrophic (phenomena of fatty dystrophy, lack of a submucosa, formation of cysts).
III. On a functional sign
1. With normal secretory function.
2. With moderately expressed secretory insufficiency: absence free salt to - you on an empty stomach (or decrease in its concentration after a trial irritant is lower the 20th caption, unit); reduction of concentration of pepsin after a trial irritant to 1 g of %, is lower than concentration of mucoprotein 23%, positive reaction to introduction of a histamine, normal content of uropepsinogen.
3. With sharply expressed secretory insufficiency: absence free salt to - you in all portions of a gastric juice, decrease in concentration of pepsin (or its total absence), absence (or traces) mucoprotein, gistaminrefrakterny reaction; decrease in content of uropepsinogen.
IV. On a clinical current
1. Compensated (or a phase of remission): absence a wedge, symptoms, normal secretory function or moderately expressed secretory insufficiency.
2. Dekompensirovanny (or phase of an aggravation): existence clear wedge. symptoms (with a tendency to progressing), resistant, difficult giving in to therapy, sharply expressed secretory insufficiency.
V. Special forms of chronic gastritises
2. Huge hypertrophic (Menetriye's disease).
VI. The chronic gastritis accompanying other diseases
1. At Addison's anemia — Birmera.
2. At stomach ulcer.
3. At cancer.
Hron, gastritis — a polietiologichny disease, is a consequence of untimely and insufficient treatment of acute G., and also long disturbance of food, consumption of the products irritating a mucous membrane of a stomach (spices, onions, garlic, pepper), addictions to hot food and drink, bad chewing of food, food with no drink, the frequent use of alcoholic beverages, defective food, especially at a lack of protein, vitamins and iron. Long reception of some medicines (quinine, quinophan, a foxglove, salicylates, Butadionum, Prednisolonum, sulfanamide drugs, potassium chloride, antibiotics, etc.), influence of such factors as inhalation of cotton, metal, coal dust, vapors of alkalis and to - t can be the cause. Disturbances in endocrine system (diabetes, gout) can cause development of structural changes of a mucous membrane of a stomach. Allocation through a mucous membrane of a stomach of such products of exchange as acetone, an indole, skatole, like toxins at infectious diseases and the local centers of an infection, causes so-called eliminative G. Hron's development, diseases of the digestive system (appendicitis, cholecystitis, colitis, etc.) are of especially great importance in development hron. G. Chasto hron. Develops at the diseases causing a hypoxia of fabrics (hron, a circulatory unefficiency, a pneumosclerosis, anemia).
From blood serum of patients hron. Antibodies by means of which the model of autoimmune damage of a stomach is reproduced are allocated. However the pathogenetic essence of the circulating gastric antibodies is not found out yet. There are data on a role of genetic factors in emergence hron. G. U of patients with a severe form of atrophic G. relatives of the first degree of relationship are predisposed to this disease that is shown early (at young age) by G.'s emergence and its bystry transformation in a severe form.
The pathogeny is difficult and is not identical at various forms hron. G. At hron., developed from acute, there is a progressing of primary inflammatory changes in a stroma and development secondary dystrophic - regenerator changes in the ferruterous device (an atrophy, a hyperplasia, a metaplasia and so forth). Mechanism of development of separate forms hron., etiologically connected with various disturbances of food and nervnoreflektorny impacts on a stomach, comes down to functional sekretornodvigatelny frustration stomach (see) with the subsequent structural changes in its ferruterous device and development of inflammatory process in a stroma. Change of secretory activity of a stomach and nervnoreflektorny influences from the struck body are in turn a cause of infringement of activity of other bodies of the digestive device.
On morfol, to signs distinguish superficial G., various stages of a mucosal atrophy. Ts. G. Masevich (1967) allocates G. with an adenosis beya to a mucosal atrophy and G. atrophic. Schindler (R. Schindler, 1968) and Elster (To. Elster, 1970) allocate hypertrophic.
Results gistokhy, and an elektronnomikroskopichesky research of biopsy material allow to consider that forms hron. Regenerations of a mucous membrane of a stomach are phases of disturbance fiziol. According to Syurala (M. of Siurala) et al. (1963, 1966), Ts. G. Masevich (1967) and others, superficial G. passes into G. with an adenosis, and then into atrophic. Syural et al. (1968) is considered that this process occupies apprx. 17 years.
Chronic superficial gastritis it is characterized by a picture of hypersecretion of slime, sometimes with dominance of a phase of excretion over a phase of accumulation of a secret: in apical department of cells there are no neutral mucopolysaccharides, on a surface of cells — a large amount of slime. Existence indicates CHIC-positive of granules over kernels the increased synthesis of slime (see. CHIC reaction ). Sometimes the epithelium covering areas gastrica and dimples looks flattened, with a narrow strip of mucoid, rare nadjyaderny granules and with high content of RNA. Granular and vacuolar dystrophy of an epithelium, infiltration lymphoid and plasmocytes of own cover of rollers comes to light (tsvetn, the tab., fig. 4). The additional cells normal located in recervical department of gastric glands often extend to their average third.
At chronic gastritis with an adenosis the superficial epithelium of a mucous membrane is flattened, deepening of gastric dimples, additional glandulotsita of a giperplazirovana is noted.
In the main glandulotsita vacuoles (fig. 1) containing neutral mucopolysaccharides come to light (tsvetn, the tab. of fig. 5). In cytoplasm of these cells, among granules of zymogen, the shapeless masses in places surrounded with a membrane are found. This masses is similar to «unripe» or «mature» mucoid. In a nadjyaderny zone the developed lamellar complex (Golgi) with expanded tanks (fig. 2) comes to light. Thus, in these cells elements as main (zymogen, RNA, an ergastoplazm), and additional glandulotsit (neutral mucopolysaccharides, well developed lamellar complex) are found. These cells are, apparently, unripe main glandulotsita of recervical department of gastric glands. As a result of delay of their differentiation they occupy the territory of mature main glandulotsit. Additional glandulotsita also «unripe», with the developed lamellar complex and ergastoplazmy; they are found in those departments of glands where usually are not observed.
Chronic atrophic gastritis it is characterized by reduction (sometimes considerable) numbers of the main and additional glandulotsit, deepening of gastric dimples (tsvetn. fig. 7 and tsvetn, the tab. of fig. 6 and 7) which often have a shtoporoobrazny appearance (fig. 3), a hyperplasia of additional glandulotsit. The epithelium covering areas gastrica and dimples is quite often flattened, contains many RNA and few neutral mucopolysaccharides, in places is replaced with an intestinal epithelium (tsvetn. the tab. of fig. 8) with typical enterocytes, scyphoid cells and cells Panetta (an intestinal metaplasia). Gastric glands are quite often replaced mucous (a peloric metaplasia). The remained main glandulotsita of a vakuolizirovana, in an obkl exact glandulotsita depression of cytoplasm in a perinuclear zone and around intracellular tubules, and also reduction of quantity of microvillis and tubulovezikul comes to light; the reduction of cristas of mitochondrions of obkladochny glandulotsit is noted.
Wolf (G. Wolf, 1968) allocates three stages of a mucosal atrophy of a stomach: the beginning atrophy, at a cut of gland are not shortened yet, but look as if squeezed; a partial atrophy (glands), at a cut the groups of glands containing the main and parietal (obkladochny) glandulotsita are kept; a total atrophy of glands (mucosal atrophy) when the main and parietal (obkladochny) glandulotsita do not come to light, glands are covered only by a muciparous epithelium.
Chronic hypertrophic gastritis — a thickening of a mucous membrane and the strengthened proliferation of an epithelium (tsvetn. fig. 6, tsvetn. table of fig. 9 and fig. 7).
Distinguish three forms hron, hypertrophic G.: intersticial, proliferative, ferruterous. The plentiful limfoplazmotsitarny infiltration which is found in the regions of ulcers is characteristic of an intersticial form; for proliferative — growth of a superficial epithelium, deepening of dimples, the ferruterous device without changes; at a ferruterous form the mucous membrane is thickened by 2 — 7 times at the expense of a hyperplasia of glands; this form hron. Meets at an ulcer of a duodenum (see. Peptic ulcer ), Zollinger's syndrome — Ellisona (see. Zollingera-Ellisona syndrome ) and as independent disease. Some authors carry to a ferruterous form hron. And Menetriye's disease, designating it as gastritis hypertrophica gigantea though Menetriye considered this condition of a mucous membrane not as hypertrophic G. and as «creeping adenoma». Most of authors (Yu. N. Sokolov, P. V. Vlasov, etc.) denies communication of a disease of Menetriye with G., considering it as anomaly of development of a mucous membrane of a stomach.
Clinical picture. Depending on a condition of secretory function of a stomach distinguish hron. With normal and hypersecretion and hron. With secretory insufficiency.
Chronic gastritis with normal and hypersecretion occurs usually at young age, a thicket at men. The main symptoms — dispeptic frustration and pains which usually develop in the period of an exacerbation of a disease, after errors in a diet, the uses of alcoholic beverages, including table wines and beer. Patients complain of heartburn, an eructation acid, pressure sense, burnings and a raspiraniye in epigastriß area, locks (sometimes ponosa), seldom vomiting. Pains usually stupid, aching, without a certain irradiation, are localized in epigastriß area, their emergence is, as a rule, connected with meal. But pains can be both «hungry», and «night» and abate after meal.
Early complications — motive disorders of activity of intestines and biliary tract (hyper - and hypomotor dyskinesia). Further functional frustration are replaced by organic changes, and then develop hron, cholecystitis (see), hron. pancreatitis (see), hron, a coloenteritis with disbolism — hypovitaminoses, an iron deficiency anemia, etc. (see. Enteritis , coloenteritis).
Massive bleedings from a mucous membrane of a stomach which average a half of not ulcer bleedings are possible. In this case speak about so-called hemorrhagic gastritis. Hemorrhagic gastritis — a concept a wedge.; morfol, his picture can be various. Bleeding at G. is most often connected with development of erosion, but sometimes the mechanism of bleeding remains not clear even after gistol, researches of the resected part of a stomach. A certain significance in developing of gastric bleedings is attached by gastric acidities (the acidity is higher, the bleedings are more often). Plentiful gastric bleedings develop usually at patients with insignificant a wedge, manifestations at which, as believe a hyperpermeability of blood vessels of a stomach. Also allergic reactions can be the cause of development of massive gastric bleedings (see. Gastrointestinal bleedings ).
Person wedge. - morfol. form hron. With normal and hypersecretion is gastroduodenit (a synonym: a pyloroduodenitis, hypertrophic glandulyarny G., a hypertrophic hyper secretory gastropathy) which meets preferential at young age. It is similar on a wedge, to manifestations to a peptic ulcer of a duodenum, though is not identical to it. I. M. Flekel (1958) considered gastroduodenit a prestage of a peptic ulcer or a form of «a peptic ulcer without ulcer». Frequency of a disease (within a day and years) is expressed less, than at a peptic ulcer. From a wedge, symptoms the pains («painful gastritis») which are localized usually under a xiphoidal shoot or more to the right of it are most characteristic. Often the combination of pains right after meal with «hungry» and «night» pains takes place.
Secretory and kislotoobrazovatelny functions of a stomach are usually strengthened, but it is less, than at an ulcer of a duodenum: the size of basal secretion — to 10 mekv / hour, and maximum — 35 mekv / hour (Yu. I. Fishzon-Ryss, 1972). Plentiful gastric secretion is quite often observed at night.
Chronic gastritis with secretory insufficiency meets at persons of mature and advanced age more often. At patients weight is usually lost, there is an adynamia, symptoms of polyvitaminic insufficiency — a xeroderma, a razrykhlennost and bleeding of gums, changes of language (a thickening, reddening, a smoothness of nipples, existence of prints of teeth), cracks on lips, in particular in corners of a mouth come to light. From gastric symptoms note disturbance of appetite and aspiration to the use of spicy and spicy food out of the period of an aggravation. Some patients cannot eat firm food without liquid, to-ruyu they drink before food and in the course of food. Patients note off-flavor in a mouth, especially in the mornings, nausea, feeling of overflow and a raspiraniye in epigastriß area, an eructation air. A chair unstable with bent to a diarrhea. The dispeptic phenomena arise usually soon after meal, especially badly patients transfer milk. In some cases nausea and hypersalivation happen resistant and painful for patients, and they aim to facilitate the state frequent meals. Pains in epigastriß area are sometimes noted.
Complications — a hyper motor dysmnesia of intestines or involvement in patol, process of a pancreas and gall bladder. Gastric bleedings happen seldom. Allergic reactions to a nek-eye to food and medicinal substances are found in a part of patients.
Sometimes (is more often at women) develops iron deficiency anemia (see). Changes from intestines are often noted, vneshnesekretorny function of a pancreas decreases, develops dysbacteriosis (see), shown fermentative or putrefactive dyspepsia.
Special forms hron. (Rigid, polypostural and huge hypertrophic) differ in an originality a wedge, manifestations and morfol, in features. Some researchers carry these forms to complications hron.
Rigid gastritis A. N. Ryzhikh and Yu. N. Sokolov is for the first time described (1947). It is shown by persistent dyspepsia (see) and achlorhydria (see). The diagnosis is established at rentgenol. a research and on the basis of data of gastroscopy. Preferential the output department of a stomach which owing to hypertrophic changes, hypostasis and spastic reduction of muscles is deformed is surprised, turning into the narrow pipelike canal with dense rigid walls.
Polypostural gastritis (tsvetn. fig. 8) develops usually against the background of atrophic G. with a gistaminrefrakterny achlorhydria, it can be considered as further progressing hron. (Disregeneratorny hyperplasia of a mucous membrane).
The huge hypertrophic gastritis or more precisely overdevelopment of a mucous membrane described by Menetriye (P. Menetrier, 1886) — rather rare disease which is shown disbolism (is more often than proteinaceous) and is very rare development of an iron deficiency anemia. Change of acid-forming function of a stomach happens various (see also tab.).
The diagnosis is based on the analysis a wedge, displays of a disease, results of a research of gastric secretion (see. Stomach , methods of a research), rentgenol, researches, data gastroscopies (see) and gastrobiopsiya.
In assessment morfol, pictures of a mucous membrane of a stomach it is necessary to give preference given to a gastrobiopsiya. Exfoliative cytodetection, definition of vsasyvatelny and excretory function of a stomach are of secondary importance.
At functional disturbances of a stomach usually there are no changes sharp morfol. Besides, they have rather short-term (till 1 year) a current, smaller dependence of developing of pains from meal, big variability a wedge. manifestations that is connected with psychological influences, atypical localization of morbidity at a palpation of a stomach and, at last, sharp fluctuation of acidity at separate researches.
Radiodiagnosis is based on a careful rentgenol, a research of a stomach. At the same time reorganizations of a relief of a mucous membrane of a stomach and others X-ray-functional and morfol, symptoms are defined. Treat them: supersecretion on an empty stomach, bystry increase of secretory liquid, change of a tone, permanent deformation of a pyloric part of a stomach, disturbance of a vermicular movement, etc. The symptom of the increased secretion on an empty stomach which is shown sometimes a horizontal fluid level against the background of a gastric bubble before reception of a baric suspension is most constant. The first one-two drinks of a suspension of barium confirm existence of excess of liquid. On the nature of mixing of barium with liquid it is possible to judge amount of the slime which is contained in it to a certain extent: slow mixing with formation of shapeless flakes indicates availability of slime. Other symptom of availability of slime (a phenomenon of slime) are punctulate enlightenments in a layer of a baric suspension — the smallest droplets of slime weighed in suspension of barium. The phenomenon of slime is indiscernible at raying and can be stated only in pictures with a compression. Hron. Is followed by decrease in a tone of a stomach more often. Increase in a tone often has local character; at antral G. it is shown by spastic conditions or motive excitement of the exit end of a stomach. Disturbance of peristaltic function not always comes to light. Approximately in half of cases hron. The superficial and rare peristaltics is observed. The expressed frustration of a vermicular movement up to emergence of an aperistaltichesky zone are observed at so-called rigid antral G. Evacuation of barium usually comes from a stomach in normal terms though occasionally it can be slowed down.
Forms hron. Radiological hl differ. obr. on character of a relief of a mucous membrane. On Schindler's classification — Guttseyt is allocated: hypertrophic G., the atrophic G. mixed by G. superficial hron, mucous Qatar. In turn hypertrophic G. has subspecies: polypostural, warty, ulcer or erosive. However this classification became outdated and needs review since inaccuracy rentgenol is proved. criteria of a hypertrophy and mucosal atrophy; besides, at hron., As a rule, atrophic processes progress.
On the basis of opportunities rentgenol. a method distinguish: hron, universal G., hron, antral G. and its wedge, and rentgenol, versions (including rigid antral G.); hron, polypostural (warty) G.; hron, granular G.; erosive G.; the so-called accompanying gastritis (accompanying), napr, at a peptic ulcer.
Rentgenol, data hron. Can be taken into account only at corresponding a wedge, a picture, the anamnesis and so forth. The numerous facts when expressed rentgenol, G.'s symptomatology was not confirmed by data of a biopsy are known and, on the contrary, morphologically proved G. was not shown radiological.
At hron, universal G. the area of the reconstructed relief is usually very extensive (also the body of a stomach is taken). As a result of hypostasis, a hyperemia and inflammatory cellular infiltration, generally submucosal layer and a connective tissue stroma, a fold of a mucous membrane unevenly bulk up (fig. 4 and 5), sometimes it is so considerable that their quantity decreases. Places of a fold form polipopodobny thickenings and have a chetkoobrazny appearance (fig. 6). Along big curvature the slanting and cross located crossing points between folds therefore a contour of big curvature, hl are thickened. obr. the lower half of a body of a stomach and a sine, becomes gear and fringed. At the expressed hypostasis the mucous membrane loses the plasticity that is followed by a symptom of rigidity of a relief. Inflammatory reorganization of a relief of a mucous membrane at hron. It is sometimes so chaotic and chaotic that it is difficult to distinguish it from an atypical relief at a carcinoma of the stomach. Only series of aim pictures of a relief of a mucous membrane help to establish still the remained variability of its drawing. In hard cases it is useful to resort to pharmakol, stimulations of a vermicular movement (morphine).
The described changes of a relief of a mucous membrane are not specific to. Similar pictures can meet at allergic hypostasis of a mucous membrane, at general diseases, etc. Important help in radiodiagnosis hron, universal G. is the symptom of hypersecretion, and also signs of availability of slime in gastric contents on an empty stomach.
Hron, antral G. carry to the most often found versions hron. G. It has bright, diverse, and, above all most convincing X-ray semiotics. Rentgenol, a picture is characterized by signs of hypersecretion, a phenomenon of slime, patol, reorganizations of a relief of a mucous membrane. Besides, deformation of antral department and disturbance of its vermicular movement are found. The drawing of a relief varies: sharply bulked up, expanded folds but which kept usual lengthwise direction, quantity them are more often it is reduced. At the expressed hypostasis they form shapeless, subauriculate defects of a relief, grooves between folds disappear, the relief smoothes out. A classical example of a relief at hron. Of antral department are enough with firmness the remaining reinforced cross folds of a mucous membrane (fig. 7), on big curvature of a stomach — roughness of a contour in the form of uniform stepped appearance. At it is long proceeding hron. With secretory insufficiency the relief is chaotic and consists of shapeless protrusions (defects) and the spots which are chaotically located between them and strips of barium. In certain cases the atipizm of a relief arises owing to the increased mobility of the bulked-up mucous membrane of rather friable, vospalitelno changed submucosa. At the wide peloric channel perhaps partial loss of a mucous membrane in a bulb of a duodenum. At a normal gleam of the gatekeeper the mucous membrane of a stomach does not drop out. However periodically «slipping» mucous membrane, collecting before the gatekeeper, forms the peculiar defect reminding tumoral defeat (fig. 8) here. This «phenomenon of crawling» of a mucous membrane is for the first time explained and described by Yu. N. Sokolov and V. K. Gasmayeva (1969).
Thanks to a thickening of circular and longitudinal muscles the antral department of a stomach is deformed: it is narrowed and shortened, unlike deformation at infiltriruyushchy cancer, at Krom the gleam of a pyloric part of a stomach is only narrowed, but not shortened. In process of progressing of process of a wall of antral department become thicker, lose elasticity, deformation gains resistant character. As a result of an inflammatory submucosal sclerosis (so-called sclerosing G.) the peristaltics disappears and there is rigid antral G. which, undoubtedly, is a late stage hron, antral G. with secretory insufficiency. At these patients quite often on the basis a wedge, data suspect a carcinoma of the stomach that it is often difficult to disprove at rentgenol, a research. Deformation of antral department is very expressed and has resistant character. Circular narrowing of a pyloric part of a stomach attracts attention, at Krom there is often unnoticed a simultaneous shortening of its (fig. 9). At a palpation the feeling of a dense and painful tumor is created. Points a symptom of the aperistaltichesky zone which is usually occupying all antral department to existence of cancer. Against cancer observation at least of a short-term vermicular movement testifies, edges it can be caused also by means of morphine.
At polypostural (warty) G. patol, changes are often localized in antral department. They represent multiple homogeneous in size, the roundish, unsharply outlined defects to dia. 3 — 5 mm, sometimes in the form of eminences on crests of folds, but a thicket forming the chaotic or cellular drawing (fig. 10). At true polyps, even multiple, the relief of a mucous membrane of a stomach is usually not changed. At polypostural G. also others, as a rule, are found rentgenol, symptoms. At smaller growths of G. is called warty, or verrukozny; minor defects are usually distinguished only in aim pictures with a compression.
Granular gastritis is distinguished on a symptom of «granularity» of a relief (fig. 11). This symptom was studied by W. Frik by means of pictures of a relief of an ostrofokusny X-ray tube at short excerpts (no more than 0,1 sec.). At the same time an impression of a granular mucosal surface of a cover with the smallest eminences — so-called areas gastrica is made. Comparison of data of a research of «a thin relief» to results of a gastrobiopsiya found parallelism between a picture of areas gastrica and existence of inflammatory changes of a mucous membrane. If in normal conditions diameters of fields make 0,5-1,5 mm, then at hron. Areas gastrica become more convex — «granular» type, and in far come cases — and larger (to dia. 3 mm and more), uneven, reminding a warty surface. Along with this symptom it is necessary to find also others above described rentgenol, signs of.
Erosive G. is seldom distinguished radiological since possibilities of detection of erosion rentgenol, are very limited to method of a research.
The so-called accompanying (accompanying) G. radiological constantly is found at a peptic ulcer (an exception so-called senile stomach ulcers make) and less often at a carcinoma of the stomach.
The expressed pictures of the accompanying G. are observed at an ulcer of a duodenum, after operation of a gastroenterostomy. At the accompanying G. the exit end of a stomach is surprised more often. Also all are observed above described rentgenol. G. Neredko's symptoms the rough drawing of a relief of a mucous membrane, disorder and swelling of folds is noted. Dynamic wedge. - rentgenol, overseeing by the current of the accompanying G. at a peptic ulcer show that if under the influence of conservative treatment ulcer «niche» disappears, and others rentgenol, G.'s symptoms are left without changes, then, as a rule, patients do not note improvement.
At rentgenol, a research recognition of polypostural G. which should be differentiated with true polyps of a stomach can present the known difficulties. At diagnosis hron. antral G. it must be kept in mind also pernicious anemia, at a cut polymorphic changes of a relief of a mucous membrane of a pyloric part of a stomach can be observed.
Except rigid antral gastritis, it is necessary to take in attention and other forms of antral G. with sharp reorganization of a relief of a mucous membrane which is sometimes indistinguishable from an atypical relief at cancer. In this sense the «phenomenon of crawling of a mucous membrane» described above is of particular importance. At difficulties apply a series of pictures or X-ray cinematography, a fibroskopiya and a gastrobiopsiya. At so-called general diseases only the careful analysis of all the wedge, pictures allows to come to the correct diagnosis.
See also Stomach , radiodiagnosis.
Treatment complex and differentiated. Usually treatment is carried out in out-patient conditions; patients are hospitalized at the aggravations which are especially proceeding with complications and the expressed general disturbances.
Clinical nutrition in complex therapy of G. has the leading value. In the period of an aggravation hron. Irrespective of the nature of secretory disturbances observe the principle of a shchazheniye of a mucous membrane of a stomach and its functions. Food shall be well boiled thoroughly and crushed. Exclude the products and dishes having strong sokogonny action, and also causing mechanical, thermal and chemical irritation of a mucous membrane of a stomach from a diet. Appoint a diet 1A (see. Clinical nutrition ). Food is fractional, 5 — 6 once a day. In process of subsiding of an aggravation the dietotherapy is carried out according to secretory disturbances.
At secretory insufficiency of a stomach (out of aggravations) the diet shall be full with enough proteins (110 — 115 g), fats (80 — 90 g), carbohydrates, vitamins; it shall correspond on the caloric content of work and a way of life of the patient. Appoint a diet No. 2. It is necessary to eat food 4 — 5 times a day. Include normal amount of sodium chloride and extractives in a diet. At permanent remission it is possible to appoint expanded food. Fresh bread and other fresh dough products, fried (including rolled in crackers) meat and fish, fat grades of meat and fish, hot, salty dishes, fish canned food, cold drinks, ice cream are prohibited.
At normal and hypersecretion begin with purpose of a table 1A, in 7 — 10 days pass to a table 1B, and in the next 7 — 10 days — to a diet No. 1. The diet shall be full, but with restriction of sodium chloride, carbohydrates and extractives, especially at a hyperoxemia. For the night recommend milk aperient (fresh kefir, curdled milk). Russian cabbage soup, borsch, fat meat, fried fish, pickles, smoking, marinades, vegetables in not wiped look are prohibited. Alcohol, beer, soda water, fruit water are strictly contraindicated.
Drug treatment of patients hron. Provides impact on pathogenetic links patol, process. For normalization of a functional condition of the highest departments of c. N of page recommend drugs of a valerian, small tranquilizers, somnolent.
At the function of a stomach increased secretory and motor evakuatornoy it is necessary to appoint cholinolytic drugs (atropine, Platyphyllinum, Spasmolytinum, petrolhexonium) in a combination with antacids (Vicalinum, Almagel, etc.) and the means stimulating regenerator processes (methyluracil, pentoxyl, drugs of a liquorice, etc.).
At secretory insufficiency appoint cholinolytic drugs, similar to Quateronum and Gangleronum, causing the expressed spasmolytic effect, but a little influencing tsa secretory function of a stomach. The good wedge, effect is reached at use of a Chinese yam Caucasian, juice of a plantain, Plantaglucidum which cause some increase in secretion strengthen motive function of a stomach and possess antiinflammatory and spasmolytic action. For the purpose of impact on secretory function of a stomach appoint also PP, C, B vitamins 6 and B 12 .
Out of the period of an aggravation apply replacement therapy — a gastric juice, abomin, Betacidum, Pancreatinum, etc.
Physical methods of treatment also enter into a complex to lay down. actions: hot-water bottles, mud cure, diathermy, electro-and hydrotherapy.
Sanatorium treatment of patients with chronic gastritis is carried out out of an exacerbation of a disease. Spas for drinking treatment are shown: Arzni, Arshan, Berezovsky mineral waters, Borjomi, Izhevsk, Jalal-Abad, Dzhermuk, Druskininkai, Yessentuki, Zheleznovodsk, Pyatigorsk, to Sairma, Feodosiy, Shir, etc. It is possible to apply mineral waters and in extra resort conditions: at secretory insufficiency the use of chloride, hloridno-bicarbonate waters in 15 — 20 min. prior to meal is preferable, and at the normal and increased secretory function — bicarbonate waters in 1 hour prior to meal.
Treatment hron. It is possible also in local sanatoria, and also at the usual mode under conditions of observance of a diet.
The forecast concerning life favorable. Under the influence of treatment the health of patients rather quickly improves. But the main morfol, the changes characteristic for hron., as well as secretory function of a stomach, under the influence of treatment are not normalized. At massive bleeding at patients hron. With normal and hypersecretion the forecast is more serious as well as patients with insufficient secretory function at development have at them anemias, a gastritny coloenteritis with disturbance of processes of absorption and involvement in patol, process of other bodies of the digestive device (hron, pancreatitis, hron, cholecystitis, etc.). At special forms hron. (Rigid, polypostural, huge hypertrophic) there is a danger of a malignancy.
Prevention hron. Consists in a balanced diet and observance of rules of hygiene of food, and also in fight against the use of alcoholic beverages and smoking. It is necessary to watch a condition of an oral cavity, to treat timely diseases of other abdominal organs, to eliminate professional harm and helminthic and protozoan invasions. Sick G.' medical examination
== Gastritis at children == is of great importance
Acute gastritis at children arises owing to an infection, the use of the infected, difficult digested food, an overeating and as display of an allergy. Its etiology, clinic and methods of treatment are similar to acute gastritis at adults.
Chronic gastritis occurs generally at children of preschool and school age; prevalence at children of school age is higher than it.
Origins hron. Irrational food and the mode, various diseases digestive and other systems, an infection, an allergy, and also inborn features of neuroendocrinal system and disturbance of synthesis of hydrochloric acid are that is confirmed by existence of a resistant akhiliya (at almost healthy and sick G. of children), to-ruyu it is impossible to explain the postponed diseases, defects of food.
At children with long diseases and disturbances went. - kish. path hron. As the independent disease is observed seldom. At the same time the research of a mucous membrane of a stomach by method of a gastrobiopsiya changed ideas of G.'s prevalence at children: the wedge, G.'s diagnosis is confirmed only in half of cases. At children of the advanced school age and teenagers hron. Becomes quite frequent disease.
Morphologically at children superficial G. and gastritis with an adenosis without atrophy prevails, atrophic G. is less often observed (some authors do not find it in children).
The disease usually arises gradually, affects development of the child a little, has easier current, than at adults, and will easier respond to treatment; the persistent current is sometimes observed.
Distinguish two forms hron. At children — oligosymptomatic and a form with the expressed symptomatology, quite often similar to a peptic ulcer. Also the asymptomatic current of is described.
Oligosymptomatic form hron. Meets less than a form with the expressed symptomatology; often arises at children of earlier age: pain usually develops after food, a malointensivn, is localized in epigastriums or diffuse. The dispeptic phenomena at some children are absent. Acid-forming function of a stomach is lowered or the gistaminreflektorny akhiliya is defined.
At hron. With the expressed symptomatology the painful symptom is intensive, can arise right after meal, in 1 — 2 hour or at night. Dispeptic symptoms are constant. Acid-forming function at most of sick children is increased throughout long observation. At some children the peptic ulcer comes to light further, in this case G. is essentially a predjyazvenny state.
G.'s diagnosis is established on the basis of a data set of the anamnesis, a wedge, manifestations and laboratory researches.
Differential diagnosis hron. At children carry out with peptic ulcer (see), diseases liver (see), bile-excreting channels (see. Bilious channels ) and diseases of a nervous system. In view of an exclusive rarity of malignant new growths of a stomach at children and easier, than at adults, a current hron., there are no sufficient bases for broad use in pediatric practice of a method of a gastrobiopsiya with the diagnostic purpose. It is applied only according to strict indications and it is obligatory in the conditions of specialized clinic to exclude possible complications.
Treatment of gastritis at children generally same, as at adults (taking into account age and a form of a disease).
At G. similar on clinic to a peptic ulcer, treatment is carried out as antiulcerous, including seasonal preventive courses.
Prevention hron. At children has the same principles, as at adults.
The special attention is required konstitutsionalno by the weakened children with signs of dysfunction went. - kish. a path (the increased acid-forming function, an akhiliya, etc.), with the residual phenomena after the postponed diseases digestive and other systems.
Patients hron. Children are subject to observation of the pediatrician for the purpose of prevention of exacerbations of a disease, carrying out preventive antirecurrent courses of treatment and recreational actions.
Gastritis at advanced and senile age
Features of a current of G. are caused by age changes of digestive organs and decrease in the general reactivity. A wedge, G.'s manifestations at patients of advanced and senile age are less expressed, than at young people. The dispeptic phenomena and pains are a little expressed, the loss of appetite is seldom observed. The digesting ability of a gastric juice and content of gastromucoproteins in it is reduced as well as acid-forming function of a stomach. Elektroforegramma of proteins of a gastric juice in comparison with elektroforegrammy patients of young age has more «compressed» appearance, the output of a proteinaceous component is lower in both fractions of gastric slime, and the carbohydrate component is increased in insoluble slime. Often find a vitreous basal secret — jellylike weight with a large number of desquamated cells of a mucous membrane. Atrophic changes of a mucous membrane of a stomach (according to an aspiration biopsy) and secretory insufficiency occur at patients hron. 60 years by 2 — 3 times are aged more senior more often than at 30 — 40-year-old. After 60 years atrophic G. is more often observed at women while at younger age — a thicket at men. Big prevalence of atrophic G. at advanced age is connected, apparently, with frequent development at this age hron, the diseases of a liver, pancreas, intestines promoting development hron. G.
Treatment and prevention are based taking into account accompanying hron, diseases and features of reaction of an elderly organism to administration of medicinal substances. During the definition of the forecast it must be kept in mind possibility of cancer against the background of hron, atrophic G.
for the purpose of studying of patterns of activity and mechanisms of regulation of the alimentary system in the conditions of pathology, and also developments of questions of therapy of G. on animals reproduce Model.
There are two groups of models of experimental G. which are used depending on research problems: a), caused by local impact of various damaging agents on a mucous membrane of a stomach; b), caused by unusual conditions of contact of normal atsidopeptichesky factors with a mucous membrane of a stomach.
For injury of a mucous membrane of a stomach of animals use a hot and cold water, and also chemical substances (1 — 10% solutions of silver nitrate, 1% of acetic and 10% salt to - you, solutions of alcohol, infusion of mustard, red pepper, etc.) which once or repeatedly enter into a gastric cavity. At such influence by the damaging agent it is impossible to exclude his hits in initial department of a duodenum that complicates a picture functional and morfol, disturbances and it can be not always considered. There are techniques of limited injury of a mucous membrane of a stomach reproducing focal G., usually acute. At repeated damages experimental acute G. can pass in hron, a form. In models of this group the experimental gastritis caused by introduction to a stomach of various volumes of alcohol of different concentration is of practical interest.
I. P. Pavlov created experimental G.'s models, directly injuring a stomach and watching work of the isolated ventricle. He established compensatory ability of the remained mucous membrane, in detail analyzed a difficult complex of intrasystem and stand-alone reactions in an organism in response to injuries of a stomach. I. P. Pavlov laid the foundation for classification of types of disturbances of secretion of a stomach, to-ruyu use in clinic.
Model G., caused by creation nefiziol. conditions of contact of normal products of secretion of gastric glands (atsidopeptichesky factors) with a mucous membrane, it is reached by long repeated sham feeding (the gastric juice remains in a gastric cavity), addition to food salt to - you or are a lot of gastric juice. Experimental disturbance fiziol. ratios between free and connected salt to - that in a stomach also has the damaging effect on a mucous membrane.
Experimental G. can be caused also change of a range of proteolytic enzymes or introduction of a histamine or Pilocarpinum. This model G. develops gradually against the background of disturbances of microcirculation and trophic processes in a mucous membrane, has hron, a current.
Clinicodiagnostic characteristic of some clinical forms of chronic gastritis
Bibliography: Aruin L. I. Morphological research of biopsies of a mucous membrane of a stomach, Arkh. patol., t. 31, No. 3, page. And, 1969; Aruinl. And. and Sh and - r about in V. G. K to a question of a morphogenesis of chronic gastritis, in the same place, t. 33, No. 10, page 21, 1971; Belousov A. S. Sketches of functional diagnosis of diseases of a gullet and stomach, M., 1969, bibliogr.; Gordon O. L. Chronic gastritis and so-called functional diseases of a stomach, M., 1959, bibliogr.; Gubar V. L. Physiology and experimental pathology of a stomach and duodenum, M., 1970; Kanishchev P. A. Diagnostic methods of diseases of a stomach, L., 1964; Lazovsky Yu. M. The functional morphology of a stomach is normal also of pathology, M., 1947; Levin G. L. Sketches of gastric pathology, M., 1968; L and with about the h to and B. G. N, Ultrast^uktura of glands of a stomach and its change in the conditions of chronic gastritis, Arkh. patol., t. 34, No. 10, page 11, 1972; Masevich Ts. G. Aspiration biopsy of mucous membranes of a stomach, duodenal and small bowel, L., 1967; about N e, Pretumor diseases of a stomach, L., 1969, bibliogr.; Menshikov F. K. Dietotherapy, M., 1972, bibliogr.; Pavlov I. P. Complete works, t. 2, book 2, M. — L., 1951; Peleshchuka. P. Diseases of system and digestive organs, in book: Bases gerontol., under the editorship of D.F. Chebotaryov, etc., page 322, M., 1969; Rachvelishvi-l and B. of X. Gastrobiopsiya in clinical practice, Tbilisi, 1969; P y with with S. M. Diseases of digestive organs, L., 1966; Tugolukov V. N. Modern methods of functional diagnosis of a condition of a mucous membrane of a stomach and their clinical value, L., 1965; F and sh-z about N-P y with with Yu. I. Modern methods of a research of gastric secretion, L., 1972, bibliogr.; about N e, Gastritises, L., 1974, bibliogr.; In about with k u s H. Gastroenterology, at. 1 — 3, Philadelphia — L. * 1963 — 1965; Gastritis, hrsg. v. G. Clemen-son, Basel, 1973; HafterE. Praktische Gastroenterologie, Stuttgart, 1962, Bibliogr.; M o r s o n B. C. a. Davson I. M. P. Gastrointestinal pathology, p. 80, Oxford, 1972, bibliogr.; Peleschtschuk A. P. u. a. Funktionelle und morpholo-gische Veranderungen des Magens bei Pa-tienten mil umunischer Gastritis im hohe-ren Lebensalter, Z. Alternsforsch., Bd 25, S. 271, 1972; Schindler R. Gastritis, N. Y., 1947, bibliogr.; Spiro H. M. Clinical gastroenterology, p. 155, L., 1970; Wolff G. Chronische Gastritis, Lpz., 197 4.
Radiodiagnosis of. — Red A. N. and Sokolov Yu. H. Rigid antral gastritises as precancerous disease of a stomach, Surgery, No. 4, page 34, 1947; Sagatelyan G. M. Radiodiagnosis of diseases of a gullet, stomach and gastroscopy, Yerevan, 1966, bibliogr.; Smirnova N. V. Diagnosis of gastritis of distal department of a stomach, Klin, medical, t. 49, No. 1, page 69, 1971; With about to about l about in Yu. N. and In l and with about in P. V. Relyef mucous a stomach it is normal also of pathology, M., 1968, bibliogr.; Sokolov Yu. N. and Gasmayev V. K. About a phenomenon of «crawling» mucous a stomach, Vestn, rentgenol, and radio-gramophones., No. 2, page 66, 1969; Sokolov Yu. N. of ides of river. Our experience of a research of a thin relief of a stomach at chronic gastritis, in the same place, No. 5, page 3, 19 73, bibliogr.; Tikhonov K. B. and Pruchansky V. S. Mikrorelyef mucous a stomach and its value in diagnosis of chronic gastritises, in the same place, No. 2, page 82, 1970, bibliogr.; F and N and r d-sh I am V. A N. Radiodiagnosis of diseases of a digestive tract, t. 1, Yerevan, 1961; Sh l and f e r I. G. Relyef mucous stomach and duodenum, Gastritis, ulcer, carcinoma. m, 1935, bibliogr.; Cummack D.H. Gastrointestinal X-ray diagnosis, Edinburgh — L., 1969; Pr£v6t R. u. L a s s r i with h M. Rontgendiagnostik des Magen-Darmka-nals, Stuttgart, 1959, Bibliogr.
At children — Balashov T. F. Zymoplastic function of a stomach at chronic gastritis at children, Pediatrics, No. 5, page 14, 1971; And in it is scarlet about in S. M., etc. Endocrine cells of a mucous membrane of a stomach at children, in the same place, No. 3, page 12, 1975, bibliogr.; Queen R. I. and Byalik V. L. About diagnostic value of an aspiration biopsy of a mucous membrane of a stomach at chronic gastritises at children, in the same place, JNft 12, page 22, 1966; Kossyuram. B. Stomach diseases at children, M., 1968, bibliogr.; Lukyanova E. M., Korole-z in and R. I. and Sh l y to about in I. A. Endoscopic researches of a stomach at chronic gastritis at children, Pediatrics, No. 3, page 17, 1975; The Multivolume guide to pediatrics, under the editorship of Yu. F. Dombrovskaya, t. 4, page 191, etc., M., 1963; About with t r about p about-lets S. S., etc. Morfologichna of days-n1st hroshchny to gastritis z normal i a shdvshtsena secretory funkshcheyu shlun at d1tey, Ped1at., akush. i of gshka., No. 4, page 3, 1975; Samarina G. Ya. Clinical features of antral gastritis at children, Vopr. okhr. mat. also it is put., t. 18, No. 6, page 23, 1973; Smirnov H. M. Chronic gastritises at children, Minsk, 1967, bibliogr.; Sandberg D. N. Hypertrophic gastropathy (Menetrier’s disease) in childhood, J. Pediat., v. 78, p. 866, 1971; &&Sedlckov M. a. Bedn£r B. Chronic gastritis in childhood, Gastroen-terologia (Basel), v. 107, p. 251, 1967.
F. I. Komarov; L. I. Aruin (stalemate. An.), M. B. Kossyura (ped.), H. N. Lebedev (stalemate. physical.), A. P. Peleshchuk (geront.), Yu. N. Sokolov (rents.), author of table F. I. Komarov.