Specialty
Peptic acid disease
Doctor:
Octavio Rojas Diaz
Specialty
Gastrosurgeon / Acid Peptic Disease
Address
Av. Coyoacán 715
Cp 03100 Col Del Valle CDMX
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What is Peptic Acid Disease?
Gastritis is an inflammation of the gastric mucosa that can be caused by various factors. Although there is some confusion among doctors and patients about this disease, it can be accurately diagnosed by endoscopic study and histopathological analysis.
There are different types of gastritis, the endoscopic classification being the most practical: erosive and hemorrhagic gastritis, non-erosive gastritis, and gastritis other than the above. Gastritis can affect the entire surface of the stomach or only a part of it.
Erosive and hemorrhagic gastritis usually present in critically ill patients, such as those in intensive care or who have suffered burns, neurological patients, or those taking nonsteroidal anti-inflammatory drugs. It can also be caused by rheumatic diseases such as arthritis and in alcoholic patients.
In these cases, prophylactic therapy is essential. In addition, vascular constriction and prostaglandin inhibition may allow hydrochloric acid to injure the gastric mucosa. It is usually not associated with abdominal pain, except in the case of patients taking anti-inflammatories. When bleeding occurs, although it is not the main cause, it can be serious and require emergency surgery.
Laparoscopic super selective vagotomy is the surgery of choice to treat this type of gastritis. The diagnosis is established by endoscopy and biopsy to differentiate it from other causes of upper digestive tract bleeding.
non-erosive gastritis
Non-erosive gastritis is a clinical entity that is diagnosed through the endoscopic appearance of the gastric mucosa and the histopathological study.
The most common cause of this type of gastritis is infection by Helicobacter pylori, a bacterium that can cause gastric and duodenal ulcers. However, there are also other causes, such as alkaline or duodenogastric reflux, pernicious anemia, lymphocytic gastritis, and reactive gastropathy.
It is important to note that non-erosive gastritis can be asymptomatic or present with mild gastrointestinal symptoms such as abdominal pain, nausea, and vomiting. Therefore, it is essential to make an early diagnosis and adequate treatment to prevent possible complications.
The discovery of H pylori has been one of the most important of the 20th century, being the most common cause of non-erosive gastritis. Despite this, a significant number of patients with H pylori remain asymptomatic throughout their lives.
Pathologist J. Robin Warren and gastroenterologist Barry J. Marshall identified Helicobacter pylori as the causative agent of ulcers and gastritis, winning the Nobel Prize in Medicine in 2005 for their discovery. H. pylori is a Gram (-) bacillus found only in the gastric mucosa, causing chronic inflammation of the same.
It is the most common infection in the stomach, and is associated with gastric or duodenal peptic ulcer in 10% of infected patients. Despite this, an adequate way to eradicate H. pylori has not yet been found. Transmission is from person to person, and in Mexico almost nine out of 10 people over the age of 20 have been exposed to this bacterium.
The diagnosis is established by endoscopy and biopsy of the gastric mucosa, being the most direct technique for its detection. The most common symptoms include intense epigastric pain, burning, abdominal distension, among others. It is important to treat the infection early to avoid complications such as gastric cancer.
Eradication therapy must be carried out in conjunction with prevention of transmission by saliva and unpurified water, and it is recommended to treat members of the patient's family and promote dental hygiene.
Alkaline or biliary gastritis
A type of gastric inflammation.
In some patients with motor disorders of the antrum, pylorus, or duodenum, duodenal contents, bile, and alkaline pancreatic juice can damage the gastric mucosa and promote duodenal reflux into the stomach. This is known as alkaline biliary gastritis, an increasingly common entity that occurs more frequently in women who have undergone gallbladder removal.
In the endoscopic study, it is common to find abundant bile content in the stomach, and in some cases, active duodenal reflux into the stomach can be observed.
The most common symptoms of this gastritis include pain after eating, nausea, vomiting bile, bloating, and gas. Although antiulcer therapy may provide some initial improvement, it does not neutralize the alkaline substances and therefore the clinical picture worsens over time.
Recent studies indicate that these patients have increased pressure in the duodenum, which makes gastric emptying difficult and causes duodenal gastric reflux. Currently, the technique of laparoscopy of myotomy duodenum is used to treat this gastritis when it does not respond to therapy, and very good results have been obtained.
In addition to alkaline biliary gastritis, there are other types of gastritis, each with different causes and symptoms. Generally, these types are diagnosed by histological analysis. The following table shows some examples:
Type: Erosive and Hemorrhagic
Example: Non-steroidal anti-inflammatory drugs, stress in critical illnesses, alcoholic patients, etc.
Type: Non-erosive
Example: H. pylori gastritis, biliary gastritis, pernicious anemia, reactive gastropathy, lymphocytic gastritis.
Various Cytomegalovirus, Menetrier's disease, generalized GI disease, Crohn's disease, eosinophilic gastroenteritis, systemic diseases, sarcoidosis.
Ulcers
Peptic ulcer is a loss of integrity of the gastrointestinal mucosa, round or oval in shape, of variable dimensions, which extends to the musculasis mucosae, it is not always unique. It is most often found on the lesser curvature of the stomach and in the duodenal bulb.
It is secondary to a loss of balance between the secretion of hydrochloric acid and the defensive barrier. Duodenal ulcer is more frequent in men and it seems that in the last two decades it has increased in women. Gastric ulcer occurs more frequently in patients taking nonsteroidal anti-inflammatory drugs. Acid and pepsin cause ulcers only when mucosal defense, repair, and healing mechanisms are impaired by the presence of Helicobacter Pylori or ingestion. of NSAIDs.
The mechanism is acid hypersecretion, as well as a series of factors such as: family, psychological, hormonal, physiological, gastrinomas, local, the presence of Helicobacter Pylori and non-steroidal anti-inflammatory drugs (NSAIDs).
The vast majority of peptic ulcers develop in conjunction with chronic antral gastritis or antritis and is characterized by an active inflammatory process. It is located mainly in the antrum, but can affect the entire stomach. Prepyloric gastric ulcer and pyloric canal ulcer behave like duodenal ulcers. Peptic ulcer can be round, oval, irregular and linear when it is healing. It is located mainly in the body and in the gastric antrum.
The differential diagnosis between a benign gastric ulcer and a malignant gastric ulcer is sometimes difficult, the histological study of the biopsies and the cytology of brushing establish the diagnosis. Gastric metaplasia in the first portion of the duodenum is related to hypersecretion, Helicobacter Pylori and duodenal ulcer.
STRESS ULCERS
Stress ulcers are an injury that occurs in patients with prolonged stress, in those who have burns with more than twenty-five percent of the body surface, in those who undergo prolonged surgical interventions, in septicemia and in severe polytraumatized patients. or in terminal phase.
They are generally multiple, located in the body and upper part of the stomach where acid is produced and affect the mucosa and the muscularis mucosae, in 10% of cases they are perforated. These lesions are related to ischemia of the gastric mucosa, due to decreased circulation at the level of the microcirculation and to the destruction of the mucosal barrier by the acid.
They appear between the second and fourth day after the onset of the disease and are manifested by hemorrhage that compromises the patient's life, epigastric abdominal pain is frequent and when there is perforation, peritoneal signs appear.
Stress ulcers in these patients should be suspected when there are signs of upper gastrointestinal bleeding, however the diagnosis is established by endoscopy. The stress ulcer is a raised lesion, sometimes surrounded by a whitish-yellowish halo, the vertex is ulcerated and umbilicated, and it is surrounded by a hyperemic mucosa. Ulcers are located at the esophagogastric junction, at the bottom and in the body of the stomach.
The complications of ulcers are bleeding manifested by vomiting blood and black stools, perforation that presents as a violent picture of abdominal pain and attack on the general condition, and critical narrowing of the pyloric canal. These complications generally require surgery, the laparoscopic approach is the ideal.
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