Dispepsija: the reasons and diagnostics

dispepsii experts classify the Syndrome as sovokupnost the clinical symptoms arising at infringement (delay) oporozhnenija a stomach owing to presence at the patient not only diseases of bodies pishchevarenija, but also other systems of an organism.

To to symptoms , united by the term "dispepsija" it is traditional carry :

• Feeling of weight in a stomach (sensation of overflow of a stomach), more often arising after food intake (as at once, and in some hours after meal) - some patients the specified sensations interpret as a stupid aching pain in podlozhechnoj or okolopupochnoj areas
• Feeling of fast saturation
• the Nausea (as on an empty stomach in the morning, amplifying first food intake, and arising at once or in some hours after meal)
• Vomiting (possible, but an unessential symptom) if it nevertheless has arisen after it comes, let even short, but simplification (reduction displays dispepsii)
• a stomach Swelling (meteorizm) with an eructation air or without it

the Named symptoms and degree of expressiveness at each concrete patient mozhet widely to vary. The combination dispepsii with a heartburn, a pain for grudinoj is possible at swallowing ( the symptoms caused by diseases of a gullet, chashche all gastroezofagealnoj refljuksnoj illness ), and takzhe change, more often decrease, appetite. Sindrom dispepsii is widespread enough display various zabolevany and meets, on various data, not less than at 30-40 % of the population planety. If to take in attention unitary episodes dispepsii, arising pri sharp enterovirusnyh infections or the answer to sharp toxic damage slizistoj a stomach the diversified factors, including alcohol and lekarstvami the specified figures, at least, should be increased in 2 times. Dlja the best understanding of the reasons of occurrence dispepsii shortly it is necessary to tell about tom, that occurs to food in a stomach of the healthy person. Process of digestion of food in a stomach (fig. 1) Pri food hit in a stomach there is a change of a configuration of body - muskulatura bodies of a stomach (1) relaxes, whereas target department (antruma - 2) - is reduced.

Thus pilorichesky the channel (3) representing muscular zhom, or sfinkter, remains practically closed, passing in a duodenal gut (4) only a liquid and firm parts of food less than 1 mm. In reply to hit pishchi in a stomach of its cage strengthen production providing partial himicheskoe digestion of fibers of hydrochloric acid and digestive enzyme pepsina (along with slime - the basic components of gastric juice).

activity of muscular cages of a stomach, thanks to what proishodit mechanical crushing of firm components of food and their hashing s gastric juice that facilitates its chemical digestion In parallel amplifies. This process with narastajushchej intensity of muscular reductions of a wall of a stomach proceeds nearby 2 hours. Then pilorichesky the channel opens also several powerful reductions zheludok "expels" the food rests in duodenal kishku. Zatem there comes a phase of restoration (rest) of functional activity zheludka. the occurrence Reasons dispepsii Kak already was spoken, in most cases dispepsija is caused by delay oporozhnenija a stomach. It can have as functional (without signs povrezhdenija bodies and fabrics), and the organic nature. In the latter case dispepsija arises as display of diseases of a stomach, other bodies and systems organizma.

the Nausea, vomiting, at times unrestrained, can be displays neurologic zabolevany, accompanied by increase of intracranial pressure, That is why these simptomy assotsiirovany with a headache, at times rather intensive. In such sluchajah communication of displays dispepsii with food intake accurately is not traced, naprotiv quite often specified symptoms appear against raised arterial davlenija Pojavlenie dispepsii forces the most part of people to address for the help to vrachu.

patients Without fail require consultation of the expert at which dispepsija for the first time has arisen in vozraste 45 years and is more senior , and also at persons (irrespective of age), at kotoryh take place one or the several marked below symptoms :

• repeating ( retsidivirujushchaja ) vomiting
• loss of weight of a body ( if it is not connected with dietary restrictions )
• a pain at food passage on a gullet ( disfagija )
• the proved episodes of a bleeding of a gastroenteric bleeding ( vomiting «a coffee thick», liquid degteobraznyj the chair )
• an anaemia

it is final, the development reason dispepsii in each concrete case should ustanovit the doctor. The problem of the patient - accurately to state symptoms available for it, chtoby it was easier to doctor to understand cause and effect mutual relations mezhdu them. Dlja it the patient should answer the doctor on following questions:

for the doctor the information on presence at the patient accompanying zabolevany in which occasion the patient regularly accepts medicines ( what is Important, kak is frequent, how long ), about possible contact to harmful substances, about osobennostjah a mode and a food allowance. Zatem the doctor spends objective inspection of the patient with use "classical" medical methods: survey, prostukivanija ( perkussii ), oshchupyvanija ( palpatsii ) and auscultations ( auskultatsii ). Sopostavlenie the data received at objective inspection with the information, poluchennoj at interrogation of the patient, allows the doctor to outline in most cases krug possible diseases and statuses which could cause occurrence dispepsii. Thus such important factors, as a floor, vozrast, an ethnic accessory of the patient, its heredity ( presence zabolevany, proceeding with dispepsiej at blood relatives ), time goda and some other factors are necessarily considered. the Inspections used in diagnostics of the reasons of development dispepsii and ih the diagnostic importance

Except the marked methods of research for diagnostics actually infringements oporozhnenija a stomach can be applied skin and intragastric elektrogastrografija, radio isotope research with use special izotopnogo a breakfast. Now these methods are used mainly in nauchnyh the purposes whereas in daily clinical practice their application vesma is limited. Treatment dispepsii

the Integral component of treatment dispepsii irrespective of the reason of its development javljaetsja updating of a mode of a life and a food, diet correction. These rekomendatsii are absolutely simple and on the are banal, but from that, how much patsient can execute them in many respects efficiency medicinal lechenija, and sometimes even its expediency depends.

Here substantive provisions:

the Presented rules cannot be perceived as dogma, deviations kak towards their toughening, and softening are possible. The main task - to reduce razdrazhajushchee/povrezhdajushchee action ( mechanical or thermal ) on slizistuju a cover of a stomach of the food, hydrochloric acid, the bile thrown from dvenadtsatiperstnoj of a gut in a stomach at the big breaks between meal, medicines i etc. Last remark is especially important, that is why before to begin treatment dispepsii the patient is followed with the doctor by a connectivity of occurrence of the given syndrome s reception of medical products. V a case if in a basis dispepsii functional infringements of process evakuatsii lay peep from a stomach in most cases enough correction rezhima a life and a food, a diet for elimination of displays of data sindroma. Small that, medical products ( for example, antatsidy, antagonisty Н2receptors ) which urged to reduce/eliminate dispepsiju, mogut, at unreasonable purpose and irrational application to strengthen it projavlenija. Variants of medicinal therapy dispepsii in many respects depend from togo, diseases which has caused its occurrence. Tak the reason of a chronic gastritis with inflammation localisation in the day off (antralnom) otdele a stomach ( more often Helicobacter pylori or a bile reflux ) opredeljaet and variants of medicinal treatment. Pri proved ( see above ) the bacterial nature of a gastritis, in sootvetstvii with the international standards ( the Maastrihsky consensus-2, 2000 ), patsientu with dispepsiej can be appointed ( at least to 7 days ) antimikrobnaja therapy by two antibacterial preparations (in various kombinatsijah klaritromitsin, amoksitsillin, metronidazole, tetratsiklin, is more rare nekotorye others) and one of blokatorov than the protonew pump ( omeprazolom, lanzoprazolom, pantoprazolom, rabeprazolom, ezomeprazolom ). The same scheme ispolzuetsja and in stomach ulcer treatment.

Despite high probability of disappearance Helicobacter pylori from zheludka after such treatment, display dispepsii can be saved, that potrebuet treatment continuations, but already only blokatorom the protonew pump or ego combinations with sukralfatom or antatsidami ( maaloks, almagel, fosfoljugel, etc. ) situationally - in 2 hours after meal if following priem food will be at a distant day, before a dream.

the Obligatory condition of purpose blokatora the protonew pump javljaetsja its reception 30 minutes prior to the first the tonic of food!

It is possible, but it is not always obligatory, the second reception of a preparation ( more often in the second polovine day, in 12 hours and too on an empty stomach ). Less expressed blocking dejstviem on secretion of hydrochloric acid in a stomach antagonists Н2 retseptorov (tsimetidin, ranitidin, famotidin, nizatidin, roksatidin) possess. They also kak blokatory the hydrogen pump are capable to eliminate displays dispepsii. Pri refljuksnom a gastritis all are appointed the same blokatory the protonew pump in kombinatsii with antatsidami or sukralfatom. Antatsidy or sukralfat are accepted kak and at chronic Helicobacter pylori the induced gastritis: situatsionno - in 2 hours after meal if the following food intake is at a distant day and objazatelno before a dream ( protection mucous a stomach from hurting action zhelchi which probability of hit in a stomach at night above ). Eshche in treatment refljuksnogo a chronic gastritis can be used ursodioksiholevaja acid (2-3 capsules before a dream) or so-called prokinetiki (metoklopramid, domperidon, tsizaprid), preparations which strengthen sokratitelnuju ability of muscles of a digestive path including piloricheskogo sfinktera. Thanks to this effect prokinetiki not only facilitate oporozhnenie a stomach, but also reduce probability hit in it of bile. They naznachajutsja 30 minutes prior to meal and before a dream. Their reception is undesirable to persons, job kotoryh is connected with traffic safety, demands exact koordinirovannyh dejstvy as there is a probability of brake influence on activity golovnogo a brain. Revealed at tsisaprida ability negatively to influence on serdechnuju activity (raises probability of development of unsafe infringements serdechnogo a rhythm) demands cautious use of the given preparation, and vozmozhno and others prokinetikov from cardiological patients (preliminary dolzhna to be removed the electrocardiogram - in the presence of signs of lengthening of interval QT) tsisaprid protivopokazan. Eshche one preparation which is used for elimination of such display dispepsii as the stomach swelling, is simetikon ( espumizan ). It lechebnoe action is reached at the expense of decrease poverhnostnoog liquid tension v a digestive path. The preparation can be applied as independently, and in sochetanii with antatsidami. V those cases, when dispepsija has arisen at the patient with a diabetes, pochechnoj or hepatic insufficiency - the primary goal is umenshenie displays of these diseases and statuses. Tak at a diabetes dispepsija basically appears at the bad control for urovnem glucose in blood ( on an empty stomach and in 2 hours after meal ). Therefore for ustranenija dispepsii it is necessary to correct treatment saharosnizhajushchimi preparatami. For this purpose it is necessary to address to the doctor. There are some variants, kakoj it is necessary to choose from them-mestno the patient and the doctor solve. Esli the patient accepts insulin - there are no problems, under the control glikemicheskogo profilja ( definition some times within days of level of glucose ) podbiraetsja an adequate dose of insulin so that level of glucose of blood on an empty stomach not prevyshal 7,0 mmol/l, and were better below 6,0 mmol/l. A little bit more difficult with snizhajushchimi blood glucose tabletirovannymi preparations. Many of them can vyzvat dispepsiju, therefore such patients should co-ordinate with the doctor tselesoobraznost preparation replacements, or, let even is temporary, before normalisation gljukozy, to pass to insulin. After achievement of target level of glucose - it is possible obratnyj transition (besides under the control glikemicheskogo a profile) on tablitirovannye preparations. Gor azdo it is more difficult to struggle with dispepsiej at patients with nephritic or hepatic nedostatochnostju as it is irreversible statuses. Along with actions on zamedleniju their progressing it is provided greatest possible sparing for zheludka a life and food mode ( see above ), reducing its probability povrezhdenija. Esli at the heart of infringement of evacuation of food from zhelud ka narrowing of target department opuholju or the cicatricial fabric formed at healing of ulcers piloricheskogo kanala or a bulb of a duodenal gut, medicinal therapy not effektivna lays. In such cases surgical treatment should be spent.

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