Chronic erosion — the peculiar form of ulcerations different from acute erosion of a mucous membrane of a stomach existence in their basis of granulyatsionny fabric with a large number of vessels. Such erosion differ from an ulcer in lack of destruction of a muscular plate of a mucous membrane.
Chronic erosion of a mucous membrane of a stomach find at a gastroduodenoskopiya in 4,3% of the inspected patients concerning pain in upper parts of a stomach. Chronic erosion meet at patients aged more often 40 years are more senior.
There are different views on an etiology and a pathogeny of chronic erosion. Some consider chronic erosion izjyazvivshimisya as giperplaziogenny polyps. Others assign the main role in genesis of these erosion to pathological microflora and immune disturbances. Development of chronic erosion contacts long reception (more than 2 years) of medicines (NSPP, corticosteroids) and a duodenogastralny reflux.
Erosive polipovidny educations in a stomach can be display of an illness Krone. In forming of chronic erosion the leading role belongs to changes of the vascular and connective tissue device of a mucous membrane and a submucosal layer. The expressed hypostasis and treatment by fibrin of a mucous membrane in a zone of erosion therefore the erosion as if eminates in a stomach gleam on the edematous and inflammatory basis are observed.
The assessment of a clinical picture of chronic erosion is complicated by the fact that in 80% of cases they are combined with other diseases of the digestive system (a peptic ulcer, chronic cholecystitis, chronic pancreatitis) which symptoms usually dominate. A. A. Ilchenko (1985) at patients with the chronic erosion of a stomach proceeding as an independent disease allocated a gastritichesky syndrome which meets at advanced age more often, and a yazvennopodobny syndrome which is usually observed at young age. Bleeding is not characteristic of chronic erosion of a stomach.
Diagnosis of chronic erosion at endoscopic survey does not present special difficulties. More often they multiple, are localized in antral department of a stomach, have an appearance of polipovidny educations with the central defect of oval or rounded shape. Often chronic erosion are located at tops of folds, forming characteristic "paths". Usually when inflating a stomach fold air completely finish, and polipovidny educations remain. The mucous membrane in a zone of erosion can be moderately hyperemic, edematous or almost not changed. Amount of formations from 0,2 to 1,5 cm.
Dynamic endoscopic supervision over these patients showed that the wavy current is peculiar to this damage of a mucous membrane.
During remission chronic erosion become hardly noticeable: from top the plaque disappears, erosion get more flat form and look as the small, slightly hyperemic, moderately towering over the level of a mucous membrane educations with small retraction at top. Chronic erosion can sometimes be exposed to involution.
At X-ray inspection chronic erosion of a mucous membrane of a stomach reveal in the form of defects of rounded shape the sizes up to 1 cm with dot "depot" of a baric suspension in the center of defect.
Differential diagnosis of chronic erosion with izjyazvivshimisya polyps, malignant new growths and submucosal benign tumors is based on results of endoscopic research with an aim biopsy and usually comes easy.
The treatment differentiated. At dominance of a yazvennopodobny syndrome and at a combination of chronic erosion to a peptic ulcer carry out usual antiulcerous therapy which includes a diet No. 1, (Vicalinum, Almagel, fosfalugel), cholinolytic (atropine, Platyphyllinum, Methacinum). Considering an important role which is given to a duodenogastralny reflux in development of chronic erosion, include the drugs normalizing motor evakuatornuyu function of a stomach in complex treatment (a raglan on 0,01 g 3 times a day in 30 min. prior to food or eglonyl of 0,05 g 3 times a day). At dominance of a gastritichesky syndrome, it is effective karbenoksolon sodium (Biogastronum). Biogastronum is recommended according to the following scheme: within the first week on 2 tablets (100 mg) 3 times a day in 30 min. after food, and in the next weeks on 1 tablet (50 mg) 3 times a day, also in 30 min. after food.
At a combination of chronic erosion to other diseases of the digestive system treatment is korrigirut taking into account these diseases.
It is not possible to achieve remission by means of conservative therapy from some patients. In these cases delete it is long not epithelized chronic erosion of a stomach by means of the standard loop used at a polypectomy with the subsequent histologic studying of a remote fragment of a mucous membrane of a stomach. Defect of a mucous membrane of a stomach after removal of a chronic erosion usually begins to live in 10 — 14 days. However, according to endoscopic supervision, recurrence of a chronic erosion of a mucous membrane of a stomach is observed in 32 — 38% of cases.
At the recurrent course of a chronic erosion or inefficiency of conservative therapy V. N. Preobrazhensky and soavt. (1987) offered local introduction via the endoscope to the area of erosion of a concentrate of granulocytes (donor odnogruppny leukocyte weight) by means of a special injektor. The drug is administered on 2 — 3 ml in each erosion, and at multiple erosion — to only 10 — 12 ml for one session. Procedure is repeated with an interval of 7 days, erosion are usually epithelized for 2 — 3 weeks. The method allows to extend the remission period.
Patients with chronic erosion of a stomach have to be under dispensary observation. It is necessary to appoint control gastroscopic researches 1 — 2 time a year in necessary cases for the purpose of differential diagnosis carry out an aim biopsy.
Preventive treatment is shown in the spring and in the fall. Patients within a month have to adhere to the diet close to No. 1, from medicamentous means appoint the antacids and drugs normalizing motility of a stomach (a raglan, cerucal). Undoubted value in the prevention of recurrence of chronic erosion has timely treatment of such associated diseases as a peptic ulcer, chronic cholecystitis, chronic pancreatitis etc. It is reasonable to exclude reception of the medicines having side ulcerogenic effect.