Gastritis symptoms and treatment in pregnant women. Diagnosis of gastritis during pregnancy, preventive measures

Gastritis during pregnancy is a disease associated with the fact that the tissues of the stomach become inflamed due to the changes that the bearing of the child entails. Moreover, if a woman had problems with the gastrointestinal tract even before pregnancy, then gastritis is likely to appear again, and will last the entire period of gestation.

Of course, gastritis will worsen the well-being of a pregnant woman - it is quite possible that it will cause the formation of early toxicosis, accompanied by severe vomiting.

ICD-10 code

K29 Gastritis and duodenitis

Causes of gastritis during pregnancy

The reason for the development of a chronic form of gastritis in the process of bearing a child may be such factors:

• stress, which entails a violation of the natural biorhythm of life - for example, the lack of a normal night's sleep and work at night, as well as various problems and conflicts in the family or at work;
• poor nutrition - dry food, unbalanced irregular meals with snacks on the go;
• poor quality food;
• frequent consumption of foods containing refined oils and refined grains, as well as foods containing emulsifiers and preservatives. Animal food with antibiotics and hormones is also harmful;
• infection of the body with an infectious bacterium Hp.

Approximately 75% of women with chronic gastritis suffer from an exacerbation of this disease during pregnancy. Basically, in such women, toxicosis begins early, which, moreover, can proceed in a rather severe form, and even drag on for 14-17 weeks.

At the same time, we note that chronic gastritis during pregnancy does not have any negative impact on the process of gestation and development in the abdomen of the fetus. In this case, troubles will haunt only the expectant mother, who will feel unwell.

Pathogenesis

The appearance and development of a chronic form of gastritis occurs as a result of a combination with other factors of a negative impact on the gastric mucosa. The pathogenesis of the disease in various types and forms has some features. We often observe gastritis during pregnancy.

There are 2 groups of etiological causes of gastritis - exogenous and endogenous.

Endogenous causes of gastritis:

• genetics;
• autoimmune causes;
• endogenous poisoning;
• endocrine dysfunctions;
• chronic infection;
• hypoxemia;
• metabolic problems;
• duodenogastric reflux;
• hypovitaminosis;
• influence exerted on the stomach by other diseased organs.

Autoimmune atrophic gastritis in a chronic form occurs as a result of the appearance of antibodies in the parietal cells of the stomach, which creates such problems:

• The level of production of pepsin with hydrochloric acid will decrease;
• Atrophy in the fundus of the gastric mucosa;
• The rate of production of internal factor Castle will decrease, and B12-deficiency anemia will also begin to progress;
• G-cells in the antral mucosa will begin to produce more gastrin.

Symptoms of gastritis during pregnancy

In general, gastritis by its nature is not considered a contraindication to pregnancy and childbirth (with some extremely rare exceptions). It does not cause harm to the child in the mother's stomach. Although for the woman herself, the process of bearing will be quite difficult, as she will be tormented by severe toxicosis, vomiting, and constant heartburn. These symptoms can last all 9 months of pregnancy, until the very birth of the baby, which in itself is very unpleasant, although not dangerous to health.

Even if you have not observed any reminders of gastritis for a long time, mechanical movement of organs, changes in hormonal status and other causes arising from pregnancy can cause an exacerbation of the disease. It can manifest itself in various ways, and there are no signs that would be characteristic specifically for pregnant women with gastritis.

You should be wary if early and severe toxicosis is observed in the first half of the period of bearing a child, followed by heartburn, pulling dull pain in the epigastric part, belching with the taste of rotten eggs, problems with stools, vomiting and nausea during the day. Also, a gray coating may form on the tongue, and the temperature will rise to 37-38 degrees.

Gastritis during pregnancy with an increased acidity occurs with symptoms of hunger covering the upper abdomen. With a reduced acidity index, constipation, heaviness in the stomach, diarrhea, and bad breath are often observed. All these symptoms are aggravated by eating spicy, fatty, salty, fried, sweet foods.

To confirm the diagnosis, the doctor will have enough complaints from the patient and reading the anamnesis. If necessary, a study of gastric juice for FGS and the level of acidity can be carried out.

First signs

With gastritis, the gastric mucosa becomes inflamed, thereby disrupting its functioning - in such cases, food is poorly digested, resulting in a waste of energy and strength of the whole organism. Gastritis can be acute or chronic, have an increased, normal and low level of stomach acidity.

Gastritis has many symptoms, but they may also not have any obvious signs. The main manifestation of this disease is pain in the solar plexus, which can be aggravated after certain foods, drugs, liquids, especially if they have an irritating effect on the mucous membrane. With gastritis, you should not eat spicy dishes, drink soda - they have a bad effect on the stomach, contributing to the erosion of the mucous membrane.

Gastritis during pregnancy also has such irregular, but important symptoms - vomiting, heartburn, belching, as well as bloating and flatus. If you have 2 or more of the above symptoms, plus abdominal pain, you should consult a gastroenterologist. He will identify the type of disease and prescribe the necessary treatment - a diet, or with the use of medications.

Gastritis during early pregnancy

It has long been known that gastritis during pregnancy from the very beginning often manifests itself in the form of prolonged and difficult to tolerate toxicosis, so expectant mothers have to look for options that will calm the exacerbated gastritis and reduce pain and discomfort.

Any foods that we eat have a direct impact on gastric work and condition. Thus, if you have exacerbated gastritis, the diet will have to be strictly controlled by removing a large number of different products from it. Initially, such food is prohibited that can have an aggressive effect on the mucous membrane of your stomach: these are spicy, sour, spicy, smoked, salty, fatty, canned foods, as well as too cold or hot food.

If your diet contains foods that can be attributed to any of the above groups, they will have to be excluded from there. In addition, it is forbidden to eat foods containing a large number of carbohydrates, as well as synthetic additives.

The basis of the diet should be semi-liquid, natural food, which is cooked in a gentle mode - dairy products, stewed and boiled vegetables, light soups made from vegetables and cereals, omelettes, fruits, soft-boiled eggs, jelly.

Forms

Acute gastritis during pregnancy

Gastritis at its 1st stage has an acute form - when the mucous membrane of the duodenum and stomach becomes inflamed. Such a disease has many causes - among those are both bacterial and mechanical, temperature or chemical stimuli.

Acute gastritis for the most part develops in this way - first, the upper cells and glands of the gastric mucosa are damaged, becoming the beginning of the inflammatory process. It will affect the upper layer of the mucosal epithelium, but inflammation can go further - along the walls of the stomach, penetrating even into its muscle layers.

Many women who have a chronic form of this disease often notice that gastritis worsens during pregnancy. In most of them, it occurs against the background of early toxicosis, which is accompanied by profuse vomiting. This symptom can last 14-17 weeks, proceeding in a severe and very unpleasant form.

But in itself, chronic gastritis is not considered a contraindication for pregnancy - it does not threaten the development of the fetus in any way, and does not affect childbirth. Although the sensations from him in the expectant mother will definitely be unpleasant. And, of course, after the birth of a child, this disease will need to be cured without delay.

Chronic gastritis during pregnancy

It should be noted right away that chronic gastritis during pregnancy does not have any special symptoms, because basically each person has this disease in its own way. For the most part, it manifests itself in the form of pain in the epigastric region, belching, nausea with vomiting, and problems with the stool. Also, because of it, early toxicosis in severe form can be observed, causing serious discomfort.

When there is a decrease in the level of acid released into the gastric juice in chronic gastritis, some of the above disorders become much more noticeable. When the acidity of the stomach remains within the same limits, or even increases (this situation is typical for young people), there are mainly sharp pains in the upper abdomen, which are often repeated.

With gastritis with an increased acidity index, many pregnant patients note the appearance of a sharp pain in the "under the spoon" area. There may also be discomfort around the navel or on the right under the ribs. Often, such pain manifests itself immediately after eating, and this is mostly fatty, spicy or sweet food. Occasionally, pain can occur that does not depend on meals - at night or even if the person has not eaten anything.

Exacerbation of gastritis during pregnancy

Signs of gastritis in a pregnant woman can be observed at different times. Its main symptoms are heartburn, nausea, pain in the epigastric region, problems with stool.

Heartburn and nausea appear at an early stage due to the fact that at this time the body begins to intensively rebuild hormonally, preparing for bearing a child. As the baby develops, the internal organs of the mother change their location - the pancreas, along with the stomach, move back. Because of this, the contents of the stomach can enter the duodenum or esophagus. Alkaline acid, located in the duodenum, corrodes the gastric mucosa, which provokes the appearance of gastritis.

Chronic gastritis during pregnancy can also become aggravated due to a change in food habits, because women in this position are often very picky about food, often wanting to eat exotic foods, sometimes in the most unimaginable combinations and types. The consumption of many foods saturated with preservatives, as well as sweets, can exacerbate a previously existing disease during pregnancy. It should be treated immediately, without delay, as otherwise fetal intoxication may occur.

Gastritis with high acidity during pregnancy

When eliminating gastritis with an increased acidity of the stomach, you should know a few important things that will help remove the symptoms of the disease.

You can take medicines that help lower the level of stomach acid, such as antacids. They should be taken approximately 30 minutes before a meal. Medicines included in this group should not be used for more than 3 days, unless you consult a doctor.

To get rid of nausea, you should undergo a course of treatment with drugs belonging to the drug category of prokinetics - their effect can improve motor activity in the stomach, reducing signs of heaviness and fullness in its epigastric region.

Attacks of pain, if you suffer from gastritis during pregnancy, can be eliminated by taking antispasmodics - they will remove spasms in the duodenum, as well as smooth gastric muscles, relieving pain and eliminating discomfort. But at the same time, it should be noted that such drugs should not be abused - they are able to hide the signs of some more serious illness, the development of which, thanks to them, will go unnoticed by you.

It should also be noted that pregnant women are prohibited from using antisecretory drugs that are part of the omeprazole group.

Erosive gastritis during pregnancy

Erosive gastritis is a type of inflammation of the gastric mucosa, in which erosion appears on its walls - areas where destruction is very noticeable. This type of disease can occur as a result of treatment with certain drugs - for example, anti-inflammatory non-steroidal substances, as well as due to the frequent consumption of alcoholic beverages and the penetration of chemicals into the stomach that have a bad effect on the mucous membrane.

This gastritis is mainly manifested in an acute form, sometimes even bleeding can occur. Although it can also be observed in a chronic form, when periods of exacerbation of the disease are replaced by periods of remission. If shallow erosions occur in the stomach, they will manifest themselves in the form of pain, a feeling of heaviness in the abdomen, and nausea. If the erosion is deep, bleeding areas will appear in the stomach, which can later develop into a stomach ulcer.

Erosive gastritis during pregnancy requires examination of the patient in a stationary mode, when she is under strict medical supervision. For the treatment of the disease, it is necessary to prescribe and observe a fairly strict diet. It is also possible to take medications, when doctors decide what the risk for the development of the child may be, as well as what the benefits of the medications for the body of the expectant mother will be.

Atrophic gastritis during pregnancy

Atrophic gastritis is one of the precursors to the development of stomach cancer. It can be identified thanks to such signs, noticing which, you should be wary:

• loss of appetite;
• Bloating, rumbling and heaviness in it after eating;
• Regular belching with an odor reminiscent of rotten eggs;
• Problems with the stool - diarrhea and constipation replace each other;
• Aching pain in the stomach that occurs at times after eating;
• The manifestation of B12 deficiency / iron deficiency anemia;
• The tongue has a polished sheen;
• You often sweat, get tired quickly, there is a general weakness;
• At a late stage of the disease, a decrease in body weight is manifested.

Basically, symptoms such as dyspepsia syndrome - nausea, loss of appetite, heaviness in the abdomen are identified and considered the most characteristic signs of the disease; rumbling in the stomach, bloating.

Atrophic gastritis during pregnancy can occur with a probability of 60-75% - this is a fairly high figure. Note that against the background of this disease, the likelihood of early toxicosis also increases.

Since, due to her position, a pregnant woman cannot undergo some diagnostic procedures, in order to make an adequate diagnosis, she needs to consult 3 doctors at once - a gynecologist, a therapist, and a gastroenterologist.

Complications and consequences

If the expectant mother suffers from chronic gastritis, then it should be expected that during pregnancy it will worsen, since more than 70% of them are affected by this disease.

Note that this disease cannot be started in any way, because complications in this case will not be slow to follow. But at the same time, it is also impossible to use some powerful drugs, because they can adversely affect the health of the child.

Any indigestion should be taken very seriously, because if you start the disease or do not cure it in time, this can lead to serious consequences and complications. For example, a miscarriage may occur, or even death. If you start gastritis during pregnancy, it can develop into a stomach ulcer, which in turn can develop to a severe stage, at which symptoms such as pain shock are possible.

But still, one should not be afraid in advance, since painful sensations can be caused by completely harmless reasons. Although consultation with a specialist is necessary in any case.

It should be noted that the strength of pain is not an indicator of the severity of the disease, because each person has his own pain threshold. Yes, and there are diseases that can develop without any visible symptoms at all.

Diagnosis of gastritis during pregnancy

Various forms of the disease have some characteristic features that make it possible to determine the clinical picture of the disease. For example, if the secretory activity of the gastric mucosa is increased, the first symptom will be pain that appears at the top of the abdomen, as well as under the right rib or around the navel. Discomfort intensifies after eating spicy or fatty (generally any heavy for the stomach) food, but can also occur at night or even on an empty stomach. This form of the disease is mainly manifested in young women and it must be treated by suppressing the secretory activity in the gastric mucosa.

If gastritis during pregnancy has a form when the acidity in the stomach is reduced, signs of dyspepsia become its signs. In this case, the pain is felt quite moderately, intensifying due to the intake of a large amount of food - the gastric walls are stretched. With such gastritis, it is necessary to take drugs that can improve the secretory activity of the glands.

Mostly because of chronic gastritis, pregnant women suffer from toxicosis, which proceed in a rather severe form. In addition, such toxicosis lasts for a long time - about 14-17 weeks, and standard treatment does not improve the situation.

Analyzes

A blood test is carried out first - a biochemical study will help to determine what level of gastrin concentration is in the body. There are procedures that can detect the presence of antibodies in the parietal cells, as well as the bacterium Helicobacter pylori. A peripheral blood test will also allow you to diagnose the presence of symptoms of B12-deficiency anemia, which often accompanies gastritis.

To clarify the diagnosis, they study how the disease developed, and they can also perform an endoscopic examination of the stomach. A special machine takes a sample of stomach acid to determine its level. Thanks to the analysis, you can find out the type of disease and determine what treatment is needed. It is difficult for a pregnant woman to endure an endoscopic procedure, but if the preliminary treatment fails to make a diagnosis, it is necessary to carry it out.

Also, if there is a suspicion of gastritis during pregnancy, in addition to blood, you need to take a stool test for occult blood and urine. Feces are taken to find out if the patient has any unnoticeable internal bleeding. This research method is often used in cases where, in addition to signs of gastritis, a pregnant woman develops iron deficiency anemia.

Instrumental diagnostics

To diagnose chronic gastritis, the following procedures are carried out:

• checking the work of secretory-motor gastric functions;
• fibroendoscopic diagnostics is very valuable and productive, but it is quite burdensome for a pregnant woman, so it should be used only if other methods are ineffective or there are special indications. If the gastritis is minor, gastroscopy will demonstrate the existing moderate swelling, coupled with irritation and inflammation on the damaged mucosa. In addition, the technique makes it possible to see focal hyperemia and an increased level of mucus formation. Chronic gastritis during pregnancy, in which there is an increased level of acidity, often occurs accompanied by erosive disorders on the mucosa;
• the procedure for x-ray diagnosis of gastritis in a pregnant patient should not be carried out, because this method is not very informative, and x-rays will have a negative effect on the child;
• an ultrasound method performed on an empty stomach will reveal the presence of hypersecretion and excess mucus in the stomach, assess the thickness and condition of all its walls and local inflammation that will appear under the device's sensor.

Differential Diagnosis

Differential diagnosis for the main types of gastritis is carried out if there are functional problems in the secretory gastric function (gastric irritation, functional achylia). Such observations take into account the fact that in a chronic disease the symptoms are more pronounced and persistent, and how the picture of mucosal inflammation changed during biopsy and gastrofibroscopy procedures.

Gastritis during pregnancy, which retains or has an increased level of acidity, as well as antral gastritis, in which pain is observed, must be differentiated from an ulcer. Gastritis does not have seasonal exacerbations and does not eat away at the gastric mucosa - it is not as dangerous as an ulcer, but if left untreated it can develop into it, so it cannot be started. Gastric polyposis should be differentiated from polyposis gastritis - here you need to focus on targeted biopsy after this examination.

To perform the differential diagnosis of large hypertrophic gastritis, which is accompanied by a gastric tumor, as well as antral gastritis, use the indications of targeted biopsy and gastrofibroscopic examination.

Treatment of gastritis during pregnancy

It is rather difficult to treat gastritis during pregnancy, since many medications are prohibited for use, but it should be noted that gastritis does not adversely affect the course of pregnancy and the development of the child.

To cure gastritis during pregnancy, you should start with the selection of a suitable diet, as well as the stabilization of the diet. When the sore is too hard, bed rest can be prescribed, as well as fractional meals - the number of meals per day is divided into 5-6 times. There should also be breakfast and a full dinner. At the very beginning of treatment (the first days), you should eat only semi-liquid food - this is necessary in order not to overload the stomach.

You should start the diet with thin soups with milk, as well as cottage cheese and dairy products. Further, you can expand the diet by including quail or chicken eggs, which are steamed or soft-boiled. You can also start eating fresh fruits and vegetables.

Chronic gastritis is treated individually, using differentiated and complex methods. If the disease worsens, Pevzner's diet No. 1 is prescribed, half-bed rest and separate (5-6 times / day) meals.

When a pregnant woman has gastritis with increased acidity, if there are no edema in the first half of gestation, she may be prescribed mineral water. It can be Jermuk and Smirnovskaya, which you need to drink one and a half to two hours after eating three times a day, 150-300 ml each. This water reduces the time of mucosal erosion by gastric juice, helping to eliminate the inflammatory process. If chronic gastritis with a reduced acidity index is present, mineral waters such as Essentuki numbers 4 and 17, Mirgorodskaya, or Arzni are prescribed.

Medications

Chronic gastritis during pregnancy with increased acidity is mainly treated in the same way that peptic ulcers are eliminated.

If gastritis B has aggravated in a pronounced form, the doctor can prescribe gastrofarm tablets (you need to take 2 tablets three times a day half an hour before meals), as it prevents inflammation.

The drug Maalox, which has an analgesic effect, and also has cytoprotective and anacid properties, can also be used. You need to take it either under the guise of a suspension, or under the guise of tablets an hour after eating.

The adsorbent drug Attapulgite helps to restore the physiological balance in the stomach, preventing the rapid formation of acid. The medicine should be taken daily 3-5 times (1 powder 1-2 hours after meals; if necessary, you can use it at night).

If there is a disease of gastritis A, the signs are disturbances in intestinal digestion, as well as the exocrine function of the pancreas. To get rid of these symptoms, prescribe 0.5-1 g of pancreatin before meals 3-4 times a day.

If problems with gastric motor function occur, metoclopramide is used. When pain occurs, antispasmodics may be prescribed.

vitamins

Chronic gastritis during pregnancy, against which the intake of vitamins worsens, can lead to quite serious complications of this disease. In some forms of gastritis, you should additionally take vitamins of groups A, B6, C, B12, PP.

These vitamins are found in fruit and berry and vegetable products - they contain folic and ascorbic acid, as well as carotene, which help restore the health and energy of the body. Nicotinic acid and vitamins A and B can be found in high-calorie foods - dairy foods, all kinds of cereals, black bread, sunflower and butter, as well as milk. But the vitamins that enter the body from food products do not always fully satisfy its daily needs, so sometimes doctors can prescribe a patient suffering from gastritis to take fortified food, the packaging of which indicates which vitamins it contains, or some multivitamin preparations.

To stabilize the level of acidity in the gastric mucosa, you should additionally take vitamins from categories C, PP and B6 - they are often prescribed to patients suffering from chronic gastritis.

Physiotherapy treatment

Gastritis during pregnancy can be treated with a physiotherapeutic method, but such procedures can be carried out subject to 2 basic conditions - to help the patient and at the same time not harm the baby in her stomach. Basically, in this position, procedures such as electrophoresis, acupuncture, and electrorelaxation are used.

Thanks to the physiotherapeutic method of treatment, the clinical signs of gastritis become less. It also stabilizes gastric motor function, improving blood circulation, and increases mucosal secretion. So, there are the following physiotherapy procedures:

• Electrophoresis, in which the drug is injected locally through the current - into the area of ​​\u200b\u200bthe violation;
• The imposition of warming substances on the stomach, heating pads;
• Electrotherapy - anti-inflammatory, muscle relaxing, analgesic effect of current is used;
• Magnetotherapy - magnets are used for treatment, which improve blood flow, anesthetize, and accelerate the healing of the affected areas of the stomach.

If a pregnant woman has early toxicosis with vomiting and nausea, with the help of physiotherapy, the vomiting center in the brain can be influenced in order to reduce symptoms that debilitate the body.

Alternative treatment

There are several folk methods for the treatment of gastritis.

With the use of lettuce - a tablespoon of chopped lettuce leaves is poured with a glass of boiling water and infused for 1-2 hours, after which the tincture should be filtered. The resulting broth is drunk twice a day for half a glass, as well as 1 glass at night.

Herbal collection, which combines several components. This is 3 tbsp. bark of brittle buckthorn and 1 tbsp. yarrow and tripoli leaves. A tablespoon of this mixture is poured into 200 ml of boiling water, after which it is infused for about 30-40 minutes. It is necessary to drink half a glass-a glass of tincture at night. This tool helps to stabilize the bowels.

Thyme is also suitable for treatment. Take 100 g of dry grass, which you need to pour 1 liter of dry white wine. The resulting mixture should be left for 1 week, shaking it from time to time. After that, the tincture must be boiled and left in a wrapped state for another 4-6 hours. Then it is filtered and drunk daily 2-3 times before meals at a dosage of 30-50 ml.

Within a month, you can eat about 8 grams of propolis every day on an empty stomach. If you are allergic to the medicine, you should stop taking it.

Gastritis during pregnancy relieves sea buckthorn - 3 tbsp. pour 500 ml of water, boil under a lid, filter and add honey (to taste). Tincture should be drunk daily before meals for 2-3 glasses.

Herbal treatment

Often, when gastritis worsens during pregnancy, many people prefer to cope with this disease with the help of natural remedies. A good effect in such cases can be tinctures and herbs that help reduce pain, and also resist the inflammatory process.

For the treatment of gastritis, which are characterized by high acidity, herbs such as St.

If the patient has developed gastritis with a reduced acidity index, wormwood flowers, cumin, thyme grass, fragrant oregano, parsley, parsnip, plantain leaves will be a good medicine.

But keep in mind that these herbs need to be bought only in a pharmacy, and brew them in accordance with the instructions. Also, you should not use too many of these tinctures, because some of them can have a negative effect on the course of complex treatment.

Herbs that have a sedative effect also contribute to the improvement of the condition with gastritis - this is motherwort and valerian. But we must remember that a pregnant woman may have a completely different reaction to any treatment, because her body is in an unusual position. So even herbal remedies should not be taken without consulting a specialist.

Homeopathy

In case of exacerbation of gastritis during childbearing, homeopathy is often used for treatment.

Homeopathic medicine Gastricumel, which has a sedative, hemostatic, anti-inflammatory, antispastic effect. It is prescribed for the treatment of chronic and acute gastritis. You need to use 1 table. under the tongue three times a day. No side effects were found. Can be used if you have exacerbated gastritis during pregnancy.

Antiemetic homeopathic medicine Spaskuprel, which gives analgesic, antispasmodic, anticonvulsant, sedative effect. It is used for gastroduodenitis and gastritis to remove vomiting. Has no contraindications and side effects. The medication is taken three times a day, 1 tab. under the tongue.

Homeopathic Nux Vomica Homaccord, which counteracts inflammatory reactions and soothes the spasms resulting from inflammation. Suitable if the patient has problems with the digestive tract due to complications resulting from drug therapy. The drug has no side effects and contraindications. Reception is carried out three times a day at a dosage of 10 drops.

Surgical treatment

Chronic gastritis during pregnancy, in the absence of adequate treatment, can develop into a peptic ulcer. An ulcer can lead to various complications, including possible bleeding in the stomach and intestines. This is very dangerous for the life of the child - a miscarriage may occur. If severe bleeding is observed in the stomach during pregnancy, urgent surgical intervention is necessary.

If the outcome is unfavorable, the ulcer can lead to the development of stomach cancer, although this disease is rarely observed in pregnant women. It is noted that the first signs of stomach cancer begin to appear at the 15-16th week of gestation. There are pain in the epigastric region, nausea begins with vomiting, there is a lack of appetite. Melena can also be observed, although here the manifestations are blurred. The diagnosis can be made based on the results of biopsy and fibrogastroscopy. In this case, only surgery is needed, conservative treatment will not give any results. But it should also be understood that in most cases the prognosis for both the mother and the child will be unfavorable.

By itself, gastritis is treated with the help of diets, medicines, various herbs and tinctures - surgery is not required to eliminate it.

Diet for gastritis during pregnancy

Pregnant women who suffer from gastritis must follow a diet, among the basic rules of which are:

• Products must be thoroughly chewed or pre-crushed or ground, turning into a puree;
• Do not eat too hot or too cold food;
• Meals should be performed 4-6 times / day, but the portions should be small.

If gastritis worsens during pregnancy, you should first use only liquid, milk-based soups made from barley, rice, and oats. Small portions, which are often consumed throughout the day, help to balance the functioning of the digestive system.

Another important task is to stabilize the chair. If you have diarrhea, drink blueberry, pear, pomegranate, blackcurrant, dogwood juices; if you suffer from constipation, juices from apricots, carrots or beets, fresh kefir or yogurt, as well as grated vegetables are suitable for you.

Eating spicy, salty and fatty foods is prohibited. Sweet is possible, but in small quantities.

Gastritis can also be treated with green apples. We peel 2 apples, remove the core from them, and rub through a fine grater. The resulting mass should be eaten in the morning. In the first month, this mixture must be eaten every day, in the second - 2-3 times a week, and in the third - only 1 time / week.

Prevention

The appearance of gastritis is easier to prevent than someone might think. Among the main conditions - to learn to eat hot food at lunch, not to dine too tightly, and in general try not to eat too quickly - to chew thoroughly and slowly.

As a preventive measure, you should use diets, observe the regimen of both work and rest. The main method is still diet. With her, the daily diet is divided into 5-6 meals - in small portions. It is important at the same time to chew food thoroughly, slowly and without swallowing large pieces. If you do not comply with the last condition, you can earn yourself indigestion.

Extractive substances, as well as food that can irritate the stomach, should be removed from the diet. Among such products are preservation, spicy seasonings and spices, fatty broths, smoked meat, strong black tea.

If you have gastritis during pregnancy, overeating is not recommended. The psychological state of the pregnant woman should also be taken into account - she should try to avoid stress, not get upset over trifles, and monitor her daily routine.

It is also important to keep your teeth in good condition, as caries can provoke an infection in the stomach.

Forecast

Spontaneous disappearance of the H. pylori bacterium has not been observed in medical practice, since this infection is characterized by the fact that it remains for life. Therefore, the prognosis can be determined based on the effectiveness of anti-Helicobacter treatment. It can become worse if there are complications such as ulcers, gastric adenocarcinoma, MALT lymphoma.

Chronic gastritis during pregnancy is not life-threatening for the patient, but the sensations from it are very unpleasant. Basically, with this disease, inpatient treatment is not necessary, but if, as sometimes happens, complications begin, aggravated by the development of a dystrophic process, the patient may be hospitalized in the gastroenterological department.

You can expect a negative prognosis and even a risk to life in the event of the development of autoimmune gastritis - this is determined by observing how pernicious anemia proceeds and dysplasia develops. In this case, the patient will have to be under active supervision all her life, in which endoscopic and morphological examinations will be used.

Autoimmune trophic gastritis can cause gastric adenocarcinoma. In general, carcinoids formed during the course of the disease are small in size.

It's important to know!

A defect in the gastric mucosa in the form of small ulcers up to 1.5 cm in diameter (erosions) can occur both against the background of a pronounced inflammatory process (erosive gastritis), and with minimal manifestations of inflammation or without them at all - erosive gastropathy.

Symptoms of gastritis can appear at any stage of pregnancy. Nausea, heartburn, pain in the epigastric region, impaired stool - these symptoms often bother pregnant women with toxicosis and gastritis. Treatment of gastritis during pregnancy should be safe for the child, but effective and effective. Medicines and medicinal herbal preparations will help restore good health and save pregnancy from complications.

Features of the course of gastritis in pregnant women

The location of the digestive tract in a pregnant woman

In the early stages, nausea and heartburn bother pregnant women due to the fact that there is an intense hormonal restructuring of the body, which is preparing to bear the fetus for 9 months.

With the growth of the fetus, the configuration of the location of the internal organs changes, the stomach and pancreas are displaced posteriorly.

This leads to the fact that reflux often occurs, that is, the reflux of stomach contents into the esophagus or into the duodenum. The alkaline content of the duodenum irritates the gastric mucosa and causes the symptoms of this disease.

In addition, an exacerbation during pregnancy can be caused by a change in eating habits. Often women in an interesting position become capricious and picky about ordinary food. The use of a large amount of sweets or products with dyes and preservatives can provoke an exacerbation of the disease that existed before pregnancy and require urgent treatment of gastritis in pregnant women in order to prevent fetal intoxication.

How to distinguish gastritis from other diseases of the gastrointestinal tract?

The mucous membrane of the stomach with gastritis

On examination, the doctor may reveal pain in the stomach, which increases with palpation. Symptoms such as heartburn, heaviness in the stomach, impaired stool, belching are also characteristic of other diseases of the digestive system. The diagnosis of exacerbation of chronic gastritis can be made accurately only with endoscopic examination, when the doctor sees the state of the gastric mucosa. The study is carried out for pregnant women according to strict indications.

Effective remedies for gastritis in pregnant women

Depending on what type of gastritis is observed in a pregnant woman, the approach to the question of how to treat gastritis during pregnancy will differ.

Treatment of gastritis with high acidity

In order to cope with the symptoms, there are several important rules.

• It is allowed to take drugs that lower the acidity of gastric juice. These include antacids, which should be taken half an hour before meals. It is advisable not to take drugs of this group for longer than 3 days without consulting a doctor.
• To cope with nausea, you can take modern drugs that belong to the group of prokinetics. They stimulate the motor activity of the stomach and relieve the symptoms of fullness and heaviness in the epigastric region.
• You can relieve painful spasms with the help. Such drugs will remove spasms of the smooth muscles of the stomach and duodenum and give an analgesic effect. But you should not abuse such drugs, as they can mask the symptoms of a more serious illness.

Important! Pregnant women are contraindicated in antisecretory drugs from the omeprazole group.

Treatment of gastritis with low acidity

• You can take drugs that will help the pancreas work and thus alleviate the course of gastritis. These drugs have in their composition, splitting proteins, fats and carbohydrates. Take this group of drugs with meals. However, so that the pancreas does not get lazy, they are recommended not to be taken every day. It is better to eat fractionally, 5 or 6 times a day and do not drink water with food. Water or tea should be drunk 40 minutes after eating.
• A very important component of the good functioning of the digestive organs is the state of the microflora of the intestinal mucosa. With gastritis in pregnant women, eubiotics can also be successfully taken, which, due to the normalization of microflora, will contribute to the speedy subsidence of the exacerbation of the disease.

Important! Antibiotics that are prescribed for type B gastritis to kill are contraindicated for pregnant women!

Treatment of gastritis with folk remedies

For the treatment of gastritis are the safest remedy for pregnant women.

You can use special pharmacy fees in filter bags that are brewed like tea.

Do not forget that some herbs, such as sage, are contraindicated in early pregnancy.

Medicinal herbs for gastritis in pregnant women

With success in gastritis with high acidity, mint, chamomile and oats are used. They relieve inflammation of the mucous membrane and envelop it, reducing the secretion of gastric juice.

To stimulate the stomach, fennel, plantain, oregano, thyme are used. These herbs make the stomach work and digest food better.

Important! Following a diet will help cure gastritis faster and more effectively. Food should be fresh, boiled, stewed or baked, spicy and smoked are excluded. Products containing chemical additives are not recommended. Useful without gas, but it will be right to drink mineral water half an hour before a meal or an hour after a meal.

Chronic gastritis is a chronic lesion of the gastric mucosa, accompanied by its structural restructuring with progressive atrophy and impaired secretory, motor and partially endocrine functions of the stomach.

ICD-10 CODE
K29.3 Chronic superficial gastritis.
K29.4 Chronic atrophic gastritis.
K29.5 Chronic gastritis, unspecified.

EPIDEMIOLOGY

According to numerous epidemiological studies, chronic gastritis is diagnosed in more than 50% of the adult population of the developed countries of the world, in the structure of diseases of the digestive system it is 35%. However, the frequency of this disease in pregnant women has not yet been established.

PREVENTION OF EXAMINATIONS OF GASTRITIS DURING PREGNANCY

Of primary importance is a balanced diet, refusal to use strong alcoholic beverages, smoking.

It is necessary to monitor the condition of the oral cavity, treat diseases of other abdominal organs in a timely manner, and eliminate occupational hazards. Patients with chronic gastritis, especially those with atrophic-disregenerative changes, should be registered at the dispensary and undergo a comprehensive examination at least twice a year.

CLASSIFICATION OF GASTRITIS

There are two forms of gastritis:
acute - occurs for the first time, proceeds rapidly;
Chronic - occurs with frequent relapses.

The main forms of gastritis are currently considered chronic gastritis A (accounting for 15-18% of cases) and chronic gastritis B caused by Helicobacter pylori (70% of all chronic gastritis).

Other forms of gastritis are observed much less frequently.

There are chronic gastritis as the main and as a concomitant disease (secondary gastritis).

According to the etiological basis, exogenous and endogenous chronic gastritis are distinguished. According to the degree of secretory disorders, chronic gastritis with secretory insufficiency is distinguished.

Based on biopsy data, superficial gastritis, gastritis with glandular lesions (without atrophy), atrophic gastritis (moderately pronounced), gastritis with restructuring of the gastric mucosa are isolated.

According to the localization of morphological changes, common chronic gastritis, antral and isolated gastritis of the body (bottom) of the stomach are distinguished. The special forms of chronic gastritis include hemorrhagic, rigid, giant hypertrophic and polyposis.

ETIOLOGY (CAUSES) OF GASTRITIS

Chronic gastritis is sometimes the result of a “protracted” acute gastritis, but more often it develops under the influence of various exogenous factors (repeated and prolonged malnutrition, the use of spicy and rough foods, addiction to hot food, poor chewing of food, the use of strong alcoholic beverages - alcoholic gastritis ).

The cause of chronic gastritis can be:

Qualitatively malnutrition (especially deficiency of protein, iron and vitamins);
Prolonged uncontrolled intake of drugs that irritate the gastric mucosa (salicylates, phenylbutazone, prednisolone, some antibiotics, sulfonamides and other drugs);
industrial hazards (lead compounds, coal, metal dust);
diseases that cause tissue hypoxia (chronic circulatory failure, pneumosclerosis, anemia);
endogenous intoxication in diseases of the kidneys, gout (urea, uric acid, indole, skatole and other substances are secreted by the gastric mucosa);
The action of toxins in infectious diseases and local chronic foci of infection (the so-called elimination chronic gastritis);
hereditary predisposition.

In 75% of cases, chronic gastritis is combined with chronic cholecystitis, chronic appendicitis, colitis and other diseases of the digestive system.

PATHOGENESIS

Under the influence of long-term exposure to endogenous and exogenous etiological factors, functional secretory and motor disturbances in the activity of the stomach first develop, and later - dystrophic and inflammatory changes and violations of regeneration processes. These structural changes develop primarily in the epithelium of the surface layers of the mucosa, and later the gastric glands are involved in the pathological process, which gradually atrophy or rebuild like crypts. Autoimmune processes play a certain role in the progression of the disease.

PATHOGENESIS OF GESTATION COMPLICATIONS

There is no single theory explaining the causes of toxicosis. Opinions agree on only one thing - toxicosis occurs in those women who have diseases of the gastrointestinal tract, liver, thyroid gland, as well as in those who work hard, smoke, eat improperly, whose psyche is overstrained.

Complications of pregnancy that occur in the first trimester up to 13-14 weeks, characterized by dyspeptic disorders and various metabolic disorders, are called "early toxicosis". Vomiting in pregnant women is the most common form of this complication. It is believed that the most likely cause of vomiting in early pregnancy is a violation of the interaction between the central nervous system and internal organs. In this case, there is an excitation of the activity of the subcortical structures of the central nervous system, where the vomiting center is located, as well as the centers for the regulation of vascular tone, salivation, and smell. The close location of these centers determines that the vomiting act is preceded by a feeling of nausea, increased salivation, deepening of breathing, increased heart rate, blanching of the skin due to spasm of peripheral capillaries.

CLINICAL PICTURE (SYMPTOMS) OF GASTRITIS IN PREGNANT WOMEN

Chronic gastritis A initially proceeds with normal gastric secretion (excretion of gastric juice); at this stage, patients do not complain and treatment is not required. The need for treatment arises when the inflammatory process in the gastric mucosa deepens, as a result of which the secretion of gastric juice decreases.

With the development of chronic gastritis B, the secretion of gastric juice in the lower parts of the stomach is increased or within the normal range, however, with widespread chronic gastritis B, the secretory function of the stomach decreases sharply, up to its pronounced insufficiency.

Chronic gastritis has no specific symptoms, the clinical picture of the disease is diverse. In most cases, the symptoms of the disease are pain in the epigastric region and dyspepsia (nausea, vomiting, belching, upset stool). In chronic gastritis with secretory insufficiency (low level of hydrochloric acid in gastric juice), gastric dyspepsia (belching, nausea, vomiting) and intestinal dyspepsia (flatulence, rumbling in the abdomen, stool disturbance) are more often observed.

With gastritis with preserved or increased secretion of gastric juice - the forms most often observed at a young age - pain prevails. Most often there are recurring pains in the upper abdomen. Most patients complain of pain in the epigastric region, around the navel or in the right hypochondrium. Pain occurs after eating, often associated with a certain type of food, less often appear on an empty stomach, at night, or regardless of food intake. The pain can be both moderate and severe (with increased production of hydrochloric acid by the stomach, the pain is usually severe, with reduced production - weak). The pain becomes worse when the walls of the stomach are stretched with a copious amount of food.

The most common is Helicobacter pylori gastritis. Once in the stomach, bacteria multiply intensively, damaging the gastric mucosa and changing the production of gastric juice. This leads to erosions and stomach ulcers.

COMPLICATIONS OF GESTATION

In 75% of women suffering from chronic gastritis, the disease worsens during pregnancy. As a rule, pregnant women suffering from chronic gastritis develop early toxicosis (vomiting), which often lasts up to 14–17 weeks and can be difficult.

Severe gastritis can lead to bleeding from the stomach and duodenum.

DIAGNOSIS OF GASTRITIS IN PREGNANCY

ANAMNESIS

In the anamnesis, as a rule, there is evidence of acute gastritis or periodic exacerbations of chronic gastritis.

PHYSICAL EXAMINATION

On palpation of the epigastric region, in most cases, patients do not notice pain.

LABORATORY RESEARCH

Laboratory diagnostics includes:
· clinical blood test;
General urinalysis - when vomiting of pregnant women is added, a positive reaction to acetone (+++ or ++++) is detected in the urine test, protein and cylinders are often detected. In blood tests, hypo- and dysproteinemia, hyperbilirubinemia, and an increase in creatinine are determined.

INSTRUMENTAL STUDIES

For the diagnosis of chronic gastritis is carried out:

study of the secretory and motor functions of the stomach.

Gastric secretion: basal up to 10 mmol / h, stimulated (after maximum histamine stimulation) - up to 35 mmol / h. Often there is abundant gastric secretion at night. In chronic gastritis, the acid-forming function of the stomach may be normal or reduced; perhaps the complete absence of hydrochloric acid in gastric juice (achlorhydria). In advanced cases, the production of pepsin (achilia) is also disrupted. endoscopic examination.

The fibroendoscopic method of research is diagnostically valuable, but rather burdensome for a pregnant woman, it should be used for diagnosis according to special indications and in case of treatment failure. With superficial gastritis, gastroscopy reveals moderate swelling, sometimes slight vulnerability of the mucous membrane, focal hyperemia, and increased mucus formation. Chronic gastritis with high acidity is often accompanied by erosive damage to the mucous membrane. Superficial erosions appear as flat defects of the mucous membrane of various sizes and shapes, covered with fibrinous plaque or clean, their edges are usually low, the mucous membrane in the area of ​​erosion is hyperemic, edematous, more often in the form of a small narrow rim, less often in the form of a wide oval. Hemorrhagic erosions are diverse not only in shape and size, but also in the depth of the lesion of the mucous membrane, and are also covered with hemorrhagic plaque. The mucous membrane around the erosion is pale, slightly edematous, often covered with a layer of scarlet blood or bloody mucus.

An x-ray examination for the diagnosis of gastritis in pregnant women should not be used, since it is of little information, and the harmful effect of x-rays on the fetus is undoubted. Ultrasound allows you to detect on an empty stomach an excess amount of mucus, hypersecretion, assess the condition (thickness) of the stomach wall, local pain under the sensor of the device.

DIFFERENTIAL DIAGNOSIS

Differential diagnosis of the main forms of gastritis is carried out with functional disorders of the secretory function of the stomach ("irritable stomach", gastric or functional achylia). In this case, take into account the fact that chronic gastritis is characterized by more persistent and pronounced symptoms, as well as a picture of inflammatory changes in the mucous membrane according to gastrofibroscopy and biopsy.

Gastritis with preserved or increased gastric secretion and antral gastritis, often manifested by pain, should be differentiated from peptic ulcer. With gastritis, there is no seasonality of exacerbations; at the height of the exacerbation, ulceration of the gastric mucosa is not noted. Polypous gastritis is differentiated from polyposis of the stomach (data of targeted biopsy are decisive).

For the differential diagnosis of antral and giant hypertrophic gastritis with a tumor of the stomach, gastrofibroscopy and targeted biopsy are of decisive importance.

INDICATIONS FOR CONSULTATION OF OTHER SPECIALISTS

Consultation of the therapist and gastroenterologist is shown.

EXAMPLE FORMULATION OF THE DIAGNOSIS

Pregnancy 16 weeks. Chronic gastritis B. Early toxicosis of pregnant women.

TREATMENT OF CHRONIC GASTRITIS DURING PREGNANCY

GOALS OF TREATMENT

Achieve disease remission.

NON-DRUG TREATMENT

Treatment of chronic gastritis should be complex, differentiated and strictly individual. With an exacerbation of the disease, half-bed rest, diet No. 1 according to Pevzner, fractional meals (5-6 times a day) are indicated.

For pregnant women with preserved or increased secretory function of the stomach, it is possible (in the absence of edema, especially in the first half of pregnancy) to prescribe Smirnovskaya and Jermuk mineral waters 150–300 ml three times a day 1.5–2 hours after a meal, since this reduces the time of action of hydrochloric acid on the gastric mucosa. In chronic gastritis with secretory insufficiency, water such as Mirgorodskaya, Essentuki No. 4, No. 17 or Arzni is prescribed.

MEDICAL TREATMENT OF GASTRITIS IN PREGNANT WOMEN

Treatment of pregnant women suffering from chronic gastritis with preserved or increased secretory function is carried out basically in the same way as for patients with peptic ulcer. Elimination of Helicobacter pylori infection during pregnancy is not carried out, since the main drugs used for this purpose (bismuth tripotassium dicitrate, tetracycline) are contraindicated. Oxacillin and furazolidone without bismuth tripotassium dicitrate are ineffective. With a pronounced exacerbation of chronic gastritis B, gastrofarm can be prescribed (2 tablets three times a day 30 minutes before meals), since it has an anti-inflammatory effect. Antisecretory agents (antacids and M-anticholinergics) are used, as in peptic ulcer. Maalox, which has antacid, analgesic and cytoprotective properties, is prescribed in tablets or suspensions 1 hour after a meal. Attapulgite has an adsorbing property, establishes a physiological balance in the stomach, does not lead to the reactive formation of gastric acid; it is prescribed 3-5 times a day, one powder 1-2 hours after a meal and, if necessary, at night. Antispasmodic drugs (papaverine, drotaverine) eliminate pain. Metoclopramide regulates the motor function of the stomach. For the treatment of chronic gastritis with normal or increased gastric secretion, infusions of medicinal plants are used that have anti-inflammatory, astringent, analgesic, enveloping, adsorbing properties: chamomile, mint, flax seed, oats, yarrow, cinquefoil, highlander, calamus rhizome, celandine, sedatives (valerian root, motherwort herb).

With severe secretory insufficiency, special attention is paid to replacement therapy (filling the deficiency of hydrochloric acid and pepsin) - gastric juice (1 tablespoon per 1/2 cup of water), betaine-pepsin in the usual therapeutic doses. For the same purpose, hyperbaric oxygenation is carried out (10 sessions at an oxygen pressure in the pressure chamber of 2 atm.). Patients with chronic gastritis with reduced secretory function are recommended such medicinal herbs that suppress the inflammatory process in the gastric mucosa and stimulate its secretory function: plantain leaves, wormwood, thyme, fennel, cumin, parsley, mint, yarrow, etc. Infusions are prepared from these herbs .

In patients with chronic gastritis A, exocrine pancreatic activity and intestinal digestion are often disturbed. To correct these disorders, pancreatin 0.5-1 g before meals 3-4 times a day is useful. As in chronic gastritis B, gastric motility disorders are corrected with metoclopramide, and antispasmodics are prescribed for pain.

PREVENTION AND PREDICTION OF GESTATION COMPLICATIONS

Compliance with the regime of work and rest, as well as diet. Treatment should be started immediately, because with the progression of toxicosis of pregnant women, vomiting becomes debilitating, hunger and weight loss increase, liver and kidney functions suffer, and blood counts worsen.

FEATURES OF TREATMENT OF GESTATION COMPLICATIONS

Treatment of complications of gestation by trimester

Pregnant women with mild vomiting can be treated on an outpatient basis. With moderate and severe vomiting, treatment is carried out in a hospital. Properly organized therapeutic regimen and the elimination of negative emotions are important for normalizing the function of the central nervous system. Of great importance in the treatment is the rational nutrition of pregnant women. Food should be varied, easily digestible, contain a large amount of vitamins; it should be taken chilled, in small portions every 2-3 hours in the supine position. Mineral non-carbonated alkaline water is shown in small volumes 5-6 times a day.

When hospitalized, the patient must be placed in a separate room. Taking into account the short gestational age, in order to exclude the negative effect on the ovum of drugs, it is advisable to start treatment with non-drug drugs. To normalize the functional state of the central nervous system and eliminate autonomic dysfunction, it is possible to use central electroanalgesia, acupuncture, psychotherapy and hypnotherapy. The use of these non-pharmacological methods alone may be sufficient for the treatment of a mild form of vomiting during pregnancy. Complex therapy is continued until a stable cessation of vomiting, normalization of the general condition, a gradual increase in body weight. Treatment of mild to moderate vomiting during pregnancy is almost always effective. The absence within three days of the effect of the treatment with excessive vomiting is an indication for termination of pregnancy.

Treatment is carried out strictly under medical supervision.

Treatment of complications in childbirth and the postpartum period

Treatment during childbirth and the postpartum period is carried out according to obstetric indications.

INDICATIONS FOR HOSPITALIZATION

Hospitalization is carried out with an exacerbation of this disease and according to obstetric indications.

TREATMENT EFFECTIVENESS ASSESSMENT

To assess the effectiveness of treatment, repeated esophagogastroduodenoscopy is most often performed. After adequate treatment, superficial and hemorrhagic erosions rapidly epithelialize (within 10-14 days), leaving no significant macroscopic traces.

CHOICE OF DATE AND METHOD OF DELIVERY

Childbirth occurs at term through the natural birth canal. CS only for obstetric indications.

INFORMATION FOR THE PATIENT

As a preventive measure, sanatorium treatment of chronic gastritis without exacerbation of the disease is indicated.

Gastritis is one of the most insidious and common diseases of the gastrointestinal tract, which affects all age groups of patients, as well as pregnant women. According to statistics, more than 70% of expectant mothers have experienced acute manifestations of the disease or have chronic gastritis, which manifests itself during pregnancy. What to do if a pregnant woman is diagnosed with gastritis, how to treat the disease?

Gastritis is an inflammation of the mucous membrane of the inner walls of the stomach, which is accompanied by a violation of the production of gastric juice and leads to malfunctions in the functioning of the digestive organ. Gastritis can have an acute or chronic form and proceed in different ways. Despite the fact that gastritis during pregnancy is not a serious pathology and does not threaten the fetus, the disease causes severe discomfort to the mother, who feels pain, heaviness in the stomach, and if left untreated, her health deteriorates sharply. The chronic form of gastritis can cause an ulcer or tumor of the stomach, which is why it is so important to recognize it and start treatment during it.

It is during pregnancy that a woman may first encounter this disease, since pregnancy is a stress for the whole organism, which, adjusting to new conditions, begins to function in a double mode and all organs, including the gastrointestinal tract, become more vulnerable and sensitive to all negative influences.

Gastritis during pregnancy: causes

In most cases, the cause of gastritis in an "interesting position" is an exacerbation of a chronic disease of the gastric mucosa, which was observed in a woman earlier. According to statistics, this is 75% of all cases of the disease.

There are two types of gastritis:

• Type A: Gastritis caused by the progressive development of atrophic processes in the walls of the stomach. Autoimmune cell damage.
• Type B. The disease begins its development after the conditionally pathogenic bacterium Helicobacter pylori enters the stomach, which a woman can become infected with in a domestic way both before conception and after. If before pregnancy the disease did not manifest itself in any way and did not bother the woman, then after a change in the hormonal background during pregnancy, gastritis becomes aggravated and aggravated. Type II gastritis is much more common and requires treatment. Hormonal restructuring, weakening of the immune system, which accompanies pregnancy, provoke an exacerbation of chronic gastritis.

To know exactly what type of gastritis you have, you need to visit a gastroenterologist. Self-diagnosis is strongly discouraged. Improper treatment can lead to complications.

Factors that contribute to the exacerbation of gastritis during pregnancy

1. Wrong and unbalanced diet. At risk are pregnant women who abuse foods high in refined carbohydrates and preservatives. It is dangerous to use those foods that contain harmful dyes, flavors and stabilizers.
2. Lack of protein and vitamins in the diet.
3. Frequent overeating, eating on the go, at night and dry food, as well as insufficient chewing of food can cause exacerbation of gastritis.
4. Iron deficiency in the body.
5. A large number of fatty, spicy foods in the diet. Too hot food exacerbates the disease.
6. Stress, nervous tension, anxiety.
7. The presence of a pregnant infectious disease in a chronic form.
8. hereditary predisposition.

It should be noted that most of the factors that provoke the development and exacerbation of chronic gastritis are associated with malnutrition and non-compliance with the daily routine.

Symptoms of gastritis during pregnancy

The manifestations of gastritis are varied: in some cases, the symptoms of the disease do not appear immediately, in others - instantly, it depends on the type of gastritis and its form.

The most widespread chronic form of gastritis, the cause of which was the defeat of the gastric mucosa by a microorganism - Helicobacter pylori. The bacterium has a detrimental effect and damages the internal walls of the stomach, disrupting the production of gastric juice and the functioning of the organ.

Chronic gastritis during pregnancy does not have characteristic symptoms, so it is quite difficult to diagnose it. Some manifestations of the disease can be mistaken for manifestations of toxicosis, especially in the first trimester. A pregnant woman may feel:

• Slight relaxation of the stool, flatulence.
• Heartburn, nausea, belching.
• Pain and discomfort in the epigastric region.
• Characterized by frequent fatigue, increased excitability, overwork from physical exertion.

In chronic gastritis, it is important to establish the level of acidity of gastric juice, the course of the symptoms of the disease and the subsequent treatment of gastritis depend on this.

Symptoms of gastritis with high acidity:

• Periodic pain in the upper abdomen, in the epigastric region, in the right hypochondrium. Occurs immediately after taking a certain food, less often it can appear on an empty stomach or at night.
• Heartburn, sour eructation, upset stool.

Symptoms of gastritis with low acidity:

With low acidity, when hydrochloric acid is produced in a smaller amount, pain in the stomach is less pronounced. Obvious signs of the disease: nausea, vomiting, unpleasant rumbling in the abdomen, a feeling of heaviness in the stomach, flatulence, general malaise and weakness.

Symptoms of acute gastritis during pregnancy

• The acute form of gastritis begins suddenly, with a sharp pain in the stomach.
• In addition to a severe attack of pain, the pregnant woman feels general weakness, vomiting, nausea and dizziness are possible.
• There are changes in the color of the tongue, it is covered with a yellow or grayish coating.
• With increased acidity, gastritis is manifested by severe heartburn, which is aggravated after eating sweet or sour foods, belching, stool disorder.
• There are pains in the stomach on an empty stomach. If the secretion of gastric juice production is reduced, the pregnant woman feels weakness, nausea, unpleasant rumbling in the abdomen, belching and a specific smell from the mouth, flatulence.

Acute gastritis of the stomach during pregnancy can be provoked by taking medications, products that irritate the mucous membrane of the walls of the stomach, prolonged nervous tension in which the pregnant woman is.

How to diagnose gastritis during pregnancy

At the first suspicion of the presence of the disease and its obvious symptoms, it is necessary to consult a doctor. The insidiousness of gastritis is that many of the symptoms of the disease are similar to other diseases of the gastrointestinal tract and resemble the manifestation of toxicosis during pregnancy, so many expectant mothers are in no hurry to visit the doctor, but try to deal with nausea or heartburn on their own. Diagnosis of gastritis consists in such activities:

• Biochemical analysis of blood, feces, urine of the patient.
• Endoscopy - the removal of digestive fluid from the stomach by probing. This diagnosis allows you to establish the nature of acidity and continue the correct further treatment of the disease.
• Palpation is a method that allows you to determine the affected areas of the gastric mucosa.
• Ultrasound of the digestive tract, which allows you to assess their condition.

How to treat gastritis during pregnancy: treatment methods

Treatment of gastritis is a long and troublesome process that requires the strict implementation of all prescriptions and recommendations of the attending physician. It is especially important to pay attention to the diet and diet, as well as to exclude all stress factors that can re-provoke an exacerbation of gastritis. Before starting treatment, it is imperative to undergo all examinations and determine the form of gastritis, on which subsequent therapy will depend.

For pregnant women, who belong to a special category of patients, endoscopy is prescribed in rare cases, since swallowing a probe is a rather unpleasant procedure.

Proper nutrition for gastritis in pregnant women: diet

If a pregnant woman has exacerbated gastritis, especially in the early stages of pregnancy, which is accompanied by toxicosis, she is first prescribed a special diet. If a woman feels weakness, malaise, the disease proceeds with complications, she is recommended bed rest and rest. Nutrition for gastritis should be fractional, the number of meals from 5 to 6 times a day. In the early days of a diet for gastritis, the consistency of food should be semi-liquid so as not to injure the mucous membrane and not burden the stomach. It can be light vegetable puree soups, milk porridges and soups, milk and cottage cheese are allowed. After a few days, hard-boiled eggs, fresh vegetables, fruits, vegetable side dishes can be introduced into the diet. Over time, pregnant women can switch to a normal diet, not forgetting that foods such as:

• fried foods, spices, seasonings, smoked meats;
• legumes (peas, beans);
• vegetables: cabbage, radish, onion;
• pickles;
• confectionery and sweets;
• meat and fish broths;
• coffee.

Diet for gastritis during pregnancy: basic rules

A diet for gastritis, which is carried out for medicinal purposes, has its own basic rules, which the expectant mother must adhere to.

1. Fractional nutrition, with frequent meals from 6 to 8 times a day.
2. Food should not be coarse, but have a semi-liquid, puree, mushy form.
3. It is strictly forbidden to eat smoked meats, spicy and fried foods, as well as the use of acidic foods that contribute to the production of gastric juice.
4. If possible, limit the use of salt, exclude pickles, pickled foods from the diet.
5. Limit consumption or completely abandon foods containing fast carbohydrates (sweets, flour and confectionery).
6. The daily diet should be varied and nutritious, include a sufficient amount of fats, carbohydrates, vitamins and minerals.
7. With gastritis, you should not eat excessively hot or cold food, food should be at a pleasant temperature, close to body temperature.

• Dried white bread.
• Milk products.
• Boiled river fish (pike, zander or perch are great).
• Boiled poultry meat.
• Steamed vegetable stews, pureed soups, milk soups, steam cutlets, meatballs, quenelles, soft-boiled eggs, semi-liquid porridge.
• Do not forget to include fresh vegetables, fruits, herbs in the menu.

Treatment of gastritis with mineral water

In some cases, for the treatment of gastritis, the doctor may prescribe mineral water to the pregnant woman.
With low acidity, Essentuki No. 4 and 17, Mirgorodskaya have proven themselves well, and with high acidity - Jermuk, Borjomi and others.
Healing mineral water is taken after meals, after 1.5-2 hours. It is not recommended to drink mineral water without consulting a doctor.

Gastritis during pregnancy: drug treatment

Gastritis is a disease for the treatment of which there are a large number of medicines that alleviate the patient's condition. But, do not forget that many of them are contraindicated for pregnant women. Therefore, the main direction of treatment of gastritis in pregnant women is a therapeutic diet.

During pregnancy, antibacterial drugs are prohibited, the action of which is aimed at suppressing the Helicobacter pylori infection. Taking such drugs adversely affects the development of the fetus. Also, antisecretory drugs are not used for treatment.

Pregnant women are prescribed the following medications:

1. Probiotics. It is recommended to take products with a high content of lactic acid bacteria, such as bifid-yogurt, kefir, fermented baked milk. Lactic acid bacteria are available in the form of capsules, powders. Pharmaceutical products: Narine, Bifiform, Bifidum.
2. Dimethicone. Has a regenerating effect.
3. Antispasmodics. Quickly relieve pain, spasms.
4. Cerucal, Raglan. Eliminate nausea, heartburn.
5. Medications with gastric and pancreatic enzymes. May be prescribed if decreased secretory activity is observed.

Phosphalugel, Almagel, Gastal, Maalox, containing aluminum, medicines are not recommended for pregnant women.

Folk remedies for gastritis during pregnancy

For the treatment of gastritis, alternative methods of treatment can be used, which expectant mothers should use only after the approval of the attending physician. It is worth remembering that some medicinal herbs that are effective in folk medicine for the treatment of gastritis are prohibited from taking in the 1st trimester of pregnancy. These herbs include: sage, thyme, plantain, calamus.

Herbal treatment

Herbal decoctions are widely used to treat gastritis. Mint, cinquefoil, chamomile flowers, yarrow relieve pain and reduce inflammation. A decoction of fennel, cumin, thyme gently stimulates the inner walls of the stomach with low acidity. To prepare the decoction, it is necessary to brew 2-3 tablespoons of the collection in 0.5 liters of boiling water, let it brew for 30 minutes, and then strain. In the pharmacy, you can buy ready-made herbal pharmacy fees, packed in phyto-bags, which are brewed like tea. Take a decoction after meals, in a warm form.

Flaxseed for gastritis

Flax seed is one of the most affordable and effective remedies for the treatment of stomach and gastrointestinal diseases. When brewing the seed, mucus is formed, which envelops the walls of the stomach, providing an anti-inflammatory effect. Pregnant women are allowed to take decoctions of flax seed, this does not pose any threat to the developing fetus. However, there is a contraindication to taking if a woman has cholelithiasis or pancreatitis.

Honey treatment

Expectant mothers can use the popular recipe for treating gastritis with honey if they are not allergic to this product. To do this, dilute 1 tablespoon of honey in a glass of warm water. If the acidity is low, drink it an hour before a meal, if it is high, 30 minutes before a meal. The duration of admission is from 1 to 2 months. Honey has a calming effect on the gastric mucosa, relieves inflammation.

Apple treatment

Regularly including apples in your diet, especially green varieties, you can not only improve digestion, but also get rid of gastritis. With gastritis, pregnant women are recommended to eat 2 grated green apples daily on an empty stomach. Eating should be after 30 minutes, not earlier, so as not to provoke increased gas formation. The duration of treatment with apples is 1 month. A month later, apples are eaten every other day, before breakfast.

Women with chronic gastritis should take preventive measures and be observed by a doctor even during pregnancy planning. It's important to stick to your diet, have peace of mind, and enjoy your pregnancy. It is recommended to exclude all harmful foods that can provoke irritation of the gastric mucosa and cause exacerbation of gastritis, which is highly undesirable for the expectant mother and the normal course of pregnancy. If you feel unwell, discomfort in the stomach area, be sure to tell your doctor about your suspicions, who will prescribe competent treatment and help overcome the disease.

Gastritis is a disease of the digestive system characterized by acute or chronic inflammation of the gastric mucosa, as well as a violation of the regenerative properties of epithelial cells. Gastritis has a progressive course and, in severe cases, leads to severe dystrophy and atrophy of the epithelial membrane and the replacement of glandular tissue with fibrous fibers. In pregnant women, exacerbation of gastritis may be associated with a decrease in immunoresistance, eating habits, and a stress factor. Treatment of gastritis during pregnancy is carried out mainly on an outpatient basis under the supervision of not only a gastroenterologist, but also a gynecologist who observes pregnancy.

Inflammation of the stomach is diagnosed in about 10% of pregnant women. The main factor provoking the development of an inflammatory reaction, experts consider a decrease in immunity, which is observed in almost 90% of pregnant women. The weakening of the protective functions of the body contributes to a change in the hormonal background (increased secretion of progesterone and prolactin), leading to a violation of the synthesis of immunoglobulins and a slow formation of the immune response. Decreased immunity can become a catalyst for the growth of pathogenic bacteria Helicobacter pylori, which today are considered the main cause of chronic gastritis in this category of patients.

Note! If a woman suffered from infectious gastritis before pregnancy, the risk of exacerbation of the pathology provoked by an increase in the area of ​​​​contamination of mucous membranes due to a decrease in immune defense will be more than 50%.

Helicobacter pylori - a dangerous enemy of the gastrointestinal tract

Nutritional factor

Exacerbation of chronic gastritis (as well as the primary inflammatory-dystrophic process in the stomach) can also develop against the background of improper eating behavior. The maximum risks of developing gastritis are present in the first trimester and are associated with toxicosis, a painful condition characteristic of the early gestation period (up to 10-12 weeks) and associated with the formation of a “pregnancy center” in the brain, which is responsible for the behavior and physiological functions of the female body in childbearing period.

Nausea and vomiting - the main symptoms of early toxicosis - often lead to the fact that a woman completely loses her appetite, and she begins to refuse to eat. Gastric juice, which is produced in the stomach to digest food, contains components that can adversely affect the condition of the mucous membranes and even cause erosion and local ulceration. These include:

• pepsin (formed as a result of the breakdown of pepsinogen);
• hydrochloric acid;
• proteolytic enzymes (mainly of the class of hydrolases).

If food does not enter the stomach, gastric juice lingers in the cavity of the organ and destroys the epithelial membrane, leading to acute inflammation of its walls.

Important! Provoke gastritis during pregnancy can not only refuse food associated with toxicosis, but also a violation of eating behavior, for example, overeating or eating large amounts of food before bedtime. Chocolate, fatty foods, soda, sausage (especially smoked and raw smoked), spices - all these products can also lead to inflammation of the stomach and exacerbation of chronic gastritis.

stress factor

Emotional lability (a hormone-dependent psycho-emotional disorder characterized by frequent mood swings) is one of the main signs of pregnancy. If a woman is under stress, suffers from depression, neurotic disorders, the risk of gastritis and other diseases of the digestive system increases several times. To prevent this from happening, you need to be outside more often, move enough (if there are no contraindications), avoid emotional unrest and use home relaxation methods, such as audio therapy or salt baths for the feet.

Note! Massage, aromatherapy, baths with essential oils to relieve stress during pregnancy are allowed only after consulting a doctor.

With persistent structural changes in the gastric mucosa, characteristic of chronic gastritis, there are usually no signs. Pronounced symptoms appear during the period of exacerbation, and their intensity depends on the localization of the inflammatory process, the area of ​​dystrophic changes, and the degree of atrophy of the epithelial membrane. The most typical signs for gastritis during pregnancy are manifestations of functional dyspepsia, which include:

In women with chronic gastritis, there is increased weakness, lethargy, drowsiness, loss of strength. Violation of the absorption of vitamins and minerals leads to the development of complications from other organs (cardiac arrhythmia, instability of blood pressure, decreased visual acuity and hearing, etc.) and the appearance of symptoms of beriberi (dry lips and skin, brittle hair, skin rashes). Often, against the background of gastritis, pregnant women develop stomatitis, which is manifested by burning in the oral cavity and the formation of painful sores.

Important! If gastritis during pregnancy is not treated, congenital diseases and fetal defects can be the consequences. This is due to the fact that a woman receives most of the nutrients necessary for intrauterine growth and development of a child with food, after which they are absorbed into the general bloodstream and enter the fetus through the placenta. If digestion is disturbed, vitamin deficiency occurs, which can cause congenital heart defects, anemia and other diseases in the newborn, diagnosed in the neonatal period.

What examinations can be prescribed for pregnant women?

Diagnosis of gastritis during pregnancy is complicated by the inaccessibility of effective and informative diagnostic manipulations that are used to detect pathologies of the gastrointestinal tract in standard gastroenterological practice. Any examinations associated with any risk for the course of pregnancy or fetal development are prescribed to a pregnant woman only after consulting a gynecologist and obtaining an opinion on the possibility and appropriateness of using specific diagnostic methods. Typically, complex diagnostics includes the following types of studies:

• a detailed blood test and a general urinalysis;
• ultrasound examination of the abdominal organs;
• breath tests (measure the concentration of ammonia in the exhaled air after ingestion of an isotope solution of urea).

A woman can also be prescribed daily pH-metry, which allows you to measure the acidity of the gastrointestinal tract and evaluate its changes depending on meals and other external and internal factors.

pH-metry of the esophagus and stomach

Is it possible to do a gastroscopy during pregnancy?

Gastroscopy is the most accurate, effective and informative method for diagnosing gastritis, in which the mucous membranes of the stomach and duodenum are examined using an endoscope. Clinical signs of chronic gastritis during this examination are:

• local or generalized swelling of the mucous membrane;
• hyperemia (redness);
• oval or round erosions with edematous and hyperemic edges;
• increased secretion of mucus;
• increased vulnerability.

Gastroscopy for pregnant women should be carried out only if there are strict indications, since in some cases it can lead to complications, such as infection, damage to the mucous membranes, or perforation of the walls of the digestive tract (extremely rare). The procedure can also provoke an increase in the tone of the uterus and an increase in the symptoms of toxicosis, so gastroscopy is usually not performed for women with a high risk of these pathologies.

What drugs can be taken during pregnancy?

The choice of drugs approved for use during pregnancy is quite large, but any medication should be prescribed by a doctor, taking into account the possible risks to the mother and fetus. If the cause of the inflammatory process in the stomach is a confirmed Helicobacter pylori-associated infection, therapy begins with the use of antibiotics and antimicrobials. These are usually two-drug combinations that need to be taken at the same time as medications and supplements that have prebiotic properties to reduce the side effects of antibiotic treatment.

Table. Antibacterial and antimicrobial agents for the treatment of Helicobacter pylori-associated gastritis in pregnant women.

As auxiliary components, the following groups of drugs may be included in the treatment regimen:

Important! Treatment with drugs traditionally used for the treatment of chronic gastritis (bismuth drugs, proton pump inhibitors) during pregnancy is not carried out due to the high degree of teratogenic effect on the fetus.

Nutrition for gastritis

Diet therapy is the safest way to treat gastritis in pregnant women. It is recommended to adhere to the rules of nutrition for chronic gastritis throughout pregnancy in order to exclude the possibility of repeated relapses and reduce the risks of serious complications. All food with inflammation of the stomach should be consumed in crushed form (preferably in a mushy or puree state), and the temperature of the dishes served should not exceed 36-38 ° C. Do not add any spices and seasonings to the dishes (the exception is fresh herbs) and a large amount of salt. Meals are frequent and non-volume - 5-7 times a day, no more than 220 g per serving.

From the diet must be completely excluded:

• bakery products made from premium wheat flour, as well as rolls with the addition of cereals and bran;
• confectionery products with fatty layers (waffles, cakes) and chocolate (including confectionery glaze);
• fatty foods;
• smoked meat (ribs, shank, carbonade);
• canned food in marinade and brine;
• hot spices;
• carbonated drinks;
• products containing coarse vegetable fiber (raw fruits and vegetables).

The basis of the diet should be broths, salads and vegetable casseroles, boiled lean meat, eggs, fruit purees. Of the drinks, dried fruit compotes and herbal teas (chamomile, mint, linden) are especially useful.

Important! In no case should you treat gastritis by fasting during pregnancy - this can lead to pathologies of pregnancy and abnormal development of the fetus.

Sample daily menu for pregnant women

Since morning:

• liquid oatmeal in water with a spoonful of honey;
• green tea and a sandwich with low-fat cheese and lettuce.

Late breakfast:

• cottage cheese pudding;
• a handful of berries.

Dinner:

• potato soup with meatballs;
• vegetable casserole with chicken fillet;
• dried apricot compote.

Afternoon snack:

• fruit salad with low-fat yogurt dressing;

Dinner:

• grilled fish with tomatoes and bell peppers;
• loose buckwheat;
• chamomile tea.

Before going to bed, you can drink a glass of fermented baked milk, kefir, or eat a little low-fat cottage cheese (with severe hunger).

Folk methods

Alternative medicine recipes for gastritis are a good addition to traditional treatment, but they can only be used to stimulate the regeneration of mucous membranes and reduce symptoms.

Decoction of chamomile with thyme

Pour four tablespoons of a mixture of chamomile flowers and thyme leaves (you can use dried raw materials) into a saucepan and pour 500 ml of boiling water. Cook covered for 15-20 minutes over low heat. After cooling, strain the broth. Take 100 ml 4-5 times a day between meals for 3-4 weeks.

Flaxseed with honey

Such gruel is useful not only for the treatment of gastritis: a large amount of minerals and vitamins can provide almost 30-40% of the needs of a woman and fetus in the necessary elements. To prepare it, you need:

• 5 tablespoons of flaxseed flour or ground flaxseed pour a glass of boiling water, cover and insist for 15 minutes;
• add a teaspoon of honey;
• mix everything thoroughly, add fruit if desired.

To use such a gruel should be 1 time per day for 10-20 days. It is best to eat flaxseed porridge for breakfast.

Gastritis is a serious disease, and pregnancy is not a contraindication for its treatment. Drug therapy for pregnant women should be prescribed only by a specialist after a comprehensive diagnosis and assessment of possible harm and consequences for the course of pregnancy and fetal development.

Video - Features of the treatment of gastritis