medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/2079-701X-2021-15-164-174medsovet-6451Research ArticleФУНКЦИОНАЛЬНЫЕ ЗАБОЛЕВАНИЯ ЖКТFUNCTIONAL GASTROINTESTINAL DISEASESХронический гастрит и функциональная диспепсия. Единство и борьба двух противоположностейChronic gastritis and functional dyspepsia. Unity and struggle of two oppositeshttps://orcid.org/0000-0003-4075-4096БакулинаН. В.BakulinaN. V.

д.м.н., заведующая кафедрой кафедры внутренних болезней, клинической фармакологии и нефрологии

191015, Санкт-Петербург, ул. Кирочная, д. 41

Dr. Sci. (Med.), Head of the Department of Internal Medicine, Clinical Pharmacology and Nephrology

 41, Kirochnaya St., St Petersburg, 191015

natalya.bakulina@szgmu.ruhttps://orcid.org/0000-0001-5720-3528ТихоновС. В.TikhonovS. V.

к.м.н., доцент кафедры внутренних болезней, клинической фармакологии и нефрологии

191015, Санкт-Петербург, ул. Кирочная, д. 41

Cand. Sci. (Med.), Department of Internal Medicine

 41, Kirochnaya St., St Petersburg, 191015

sergeyvt2702@gmail.comhttps://orcid.org/0000-0002-0703-9763ЛищукН. Б.LishchukN. B.

ассистент кафедры внутренних болезней, клинической фармакологии и нефрологии

191015, Санкт-Петербург, ул. Кирочная, д. 41

Assistant of the Department of Internal Medicine, Clinical Pharmacology and Nephrology

 41, Kirochnaya St., St Petersburg, 191015

lishchuk.nadezhda@mail.ruСеверо-Западный государственный медицинский университет имени И.И. МечниковаРоссияNorth-Western State Medical University named after I.I. MechnikovRussian Federation202119102021015164174Copyright © Бакулина Н.В., Тихонов С.В., Лищук Н.Б., 20212021Бакулина Н.В., Тихонов С.В., Лищук Н.Б.Bakulina N.V., Tikhonov S.V., Lishchuk N.B.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/6451

В обзорной статье описывается эпидемиология, клиническая картина, патогенез, подходы к диагностике и терапии хронического гастрита и функциональной диспепсии. Хронический гастрит – необоснованно распространенный диагноз в отечественной клинической практике, устанавливающийся у  большинства пациентов с  беспокоящими диспепсическими жалобами. В  соответствии с  международными согласительными документами, хронический гастрит прежде всего морфологическое понятие. Хронический гастрит не имеет патогномоничных клинических признаков и должен диагностироваться в процессе гистологического исследования слизистой желудка. Функциональная диспепсия – диагноз, отражающий наличие у больного определенного симптомокомплекса (боли или жжение в  эпигастрии, чувство переполнения или раннего насыщения) при отсутствии органических заболеваний, которые могли бы объяснить данную симптоматику. Вторичная диспепсия диагностируется у  пациентов с  органическими заболеваниями верхних отделов желудочно-кишечного тракта, метаболическими или системными заболеваниями, являющимися причиной диспепсического синдрома. В процессе обследования пациента с беспокоящими диспепсическими жалобами врачу целесообразно использовать диагноз «диспепсия неуточненная» — предварительный диагноз до проведения лабораторного и инструментального обследования, направленного на выявление причины диспепсического синдрома. Диспепсия, ассоциированная с Н. pylori, диагностируется у пациентов с хеликобактерной инфекцией. Диагноз пересматривается в динамике и является правомочным в случае купирования жалоб в течение 6 мес. после эффективной эрадикации H. pylori.

 Основными препаратами для лечения пациентов с жалобами диспепсического характера являются ингибиторы протонной помпы и прокинетики. Фиксированная комбинация омепразола и домперидона с замедленным высвобождением активного вещества характеризуется оптимальной эффективностью и хорошим профилем безопасности у пациентов как с функциональной, так и с вторичной диспепсией и обеспечивает высокую приверженность к проводимому лечению.

The review article describes the epidemiology, clinical picture, pathogenesis, approaches to the diagnosis and treatment of chronic gastritis and functional dyspepsia. Chronic gastritis is an unreasonably common diagnosis in our clinical practice, which is diagnosed in patients with disturbing dyspeptic complaints. According to the agreement documents, chronic gastritis is primarily a morphological concept. Chronic gastritis has no pathognomonic clinical signs and should be diagnosed during the histological examination of the gastric mucosa. Functional dyspepsia is a diagnosis that reflects the presence of a certain symptom complex (pain  or burning sensation in  the  epigastrium, a  feeling of  fullness or early satiety) in  the  absence of  diseases that could explain the symptoms. Secondary dyspepsia is diagnosed in patients with organic diseases of the upper gastrointestinal tract, metabolic or systemic diseases that cause dyspeptic syndrome. In the process of examining a patient with disturbing dyspeptic complaints, it is advisable for the doctor to use the diagnosis “unspecified dyspepsia” – a preliminary diagnosis before laboratory and instrumental examination aimed at identifying the cause of the dyspeptic syndrome. Dyspepsia associated with H. pylori is diagnosed in patients with H. pylori infection. The diagnosis is revised over time and is competent if complaints have been relieved within 6 months after effective H. pylori eradication.

The main drugs for the treatment of patients with dyspeptic complaints are proton pump inhibitors and prokinetics. Omeprazole with domperidone sustained release (SR) in a fixed dose combination is characterized by optimal efficacy and a good safety profile in patients with both functional and secondary dyspepsia and ensures a high level of treatment adherence.

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The authors declare that there are no conflicts of interest present.