Terapija gastritisa

Eradikacijska terapija infekcije s H. pylori
Bakterija H. pylori smatra se najvažnijim rizičnim faktorom razvoja karcinoma želuca (35). Eradikacijska terapija može popraviti funkciju korpusa želuca, iako je njena uloga u regresiji atrofičnih promjena nejasna. Eradikacija također štiti od razvoja atrofije žlijezda u bolesnika na dugotrajnoj terapiji inhibitorima protonske pumpe (IPP) (36). Terapijski protokol uključuje kombinaciju antibiotika i inhibitora protonske pumpe. Terapija antibioticima se provodi 10 - 14 dana, uz intenziviranu primjenu IPP (dupla doza). Nakon toga nastavlja se primjena IPP - a kroz naredna 3 tjedna i to u punoj dozi (37). Terapijske sheme za eradikaciju H. pylori infekcije, zavisno o stopi rezistencije H. pylori na klaritromicin, prikazane su u tablici 1. Sukladno recentnim studijama, na pojedinim područjima Republike Hrvatske u kojima su provedena istraživanja, rezistencija na klaritromicin je > 20 % (38 - 40).

Antisekretorna terapija

Inhibitori protonske pumpe

Inhibitori protonske pumpe (IPP) smanjuju lučenje želučane kiseline. Koriste se u sljedećim dozama: pantoprazol (40 mg dva puta dnevno), lanzoprazol (30 mg dva puta dnevno), omeprazol (20 mg dva puta dnevno), rabeprazol (20 mg dva puta dnevno), esomeprazol (40 mg jedan put dnevno). Zbog mogućeg „rebound fenomena“, tj. pojačane sekrecije želučane kiseline uslijed naglog prestanka uzimanja terapije, nakon duljeg uzimanja terapije potrebno je postupno smanjivati dozu.

Antagonisti H2 receptora

Antagonisti H2 receptora imaju dobar učinak na supresiju lučenja želučane kiseline,te malo nuspojava. Primijenjuju se u dozama od: ranitidin (2 x 150 mg dnevno), cimetidin (2 x 400 mg dnevno), famotidin (2 x 20 mg dnevno), nizatidin (2 x 150 mg dnevno) i dr.

Ostali lijekovi

Sukralfat i bizmut poboljšavaju barijeru sluznice želuca. Misoprostol (analog prostaglandina E2) ima citoprotektivan učinak, povećava protok krvi kroz sluznicu želuca, te reducira gastrinom induciranu sekreciju želučane kiseline (41).

Napuci za bolesnike s gastritisom i gastropatijama

Opće preporuke
U osoba s blagim simptomima, promjene životnih navika mogu značajno pridonijeti ublažavanju tegoba.
Preporuča se:
Ograničiti unos hrane i napitaka koji pospješuju simptome gastritisa i gastropatija
• Smanjiti ili eliminirati alkohol.
• Prestati pušiti.
• Izbjegavati prezačinjenu hranu. 

Jesti više manjih obroka

• Jesti četiri do pet malih obroka dnevno, po mogućnosti uvijek u isto vrijeme.
• Jela ne bi smjela biti vruća, prehladna, preslatka ili prekisela.

Nadzirati unos lijekova
• Izostaviti lijekove koji mogu pogoršati simptome ili ih zamijeniti drugima.
Voditi dnevnik simptoma
• Preporuča se svakodnevno bilježiti tegobe
• Navesti učestalost i intenzitet simptoma
• Bilježiti da li su se simptomi javili nakon pojedinih obroka, s naznakom kojih.
Javiti se svom liječniku
• Kod pojave teških simptoma ili simptoma alarma (krvarenje, noćna bol ili
progresivna bol, gubitak na tjelesnoj masi, povišena tjelesna temperatura), treba
se što prije javiti svom liječniku kako bi se odredio daljnji dijagnostički i terapijski
postupak.

Prehrana za bolesnike s gastritisom i gastropatijama

Namirnice	Preporuča se	Ne preporuča se
JUHE	Nemasne juhe od pasiranog povrća (ukuhati sitnu tjesteninu, rižu, krupicu), juha od teletine i peradi, riblja juha	Masne juhe, industrijske gotove juhe, juha od suhog mesa, mesni ekstrakti
MESA	Nemasno bijelo meso pirjano u vlastitom soku, kuhano, pečeno u foliji ili vrećici (piletina, puretina, meso patke i guske)	Prženo i pohano meso, iznutrice, dimljeno meso, salame i trajne kobasice, paštete, mesne konzerve, „fast food“
RIBE	Plava riba (srdela, iglica, inćun, skuša) kuhana ili pečena u foliji, prije serviranja prelivena maslinovim uljem	Masna riba (tuna, šaran, som), riblje konzerve, sušena, marinirana, dimljena i soljena riba, kamenice
JAJA	Tvrdo kuhana jaja	Pržena jaja
MLIJEKO I MLIJEČNI PROIZVODI	Fermentirani mliječni proizvodi(jogurt, acidofil, kefir, LGG-proizvodi), vrhnje i sir s niskim udjelom masti	Punomasno mlijeko i vrhnje, svježi kravlji sir, masni sirevi, čokoladno mlijeko, frape, mliječni sladoled
KRUH I ŽITARICE	Bijeli, odstajali kruh, dvopek, tost, tjestenina, riža, kukuruzna i pšenična krupica	Crni kruh, kroketi
POVRĆE I SALATE	Kuhani krumpir, mrkva, brokula, kupus, kelj, leća, zelena salata, kopriva, radič, rikola, artičoka, cikla, šparoga	Rajčica, feferoni, češnjak, mladi luk, crveni luk, krastavci, kiseli kupus, paprika, prženi krumpir
MASNOĆE	Maslinovo ulje, suncokretovo i biljno ulje	Loj i mast, maslac, majoneza s visokim udjelom masti
SLASTICE	Bademi, keksi i kolači s niskim sadržajem šećera i masti	Čokolada, grickalice, med
VOĆE	Ananas, kokos, marelica, trešnja, jabuka, banana, dinja kruška, šumsko voće u manjim količinama	Agrumi ili citrusno voće (limun, mandarina, narandža, grejp, limeta), jagoda
PIĆA	Agrumi ili citrusno voće (limun, mandarina, narandža, grejp, limeta), jagoda	Zaslađeni gazirani napitci, voćni sokovi, alkohol, kava i čaj
ZAČINi	Đumbir	Kocka za juhu, koncentrat rajčice, ocat, metvica, kečap, čili, papar, ograničiti unos soli

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