What is the history of the stomach and intestines? How have our understanding and perceptions of these vital organs evolved over time? Discover the fascinating insights into the ancient and medieval perspectives on the digestive system.

Ancient and Medieval Perspectives on the Digestive System

Ancient and medieval anatomists had a fairly accurate understanding of the gross physiological structure of the stomach, colon, and intestines. They recognized the importance of digestion as a key aspect of maintaining the body’s humoral balance. Initially, medical practitioners viewed the stomach as an active, almost thinking agent in the body.

Galen, the renowned ancient Greek physician, saw the stomach as an animate being that could feel its own emptiness and generate the sensation of hunger. He described it as a “storehouse of nutrition that sorted the wheat from the chaff,” processing and distributing the nutrients to the body.

In contrast, the intestines and colon were seen as more passive, relying on their physical attributes of length and thickness to absorb nutrients and contain waste. Galen also observed that the longer and varied size of the intestines was a sign of a higher being, in contrast to “voracious animals” that “both feed continually and as incessantly eliminate.”

The Evolving Perspectives on Digestion and the Digestive Organs

In the early eleventh century, the medieval Islamic medical philosopher Avicenna was less concerned about descriptive anatomy and more focused on the importance of nutrition and the vulnerability of the stomach to illness. He provided copious advice about diet and digestion, recognizing the impact of mental excitement, emotion, and vigorous exercise on the digestive process.

Later medieval and Renaissance medical practitioners built upon these ideas, offering complexion theories of the stomach as a cold and dry organ that was among the principal organs of the body. In the Galenic tradition, the stomach was seen as the site of the first digestion, as the body digested nutrients in multiple ways. The shape, texture, and location of the stomach were all believed to facilitate this process.

The Influence of Increased Dissection on Anatomical Understanding

Increased dissection led to more detailed descriptions of the organs involved in digestion, and to illustrations reflecting this new approach to anatomy. In 1497, Alessandro Benedetti described the stomach as “denticulated or corrugated [in appearance] with thick skin in the manner of a blackberry.”

At the end of the fifteenth century, Berengario da Carpi wrote about the stomach’s complex structure, noting its “thick, fleshy, and muscular nature” and the presence of “various glands” within it. This increased anatomical understanding paved the way for further advancements in the study of the digestive system.

The Importance of the Stomach and Intestines in Ancient and Medieval Thought

The ancient and medieval perspectives on the stomach and intestines reveal a deep fascination with the structure and function of these vital organs. The believed that the shape, texture, and location of the digestive organs were indicative of their purpose and significance within the body.

The continued interest in the human intestines as a sign of a higher being, as well as the poetic descriptions of the stomach as a “kettle of food” with the liver as its “fire,” demonstrate the cultural and symbolic importance attached to the digestive system in these eras.

The Evolution of Anatomical Knowledge over Time

The history of the understanding of the stomach and intestines illustrates the gradual evolution of anatomical knowledge, from the relatively accurate gross descriptions of ancient and medieval anatomists to the more detailed, dissection-based insights of the Renaissance period.

This progression reflects the ongoing process of scientific discovery, where new techniques and technologies, such as increased dissection, enabled a deeper and more nuanced understanding of the human body and its internal structures.

The Lasting Impact of Ancient and Medieval Perspectives

The ancient and medieval perspectives on the digestive system have had a lasting impact on our understanding of the human body and the way we think about the relationship between the various organs and systems.

While some of the specific theories and beliefs may have been refined or disproven over time, the core recognition of the importance of digestion and the complexity of the digestive organs continues to shape our modern understanding of the human body and its functions.

The Enduring Fascination with the Digestive System

The history of the stomach and intestines demonstrates the enduring fascination that humans have had with the inner workings of the body. From the ancient Greek and Islamic medical philosophers to the Renaissance anatomists, the digestive system has been a source of both scientific inquiry and cultural symbolism.

This ongoing interest in the digestive system, and the continued efforts to understand its structure and function, reflects the vital importance of these organs to overall human health and well-being. As our knowledge of the digestive system continues to evolve, so too will our appreciation for its complexity and its central role in the functioning of the human body.

History of the Stomach and Intestines

History of the Stomach and Intestines

 HISTORY
OF THE STOMACH AND INTESTINES

“The stomach is lowest and has a hidden place in the body because
of its uncleanness, as though nature had spared the principal members and
had relegated the stomach or bowels farther away from the site of reason
and of the mind and fenced it off with the diaphragm in order not to disturb
the rational part of the mind with its importunity.  These members serve
the higher ones.  Some of them concoct the food into juice, others digest
it into various humors, others expel the superfluity.” — Alessandro
Benedetti, 1497

Ancient and medieval anatomists had fairly accurate gross physiological knowledge
of the structure of the stomach, colon, and intestines, dividing the later into
six sections whose names are still retained today in modern anatomy.   They
recognized the importance of digestion as a key aspect of maintaining the
humoral balance of the body, suggesting
that, if the stomach and intestines’ functions were impaired, other bodily functions
would suffer.  Initially medical practitioners viewed the stomach as an
active, almost thinking agent in the body.  Galen saw the stomach as an
animate being that could feel its own emptiness and generate the sensation of
hunger, writing:  “[Nature] has granted to the stomach alone and particularly to the
parts of it near its mouth the ability to feel a lack which rouses the animal
and stimulates it to seek food. ”  He additionally described it
as a storehouse of nutrition that sorted the wheat from the chaff:

“For just as workmen skilled in preparing wheat cleanse it of any earth,
stones, or foreign seeds mixed with it that would be harmful to the body,
so the faculty of the stomach thrust downward anything of that sort, but
makes the rest of the material, that is naturally good, still better and
distributes it to the veins extending to the stomach and intestines. ”  

The intestines
and colon, on the other hand, were more passive, relying on their physical
attributes of length and thickness to absorb nutrients and contain waste. 
Galen further observed that the longer and varied size of the intestines was a
sign of a higher being.  He contrasted this kind of intestine to that of “voracious
animals … [that] both feed continually and as
incessantly eliminate, leading a life truly inimical to philosophy and music,
as Plato has said, whereas nobler and more perfect animals neither eat nor
eliminate continually.”  The continued fascination with the
shape of the human intestines as indicative of their special purpose is apparent
in this early modern Islamic illustration:    

In
the early eleventh century, the medieval Islamic medical philosopher Avicenna was much less concerned about descriptive anatomy. 
Instead, he recognized the importance of nutrition and the vulnerability
of the stomach to illness, giving copious advice about diet and some about
digestion, writing primarily about the stomach
and intestines in relation to these two factors.   Very practically he
observed, “Mental excitement or emotion; vigorous exercise; these
hinder digestion.”  Later medieval and
Renaissance medical practitioners built upon these ideas by offering complexion theories of the stomach as a cold and dry organ that
was among the principal organs of the body.  In the Galenic tradition, it
was the site of first digestion, since the body digested nutrients in multiple
ways.  Every aspect of its shape and texture — even its location –
facilitated this process.  Master Nicolaus in the twelfth century
poetically wrote:  “The stomach has the liver below it like a fire underneath a cauldron;
and thus the stomach is like a kettle of food, the gall-bladder its cook,
and the liver is the fire.”  The illustration above, from a
medieval anatomy book, demonstrates this idea in the way both the liver and
stomach are drawn.  Similarly, the names of parts of the digestive system
recalled their specific functions.   Many thought that the colon was a
colander that strained the feces.

Increased dissection led to more detailed
descriptions of the organs involved in digestion, and to illustrations such as
the one below reflecting this new approach to anatomy.  

In
1497, Alessandro Benedetti lingered over its “denticulated or corrugated
[appearance] with thick skin in the manner of a blackberry.” 
At the end of the fifteenth century, Berengario da Carpi wrote:

“The stomach’s substance is predominantly sinewy. 
Its color is evident.  Its form is round and arched like a Moorish gourd. 
It is connected to the
heart by arteries, to the liver and spleen by veins, to the vein by descending
nerves.  It is attached to the anus by intestines and to the mouth by means
of the gullet.”  

None of this new detail, however, fundamentally
changed the image of the stomach.  It was still a cold and dry organ,
situated at the crossroads of the arterial and venal systems, that was literally
roused to life within the body.   In the age of Christopher Columbus,
however, descriptions of the intestines borrowed from the world of commerce and
exploration.  Andreas de Laguna observed in 1535, “Indeed the intestines
are rightly called ships since they carry the chyle and all the excrement
through the entire region of the stomach as if through the Ocean Sea.” 
He aptly compared them to “those tall
ships which as soon as they have crossed the ocean come to Rouen with their
cargoes on their way to Paris but transfer their cargoes at Rouen into small
boats for the last stage of the journey up the Seine.” 

Renaissance anatomists continued to moralize the
digestive system, associating the stomach and intestines with the impurities of
the body, organs devoid of innate spirituality that were nonetheless essential
to the proper functioning of the body.  The
body, it seems, needed to have both spiritual and natural members. 

The Renaissance artist and anatomist Leonardo da Vinci gives the most interesting reading on the gastrointestinal
tract, as he believed the digestive system aided the respiratory
system in its function.   “The compressed intestines with the condensed air which is generated
in them, thrust the diaphragm upwards; the diaphragm compresses the lungs
and expresses the air,” he wrote in his unpublished notebooks in the
1490s.  Interestingly enough,
the opening of the lungs is caused by the relaxation of the stomach muscles,
which makes the bowels descend, drawing down the diaphragm and then opening
the lungs.   In keeping with the Renaissance ideal of the
“Great Chain of Being,” in which all things of the world were
connected to each other in a clear hierarchy, breathing was a process that could
not be isolated only in the upper portion of the body.  Respiration, in
essence, was cause by intestinal air “which arises from the desiccation
of the faeces which give off vapors.”  Digestion involved not
only the organs but also the abdominal muscles, as they contracted and relaxed.

Such ideas would have interested William Harvey and his
contemporaries, if they had had access to Leonardo’s unpublished manuscripts,
though Harvey surely would not have agreed with this famous artist in all of his
conclusions.   Leonardo’s drawing of the stomach and intestines is well
worth looking at.  Do you discern any traces of his ideas in the image?

In the early sixteenth century, the German healer
and mystic Paracelsus would place special emphasis on the stomach as a chemical
laboratory within the body, as part of his efforts to reintroduce alchemical
theory into medicine.  Very few physicians in his own lifetime subscribed
to this idea, prefering a humoral account of digestion.  In the
mid-seventeenth century, a Flemish physican and follower of Paracelsus, Jan
Baptiste Van Helmont, returned to this idea.  He offered the first chemical
account of digestion. 

Eventually, medical practitioners came to see the
stomach, colon, and intestines as important, yet base and natural
organs.  The Scottish medical student John Moir recorded the following joke
in 1620 by his professor:  the “intestines are comparable to a jester, who unless gravely
insulted remains equatable. ”  When Harvey wrote about these organs in Lectures on the Whole of
Anatomy (1653), he no longer emphasized the animate qualities of the stomach
and intestines, preferring instead to describe some of quantitative features of
these parts of the body such as his estimate the the intestines were
approximately six times the length of the human body.  He continued the
process of refining descriptive anatomy.  “Intestines are, therefore, made up of tunics, and these from fibers,
flesh, parenchyma, veins, arterie, mesenterics, mucous crust, and fat.” 
Do such descriptions suggest a certain loss of poetry in accounts of the
body?

QUESTIONS:   WHAT ARE
THE DIFFERENCES BETWEEN THE IDEA OF THE STOMACH AS A PASSIVE OR ACTIVE
AGENT?  WHAT MIGHT HAVE DISTINGUISHED HUMORAL FROM ALCHEMICAL ACCOUNTS OF
THE STOMACH?

Return to the History of
the Body Home Page

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What Is Stomach Cancer? | Types of Stomach (Gastric) Cancer

Cancer starts when cells in the body begin to grow out of control. Cells in nearly any part of the body can become cancer, and can then spread to other areas of the body. To learn more about cancer and how it starts and spreads, see What Is Cancer?

Stomach cancer, also called gastric cancer, begins when cells in the stomach start to grow out of control.

The stomach

To understand stomach cancer, it helps to know about the normal structure and function of the stomach.

The stomach is a sac-like organ that’s an important part of the digestive system.

After food is chewed and swallowed, it enters the esophagus, a tube that carries food through the throat and chest to the stomach. The esophagus joins the stomach at the gastroesophageal (GE) junction, which is just beneath the diaphragm (the thin sheet of breathing muscle under the lungs). The stomach then starts to digest the food by secreting gastric juice. The food and gastric juice are mixed and then emptied into the first part of the small intestine called the duodenum.

Some people use the word ‘stomach’ to refer to the belly area. The medical term for this area is the abdomen. For instance, some people with pain in this area would say they have a ‘stomach ache’, when in fact the pain could be coming from some other organ in the area. Doctors would call this symptom ‘abdominal pain,’ because the stomach is only one of many organs in the abdomen.

Stomach cancer is different from other cancers that can occur in the abdomen, like cancer of the colon or rectum (large intestine), liver, pancreas, or small intestine. These cancers can have different symptoms, different outlooks, and different treatments.

Parts of the stomach

The stomach has 5 parts.

The first 3 parts make up the proximal stomach:

• Cardia: the first part, which is closest to the esophagus
• Fundus: the upper part of the stomach next to the cardia
• Body (corpus): the main part of the stomach, between the upper and lower parts

Some cells in these parts of the stomach make acid and pepsin (a digestive enzyme), which combine to make the gastric juice that helps digest food. They also make a protein called intrinsic factor, which the body needs to absorb vitamin B12.

The lower 2 parts make up the distal stomach:

• Antrum: the lower portion (near the small intestine), where the food mixes with gastric juice
• Pylorus: the last part of the stomach, which acts as a valve to control the emptying of the stomach contents into the small intestine

Other organs near the stomach include the small intestine, colon, liver, spleen, and pancreas.

The stomach wall has 5 layers:

• The innermost layer is the mucosa. This is where stomach acid and digestive enzymes are made. Most stomach cancers start in this layer.
• Next is a supporting layer called the submucosa.
• Outside of this is the muscularis propria, a thick layer of muscle that helps move and mix the stomach contents.
• The outer 2 layers, the subserosa and the outermost serosa, wrap the stomach.

The layers are important in determining the stage (extent) of the cancer, which can affect a person’s treatment options and prognosis (outlook). As a cancer grows from the mucosa into deeper layers, the stage becomes more advanced and treatment might need to be more extensive.

Development of stomach cancer

Stomach cancers tend to develop slowly over many years. Before a true cancer develops, pre-cancerous changes often occur in the inner lining (mucosa) of the stomach. These early changes rarely cause symptoms, so they often go undetected.

Cancers starting in different sections of the stomach can cause different symptoms and tend to have different outcomes. The cancer’s location can also affect treatment options. For example, cancers that start at or grow into the GE junction are usually staged and treated the same as cancers of the esophagus. (For more information, see Esophagus Cancer.)

Types of stomach cancer

Adenocarcinomas

Most cancers of the stomach (about 90% to 95%)
are adenocarcinomas. These cancers develop from the gland cells in the innermost lining of the stomach (the mucosa).

If you are told you have stomach cancer (or gastric cancer), it will almost always be an adenocarcinoma. The information on the following pages that discusses stomach cancer refers to this type of cancer.

There are 2 main types of stomach adenocarcinomas:

• The intestinal type tends to have a slightly better prognosis (outlook). The cancer cells are more likely to have certain gene changes that might allow for treatment with targeted drug therapy.
• The diffuse type tends to grow spread more quickly.
  It is less common than the intestinal type, and it tends to be harder to treat.

Other types of cancer that can start in the stomach

Gastrointestinal stromal tumors (GISTs)

These uncommon tumors start in very early forms of cells in the wall of the stomach called interstitial cells of Cajal. Some GISTs are much more likely than others to grow into other areas or spread to other parts of the body. Although GISTs can start anywhere in the digestive tract, most start in the stomach. For more information, see Gastrointestinal Stromal Tumor (GIST).

Neuroendocrine tumors (including carcinoids)

Neuroendocrine tumors (NETs) start in cells in the stomach (or other parts of the digestive tract) that act like nerve cells in some ways and like hormone-making (endocrine) cells in others. Most NETs tend to grow slowly and do not spread to other organs, but some can grow and spread quickly. NETs are discussed in more detail in Gastrointestinal Neuroendocrine (Carcinoid) Tumors.

Lymphomas

These cancers start in immune system cells called lymphocytes. Lymphomas usually start in other parts of the body, but some can start in the wall of the stomach. The treatment and outlook for these cancers depend on the type of lymphoma and other factors. For more information, see Non-Hodgkin Lymphoma.

Other cancers

Other types of cancer, such as squamous cell carcinomas, small cell carcinomas, and leiomyosarcomas, can also start in the stomach, but these cancers are very rare.

Anatomical classification of the shape and topography of the stomach

Abstract

The aim of the study was to present the classification of anatomical variations of the stomach, based on the radiological and historical data. In years 2006–2010, 2,034 examinations of the upper digestive tract were performed. Normal stomach anatomy or different variations of the organ shape and/or topography without any organic radiologically detectable gastric lesions were revealed in 568 and 821 cases, respectively. Five primary groups were established: abnormal position along longitudinal (I) and horizontal axis (II), as well as abnormal shape (III) and stomach connections (IV) or mixed forms (V). The first group contains abnormalities most commonly observed among examined patients such as stomach rotation and translocation to the chest cavity, including sliding, paraesophageal, mixed-form and upside-down hiatal diaphragmatic hernias, as well as short esophagus, and the other diaphragmatic hernias, that were not found in the evaluated population. The second group includes the stomach cascade. The third and fourth groups comprise developmental variations and organ malformations that were not observed in evaluated patients. The last group (V) encloses mixed forms that connect two or more previous variations.

Keywords: Stomach, Anatomical variation, Imaging, Surgery

Introduction

Classic anatomical textbooks describe the stomach as the most dilated part of the digestive tract, located beneath the diaphragm in the left hypochondriac and epigastric region of the abdominal cavity [20, 30, 32]. Its shape and position are strongly associated with organogenesis. Any developmental abnormality of the organ itself or nearby located viscera and peritoneum, as well as their vessels and nerves may influence stomach morphology [3, 20, 26, 29, 30]. The final topography depends also on contents of the stomach and surrounding viscera, respiratory phase, age and body type of the individual. The empty organ is characterized by a cylindrical form with a well-formed anterior and posterior wall, lesser and greater curvature as well as fundus, cardia, body and pylorus (Figs.  a, ). In distended one, the anterior wall increases the area attached to the abdominal wall. During inspiration the organ is displaced downward, while elevated in expiration. Any abnormal fluid accumulation in the pleural and peritoneal cavity may change the stomach shape as well. Heavily build hypersthenic individuals with short thorax and long abdomen are likely to have stomach that is placed in higher position and more transversally. In persons with a slender asthenic physique, the stomach is located lower and more vertical. More vertical position and slightly left organ translocation—secondary to a relatively large liver—are typical of young children, in particular in newborns [30].

Diagrams with the most common, anatomical variances of the stomach: typical shape of the stomach (a), malrotation (b), sliding hiatal hernia (c), paraesophageal hiatal hernia (d), mixed-form hiatal hernia (e), upside-down hernia (f), congenital short esophagus (g), cascade (h), lack of the whole organ (i), lack of the fundus (j), short body (k), advanced enlargement (l), congenital gastroduodenal (m) and gastroileal (n) fistula

A typical radiological shape and localization of the stomach

Classical anatomical description presented above, is not always seen in clinical practice. Different variations of the typical shape of the stomach are frequent. The aim of the study was to present classification of the shape and position of the unoperated stomach.

Materials and methods

The study was conducted on the retrospective data collected during various radiological examinations taken in 2006–2010 in the Second Radiological Department of the First University Hospital, Medical University of Lublin, Poland. All patients were sent for the checkup for various medical reasons with empty stomach. The examination was performed using Siregraph CF-System (Siemens, Germany) during single- or double-contrast fluoroscopy. Barium sulfuricum suspension (TERPOL, Poland) or Prontobario HD (Bracco S.P.A., Italy) was applied as a positive contrast in unoperated patients. Water-soluble contrasts such as Gastrografin (Berlimed S.A. Poligono Industrial Schering AG; Leverkusen, Germany) or Uropolinum (Zakłady Farmaceutyczne POLPHARMA; Starogard Gdanski, Poland) were administered for operated patients. Stomach air or pretreatment with Dougas (Bracco S.P.A., Italy) was used as a source of the negative contrast. Each patient was typically examined in Trendelenburg position, followed by supine, semirecumbent, antero-posterior and lateral erect position. Any other positions were used when needed. Single and serial pictures with acquisition time one up to 4–5 pictures per second were stored on the hard disc.

The classification was established exclusively for patients without any organic radiologically detectable stomach lesions, i.e., severe gastric inflammations, ulcer disease, neoplasms, etc. Five primary groups of the organ shape and topography were established: abnormal position along it longitudinal (I) and horizontal axis (II), as well as abnormal shape (III) and connections (IV) or mixed forms (V).

Obtained results were evaluated only qualitatively, since data were collected at a hospital that is highly specialized in esophageal and stomach surgery and the group of examined patients’ does not cover the general population.

Results

During evaluated period, 2,034 examinations of the upper part of digestive tract were performed. From among the whole group 1,389 patients passed the criteria of the study. Normal stomach anatomy was observed in 568 cases, while in 821 patients different variations of the organ shape and topography were reveled.

A regular, physiological position of the stomach—as presented at the introduction—was the most commonly observed among all the examined individuals (Figs. a, ). Abnormal anatomical variances were seen less frequently. In unoperated patients the two main groups of the stomach variations were established: (I) abnormal positions along the longitudinal axis of the organ, and (II) abnormal positions along various horizontal axes (Table ; Fig. b–n). Two additional groups, i.e. (III) abnormal shape of the organ, (IV) abnormal congenital connections of the stomach could also be added, however, they were not observed in our department and they do not pass the criteria of “healthy” organ. The last group (V) contains mixed forms, which pass criteria two or more primary groups (I–IV).

Table 1

Morphological classification of the shape and topography of unoperated stomach

I. Abnormal positions along the longitudinal axis of the organ (organoaxial)

Ia. Malrotation

Ib. Translocation to the chest cavity

1. Through the esophageal diaphragmatic hiatus (hiatal hernias)

Sliding hiatal hernia (type I)a

Paraesophageal hiatal hernia (type II)a

Mixed form (type III)a

Intrathoracic stomach—upside-down hernia (type IV)a

Congenital short esophagus

2. Through other esophageal openings (diaphragmatic hernias)

Posterolateral (Bochdalek) hernia

Anterolateral (Morgagni) hernia

Central (septum-transversum) hernia

II. Abnormal positions along various horizontal axis (mesenteroaxial)

Cascades (mesenteroaxial volvulus)

III. Abnormal shape of the stomach

Lack of the whole organ

Lack of the fundus

Short body

Advanced enlargement (dilatation)

IV. Abnormal congenital connection of the stomach

Gastroduodenal fistula

Gastrointestinal fistula (-ileal, -jejunal)

Gastrocolic fistula

Gastrocutaneous fistula

Other, less common fistulas

V. Mixed form of the stomach shape

The first group included the stomach rotation (Ia), and translocation to the chest cavity (Ib). Different degrees of the stomach rotation were easily seen when position of the pylorus and the lesser and greater curvatures were examined (n = 84). In the extreme situation, a frontward (n = 3/84) and backward (n = 11/84) direction of the lesser curvature was found (Figs. b, ). However, the most common type of the anomaly in the first group was the sliding hiatal diaphragmatic hernia (n = 522) (Figs. c, a). Less frequently, the paraesophageal hiatal (n = 12) (Figs. d, b), mixed-form (n = 43) (Figs. e, c) and upside-down hernias were found (n = 37) (Figs. f, d). The congenital short esophagus (Fig. g) and other diaphragmatic hernias of the stomach were not revealed, although all of them could be added to the Ib group.

Stomach rotation along the longitudinal axis

The sliding (a), paraesophageal (b), mixed-form (c) and upside-down (d) hiatal stomach diaphragmatic hernias

The second group contains stomach cascade of different stages (n = 80) (Figs.  h, a). Furthermore, the upside-down diaphragmatic hernia (n = 12/37) with both cardia and pylorus in the infradiaphragmatic position (Fig. f) could be included to this group as well.

The third group contains congenital abnormal shape of the organ i.e. lack of the whole organ (Fig. i), lack of the fundus (Fig. j), short stomach body (Fig. k) and prominent organ enlargement (dilatation) (Fig. l).

All the abnormal congenital connections of the stomach were enclosed in the fourth group. According to the available literature, the most common fistulas are gastroduodenal (Fig. m), gastrointestinal (Fig. n), gastrocolic and gastrocutaneous.

The last group (V) contains mixed forms. Such abnormalities were seen in 44 patients with a cascade and malrotation or different types of diaphragmatic hernias (Fig. b).

Discussion

The currently presented classification seems to be the first that clearly and completely describes anatomical positions of the stomach. Similar classifications were not available in the world literature.

Among all the examined patients with anatomical variances of the stomach, the most common position was the hiatal hernia (about 60–75% depends of the year). However, such high incidence cannot be regarded as typical for the Polish and even local population, while the study was performed in the University Hospital with a Surgical Department that is highly specialized in the esophageal and stomach surgery and is referential for the south-east part of Poland. Moreover, some patients were admitted to the hospital with previous, well-documented diagnosis and additional radiological examinations were not performed.

Since the first description in 1926 [2], confirmed by later studies, translocations of the stomach along its long axis is divided into sliding, paraesophageal and mixed-form hiatal diaphragmatic hernia, as well as a congenital short esophagus.

The sliding hiatal diaphragmatic hernia is the most common type seen on the level of esophageal hiatus and is characterized by the direct dislocation of the stomach cardia into the posterior mediastinum. Such anomaly is observed in 80–90% of the abnormal translocations of the stomach through this foramen [23]. Epidemiological data suggest a strong geographical and socioeconomic-dependent distribution of the disease. Its highest prevalence was observed in well-economically developed communities of the North America and the Europe, where the incidence reaches 15–20% of the adults. It increases with age, from 10% in patients younger than 40 years to 70% in those older than 70 years [41, 47]. However, much lower incidence (0.3%) was presently found among 637,518 Americans by Hauer-Jensen et al. [21]. Contrary to those data, the disease is extremely rare in rural African communities. Such abnormal stomach position was revealed in four out of 1,030 examined Nigerians [4], one of 1,000 Kenyans [44] and one of 700 Tanzanians [19]. A low incidence was also reported throughout India, the Middle East and East Asia [9]. A strong environmental influence, with no or low genetic predisposition was proved by observation of the same incidence of the sliding hiatal hernia in Afro-Americans and Caucasian Americans [9]. It was also noted in two different Korean studies taken at a 35-year interval, characterized by extremely high positive socioeconomic changes of the country. Kim [25] found only 14 cases (1.4%) of the hernia among 1,000 examined patients, while in 1999 it was revealed in 41 (4.1%) out of 1,010 individuals [46]. Unlike other investigations, Boghratian et al. [7] observed male gender predilection in patients with hiatal hernia after examination of 4,700 Iranians. Moreover, the disease is observed mostly in older patients. However, due to the abnormal prenatal enlargement of the esophageal hiatus, a congenital sliding hiatal hernia may also be found but have to be differ from the short esophagus (see below) [34]. Furthermore, the hernia is commonly associated with diverticular disease and less frequently with cholelithiasis—Sait’s triad [21]. Also obesity (BMI ≥ 25 kg/m²), advanced renal insufficiency, prolapse of the mitral valve [22] and persistent high intraabdominal pressure increase risk of the hernia [13, 37, 45]. High abdominal pressure was also found as one of the leading factors in other diseases associated with a hiatal hernia, i.e., inguinal hernia and prolapse of pelvic organs [13, 39]. As a consequence of herniation, a relaxation of the lower esophageal sphincter, wider cardiac angle and esophageal empting impairment increase the possibility of the gastro-esophageal reflux. On the other hand, the hiatal hernia and gastro-esophageal reflux disease (GRED) itself are risk factors for Barrett’s esophagus, chronic blood loss and iron-deficiency anemia [5, 36], vertebral fracture [31], atherosclerosis, as well as esophageal and laryngeal neoplasms [5].

The second type of hiatal hernia is the paraesophageal one, morphologically characterized by the normal position of the cardia but the adjusted part of the stomach fundus is slided superiorly through the esophageal hiatus. The paraesophageal and mixed-form hernias—that combined sliding and paraesophageal features—have not been extensively epidemiologically studied. Both types (II and III according to Akerlund) are observed less often [23] nevertheless their surgical treatment significantly increases morbidity and mortality [12, 40]. In advanced stage of the mixed-form hernia, the whole stomach is located intrathoracically (upside-down stomach hernia). Nowadays, prevalence of such anomaly increases especially in symptomatic patients [35]. According to the currently published data, a frequency of the intrathoracic stomach is about 52 per one million persons. The disease is strongly associated with age, and affects especially elderly people (>65 year), more commonly blacks than whites [35].

The last type of the hiatal hernia is the congenital short esophagus. According to the classic description by Peters [34], it significantly differs from the acquired type that is always associated with the sliding diaphragmatic hernia (Table ). The incidence of the developmental anomaly is estimated as 3–14% of all patients that undergo antireflux surgery [14] and 0.084% of the general population [34].

Table 2

Differences between the congenital and acquired short esophagus based on Peters [34]

All anomalies listed above have to be distinguished from congenital or acquired diaphragmatic hernia, in which the stomach with or without other abdominal organs enters the thoracic cavity through diaphragmatic openings other than the esophageal hiatus. Most frequently they are enlarged sternocostal and lumbocostal triangles or pathological openings that are secondary to diaphragmatic injuries or their abnormal development. The congenital diaphragmatic hernia occurs one in every 2,500 live births, and in about 30% of spontaneous abortions [42]. The posterolateral (Bochdalek) and anterolateral (Morgagni) types are found in 70 and 27%, respectively. In remaining cases (2–3%), the opening is located on the level of the central tendon (septum-transversum type). From among all the Bachdalek’s hernias, the left (85%) and bilateral (2%) ones normally include the stomach [17, 18]. Experimental data suggest that, prenatal exposure to herbicide (i.e., nitrofene), corticosteroids and non-selective cyclooxygenase inhibitors increase the risk of the anomaly. All those xenobiotics may disturb organogenesis by the influence on vascular development of stomach, surrounding viscera and abdominal wall, including diaphragm [8, 10, 11, 18, 29, 33]. However, those findings were not entirely confirmed in humans [24], in which a strong correlation with genetic (Sonic Hedgehog—Shh gene pathways) and environmental factors were found [11]. Furthermore, the disease is more common in males and whites. It commonly complicated respiratory distress, pulmonary hypoplasia, and less frequently, pleural effusion, esophageal reflux, patent ductus arteriosus, atrial and ventricular septal defects, as well as congenital infections, acidosis and neonatal jaundice [28].

The second subgroup of abnormal position of the stomach along the long axis of the organ is various degree rotations of the stomach, which are secondary to the malrotation of the gastrointestinal tract that normally took place in an early stage of the prenatal life [16, 30]. They include: lack, incomplete (<90^o) or over-rotation (>90^o) of the stomach. When the lesions are limited to the stomach or other part of the gut, they may be asymptomatic [1]. Clinically, abnormal rotation of the stomach without its obstruction is also called volvulus. However, the malrotation of the organ could also be associated with various developmental anomalies of the stomach (i.e., congenital paraesophageal hernia), and constitute a part of serious congenital syndromes (e.g., gastric organo-axial, heterotaxy, Meckel–Gruber syndrome) [6, 15, 43]. Additionally, in Meckel–Gruber syndrome, the stomach has a longitudinal, intestine-like shape, without the proper fundus [15].

The group of abnormal positions among horizontal axis contains gastric cascades characterized by a biloculation of the gastric cavity into a ventral (corpus and antrum) and a dorsal (fundus) recess [27]. Such abnormal position may be congenital, functional or secondary to organic disorders of the stomach and surrounding organs, mostly peritoneal adhesions. Due to lack of any specific symptoms its incidence is unknown.

Stomach shape may be also affected by the feeding habits. A chronic large amount of food taken day after day may increase the organ volume. Unlike enlargement after vagotomy, such “physiologically” large stomach may be reversible [16, 30, 38].

In conclusion four primary groups of stomach variations were established: abnormal position along longitudinal (I) and horizontal axis (II), as well as abnormal shape (III) and stomach connections (IV). The first group contained the stomach rotation and translocation to the chest cavity, including sliding, paraesophageal, mixed-form and upside-down hiatal diaphragmatic hernias, short esophagus, and the other diaphragmatic hernias. The second group included the stomach cascade of different stages. The third and fourth ones comprised developmental variations and organ malformations. The last group (V) enclosed mixed forms that connect two or more previous variations.

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Digestive system | healthdirect

Your digestive system breaks down the food you eat into nutrients such as carbohydrates, fats and proteins. They can then be absorbed into your bloodstream so your body can use them for energy, growth and repair. Unused materials are discarded as faeces (or stools).

The digestive system is made up of the digestive tract and other organs that help the body break down and absorb food.

Your digestive tract is a long, twisting tube that starts at your mouth, and then involves your oesophagus, stomach, small intestine, large intestine and anus.

Other organs that form part of the digestive system are the pancreas, liver and gallbladder.

What is the digestive system?

Each organ of the digestive system has an important role in digestion.

Mouth

When you eat, your teeth chew food into very small pieces. Glands in your cheeks and under your tongue produce saliva that coats the food, making it easier to be chewed and swallowed.

Saliva also contains enzymes that start the digestion of the carbohydrates in your food.

Oesophagus

Your oesophagus is the muscular tube that carries food from your mouth to your stomach after you swallow. A ring of muscle at the end of the oesophagus relaxes to let food into your stomach and contracts to prevent stomach contents from escaping back up the oesophagus.

Stomach

Your stomach wall produces gastric juice (hydrochloric acid and enzymes) that digests proteins. The stomach acts like a concrete mixer, churning and mixing food with gastric juice to form chyme — a thick, soupy liquid.

Small intestine

Bile from your gall bladder and enzymes in digestive juices from your pancreas empty into the upper section of your small intestine and help to break down protein into amino acids and fat into fatty acids. These smaller particles, along with sugars, vitamins and minerals, are absorbed into the bloodstream through the wall of your small intestine.

It is called small because it is about 3.5cm in diameter but it is about 5m long to provide lots of area for absorption. Most of the chemical digestion of proteins, fats and carbohydrates is completed in your small intestine.

Large intestine and anus

The lining of your large intestine absorbs water, mineral salts and vitamins. Undigested fibre is mixed with mucus and bacteria — which partly break down the fibre — to nourish the cells of the large intestine wall and so help keep your large intestine healthy. Faeces are formed and stored in the last part of the large intestine (the rectum) before being passed out of the body through the anus.

Illustration showing the various organs that form part of the digestive system.

Common conditions related to the digestive system

Gastro-oesophageal reflux

Gastro-oesophageal reflux (GORD) occurs when acidic stomach contents move from the stomach back up the oesophagus. It causes a burning sensation in the chest or throat.

Diverticulitis

Diverticulitis is caused by inflammation or infection of abnormal pouches in the lower part of the large intestine. It can cause mild or severe pain on the lower left-hand side of the abdomen.

Stomach ulcers

Stomach ulcers are commonly caused by the bacterium Helicobacter pylori that can live in the stomach of about 4 in 10 Australians. They can cause long-term, low-level inflammation of the stomach lining in some people. They can cause long-term, low-level inflammation of the stomach lining in some people. It is not well understood why they cause stomach ulcers in some people and not in others.

Haemorrhoids

Haemorrhoids are itchy or painful lumps that occur in and around your anus. The lumps contain swollen blood vessels. Haemorrhoids can cause bleeding during bowel motions — you might notice bright red blood on the toilet paper or in the toilet. If you find blood on the toilet paper or in the toilet, always seek medical advice.

Medical Illustration Gallery – Learning Modules | CT Scanning | CT Imaging | CT Scan Protocols

Acute Non-traumatic Maternal Illness in Pregnancy:

Imaging Approaches

Shah KB, Thompson SKS, Goldman SM, Wagner LK, Raval BK, Corl FM, Sheth S, Fishman EK, Noble VK, Zelitt DL, Chen PC, Barron BJ, Sandler CM

These medical Illustrations were part of an exhibit and journal publication reviewing the acute processes that coincide with pregnancy and the required diagnostic examination.

Bariatric Surgery

Behrooz Vaziri, MD; Nevil Ghodasara, MD; Franco Verde, MD; Sara Ramin Pour, BS; Hannah Ahn, MA ; Elliot K Fishman, MD; Pamela T Johnson, MD

Bariatric surgery consists of a range of surgical and endoscopic procedures. Accurate interpretation of post-operative abdominal CT scans requires an understanding of the normal post-operative anatomy as well as potential complications of each type of surgical procedure.

Bowel Obstruction

Bowel Wall Target Sign

Cecal Volvulus

CT of Cecal Volvulus: Unraveling the Image

Moore CJ, Corl FM, Fishman EK

These medical illustrations, which show cecal volvlus, were part of an RSNA exhibit and journal publication discussing the process of bowel rotation and the roll CT and 3DCT play in recognizing and diagnosing this disorder.

Complications of the Whipple Procedure

CT Appearance of Gastric Leiomyosarcomas

Duodenal Anatomy

Gastrointestinal Stromal Tumors (GIST)

Computed Tomography Imaging of Gastrointestinal Stromal Tumors With Pathology Correlation

Horton KM, Juluru K, Montogomery E, Fishman EK

Journal of Computer Assisted Tomography: Volume 28(6) 2004, 811-817

These medical illustrations depict GIST tumors of the small bowel. They were part of an RSNA exhibit and publication discussing CT technique used for visualization of small bowel.

Hepatic Portal Vein Variation

Islet Cell Carcinoma

CT of Pancreatic Islet Cell Neoplasms

Horton KM, Corl FM, Talaminin M, Fishman EK

This medical illustration depicts an islet cell carcinoma tumor in the pancreas. These illustrations were part of RSNA exhibit and journal publication reviewing the clinical presentation, diagnosis, pathophysiology, and treatment of both syndromic and nonsyndromic pancreatic islet cell neoplasms, as well as discussing the current role of MDCT and 3D imaging.

Large bowel obstruction

Major pathways of small bowel tumor spread into the mesentery

Non Neoplastic Disease of the Large Bowel

Normal Small Bowel

Portal Hepatic System

Staging of Esophageal Cancer

Variations in Hepatic Arterial Anatomy

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90,000 Anatomy in pictures. Atlas of human anatomy online. Human structure.

Human anatomy is undoubtedly the main basic subject for study in medical schools.Despite the fact that normal human anatomy is a discipline that stood at the origins of the development of medicine, a large number of scientific works still appear that make their own adjustments to modern anatomical atlases.

It would seem that human anatomy cannot change so quickly with the course of evolution, but our understanding of it is constantly improving, as new research methods appear, as evidence of this is all new versions of the atlas of anatomy.

Atlas of Anatomy of Sinelnikov R.D. in 4 volumes is perhaps the most authoritative and time-tested source of knowledge on this topic. It is constantly reprinted, delighting us with its graphic illustrations and text accessible to all. Many students tried to download Sinelnikov’s atlas for study, but the links either did not work, or there was a virus in the folder … We solved this problem by making a website dedicated to this source.

The main goal of studying human anatomy is to create a fundamental knowledge base among students for further study of other medical disciplines.It is difficult to imagine mastering the curriculum in physiology, pathological physiology, pathological and topographic anatomy, operative surgery, and a number of clinical disciplines without a thorough study of normal human anatomy.

It is very important for a student to have a visual image of the studied material, for this it is necessary to study human anatomy in pictures. The main feature of this science. of course, is the structuring of its sections and subsections, as well as a clear systematization of the entire nomenclature.

Thus, the following directions can be distinguished, which correspond to each system:

• Osteology (section on the bones of the human skeleton). Examines the skeleton, as a whole mechanism, and bones separately. The study of age-related changes in bones is also distinguished.
• syndesmology (joints, ligaments). An extremely important section for future orthopedists and traumatologists.
• myology (muscular system). He studies not only the structure, but also the development with physiology.
• splanchnology (internal organs). Includes the anatomy of the endocrine, digestive, respiratory, excretory and genitourinary systems.
• Angiology (vessels and their derivatives). Information on the structure of blood and lymphatic vessels is presented.
• neurology (central and peripheral nervous system). An extremely important section for the successful diagnosis of diseases, and perhaps the most difficult.
• aesthesiology (the science of the sense organs). All about sight, hearing.And also about gustatory, olfactory and tactile sensitivity. Closely related to neurology.

90,000 People in your colon need a healthy diet too

• Adam Rutherford
• BBC Future

May 2, 2017

Photo by iStock

Eating is not enough to keep your body healthy and healthy yogurt with probiotics.BBC Future columnist found this out by handing in one not-so-nice analysis.

It all started with what can only be called an ingenious invention. It is a fold-out sheet with sticky notes in the front and back, like a flat starfish.

The papers are glued to the toilet seat. Properly fixed, the sheet turns into a kind of hammock, on which the sample falls to take a sample.

In preparation for the procedure, I put on rubber gloves.Leaving my biomaterial in the hammock, I took a sample using a small spoon attached to the inside of the blue lid of the test tube.

Then I screwed the cap tightly and wrapped the plastic tube in the ice pack I had prepared beforehand. The valuable cargo was now ready for delivery.

And I was going to take him to Map My Gut, which promised me to find out exactly which microorganisms lurked in the depths of my intestines.

The results of various studies carried out in recent years indicate that the microorganisms living in our digestive system are much more important for our health and well-being than previously thought.

But I soon discovered that my own bacteria did not thrive very much, and that a certain diet could completely change the way we live with them.

Author of the photo, SPL

Caption,

Methanobrevibacter helps to increase the digestibility of food

There are about a thousand different types of bacteria living in the intestines of the average person.

It is difficult to determine their total number, but the count goes to trillions, and almost all of them are doing useful work for us.

The human genome has about 20,000 genes, but the microorganisms living in our body in total have about 500 times more.

This allows them to cope with rather difficult tasks: to help digest food, produce vitamins and minerals, and even prevent diseases by uniting in groups and destroying pathogenic bacteria.

But this is only a small part of their work; in fact, it depends on them who we are inside and outside.

As Ed Young, author of I Contain Multitudes, told me, “Microbes help build the human body, they shape and renew our organs as we age.”

“They can even influence our behavior and way of thinking. Numerous experiments on animals have shown that microorganisms in their gut can influence mood, temperament and resistance to anxiety and stress,” he notes.

However, how these results are applicable to humans remains to be seen.

All we know for sure is that the microbiomes of two people differ much more than their genomes.

The composition of microorganisms in the human body depends on the history of its diseases, place of residence and diet.

It is individual for each person and can be very different even among the closest relatives.

Photo author, Getty Images

Caption,

Some foods stimulate the growth of beneficial bacteria in the body much better than yogurt.

That’s why I had to empty myself on a piece of paper and take a piece of biomaterial for analysis.

I confess that when I walked into the office of Tim Spector, professor of genetics at St. Thomas’s Hospital, to see the results, I was a little nervous.

What will I learn about the mysterious inner world of my bacteria? What exactly is hiding in my colon?

To be honest, my analysis was worse than ever.

“Your score is much below average. In terms of diversity, you fall into the 10% of the population with the worst scores,” Spector told me with a faint note of joy in his voice. The joy that a scientist experiences upon discovering any deviation from the norm.

He explained that diversity is one of the main factors affecting gut health.

The point is that different microbes perform different tasks, and the more diverse this workforce, the more benefit we get.

Not only did I lack variety, but also the bacteria groups that settled in my intestines were not the most friendly.

Analysis showed that I have 65 times more Clostridium perfringens than the average person and 211 times more E. coli. Both of these bacteria can cause diseases of the gastrointestinal tract.

“These results indicate that you have a very unhealthy microbiome,” said the test results document given to me.

I, of course, could try to justify myself by saying that I was on a business trip and, perhaps, ate something dubious.

However, Spector stated that a single infection is unlikely to greatly shift the balance for the worse.

What about beneficial bacteria? Fewer than 100 species of bacteria are capable of causing infectious diseases, while thousands of species of microorganisms living in the human intestine are, as the writer Douglas Adams would say, “practically harmless.”

So how am I doing with those on my side?

At the very top of the list of “most desirable” microorganisms are bacteria such as Akkermansia and the hard-to-pronounce Christensenellaceae. Both help prevent weight gain.

Methanobrevibacter helps you digest food better, so you can eat less. Oxalobacter provides kidney stone prevention.

How many of these beneficial bacteria have I found? Zero.

So, I was not only ranked among the worst group, but also prescribed a strict diet for my intestines, promising to cancel it only if it thinks carefully about its behavior and decides to change.

Photo author, SPL

Caption,

Clostridium perfringens have been linked to gastrointestinal diseases

What can I do to improve my microbiome? Probably the most important thing is diversity.

The more varied your diet, the more species of bacteria will settle in your intestines.

Fermented foods are especially beneficial for maintaining a healthy microbiome.

“People know about live yoghurts, but an oriental fermented milk drink called kefir is a completely different level: it has five times more microorganisms,” Spector told me.

The population of our guts will also be very happy about other fermented foods, including miso soup and kimchi (sauerkraut).

If this sounds too exotic to you, keep in mind that healthy, high-fiber foods include garlic, artichokes, bananas, and whole grains.

And the polyphenols in red grapes are the favorite food of Akkermansia bacteria. I think this is a good reason to have a glass of wine.

Probiotics advertisements say they help increase bacteria in the gut, but in reality they are not worth spending money on.

There is little evidence that these bacteria remain in the body long enough to change the microbiome.

However, they have been shown to be beneficial for both very young and elderly patients and can be used to prevent indigestion when taking antibiotics.

But they will hardly help my intestines.

Since I made this shocking discovery, I have completely changed my diet. More than a month has passed since the test results were received, and during all this time I did not eat meat.

Miso soup replaced meatballs for me, and kimchi replaced fish and chips. Even though the kimchi jar smells, um … cool, my wife makes me keep it in the barn.

Only time will tell if these changes can have a lasting impact on my microbiome.

But I know that now I eat not only for myself, but also for the trillions of microorganisms that inhabit my body.

Hope this strict regime doesn’t last too long.

To read the original of this article in English, visit the BBC Future website.

Chronic gastritis: symptoms and signs, which means diagnosis, treatment of the stomach

According to various estimates, from 10 to 50% of people in developed countries suffer from it.There are many reasons for gastritis, and a strict diet is required for effective treatment. To be cured, gastritis patients must follow all medical recommendations, change their lives and give up bad habits.

What is chronic gastritis?

Gastritis is an inflammation of the gastric mucosa, which often becomes chronic due to prolonged exposure to provoking factors. As a result of inflammation, the cells of the gastric mucosa are gradually damaged, and, depending on the type of gastritis, their secretory function increases or decreases.

What is gastritis

The most common form of chronic gastritis (CG) is bacterial, it occurs in almost 70% of patients. Most often it is provoked by the bacterium Helicobacter pylori (Fig. 1). Resistant to stomach acid, it is distributed by the oral-fecal route. Enzymes secreted by H. pilory help break down the protective mucus of the stomach, which protects tissues from the aggressive effects of gastric juice. Helicobacter is represented by various strains – from relatively harmless to extremely dangerous, causing the formation of chronic ulcers and even stomach cancer.

Figure 1. Helicobacter pylori bacteria causing gastritis. SEM micrograph. Photo: Yutaka Tsutsumi

Harm and benefit of Helicobacter

Important! H. pylori does not always lead to gastritis and may be beneficial for our body. In recent years, the positive effects of these bacteria on the functioning of the immune system have been proven. H. pylori is able to interact with T lymphocytes to suppress inflammation and reduce the risk of allergies and asthma.

Among other types of gastritis:

• Autoimmune (15% of cases). It is caused by the aggression of the body’s own antibodies that attack the cells responsible for the secretion of acid in the stomach. This form of gastritis is characterized by an elevated pH level and constant secretion of the hormone gastrin, which leads to the formation of microtumors in the stomach,
• Chemical (10% of cases). It is caused by the action of various drugs (acetylsalicylic acid, non-steroidal anti-inflammatory drugs, antibacterial and other drugs) that irritate the gastric mucosa or reduce its protective properties,
• Reflux gastritis (5% of cases).Developed if bile enters the stomach. Reflux gastritis can be caused by inflammation of the duodenum or surgery to remove part of the stomach,
• Special forms (less than 1%). These include Crohn’s disease, radiation, eosinophilic, and other types of gastritis.

Important! The development of chronic hepatitis is promoted by the absence of teeth, foci of chronic infection in the oral cavity and pharynx (caries, sore tonsils), smoking, excessive alcohol consumption, stress, serious injury or surgery.

There are many classifications of gastritis: by localization (gastritis of the body of the stomach, antrum of the stomach, fundus of the stomach, pangastritis), by the degree of tissue damage (superficial, gastritis with lesions of the glands without atrophy, atrophic, hypertrophic gastritis).

Why is gastritis dangerous?

Left unattended, gastritis can acquire more and more serious consequences. Superficial inflammation over time can cause deep tissue damage – erosion and ulcers, which threatens life-threatening gastric bleeding.Certain strains of H. pylori significantly increase the risk of developing stomach cancer. The same complications are found in patients with chemical gastritis. For autoimmune gastritis, mucosal atrophy and malignant anemia with vitamin B12 deficiency are more characteristic.

Symptoms

Many people have gastritis with little or no symptoms. Obvious signs of the disease usually appear in the exacerbation phase (Table 1). At the same time, pain in the upper third of the abdomen (under the stomach) acts as the leading symptom of gastritis: dull, burning, aching, gnawing, sucking, acute.

Important! If you have any signs of chronic hepatitis, see your doctor.It is not recommended to use heating pads, enemas, or take medications before examination.

Diagnostics

Gastritis is much easier to treat if it can be diagnosed early in the development of the disease.

Who to contact

Gastroenterologists, doctors specializing in diseases of the digestive system, are responsible for the diagnosis and treatment of chronic gastritis. Often, gastritis becomes an accidental finding during a routine examination or the search for other diseases.Gastroenterology is an extensive branch of medicine that requires from a doctor not only highly specialized training, but also interdisciplinary knowledge and good erudition.

What tests to pass

The classic method for diagnosing gastritis is gastroscopy (esophagogastroduodenoscopy, EGDS), which is combined with a biopsy if a malignant process is suspected. During the procedure, a special device is inserted into the stomach of the patient through the mouth – a gastroscope, consisting of a long tube with an integrated camera.It allows the endoscopist to examine in detail the condition of the mucous membrane of the esophagus, stomach and duodenum (Fig. 2).

Figure 2. Performing gastroscopy. Photo: CC0 Public Domain

Since most cases of chronic hepatitis are associated with the presence of the bacterium Helicobacter pylori in the body, when gastritis is detected, a urease breath test (for the enzyme urease secreted by Helicobacter) is often performed, as well as a blood test for antibodies to this bacterium or a stool test for the presence of her antigens in it.

Computed tomography and magnetic resonance imaging help answer the question: is it really about gastritis and does the patient have stomach cancer (Fig. 3).

Figure 3. Gastritis detected on tomography. Photo: Eigenes Werk

Treatment

Treatment is always selected individually depending on the type of gastritis and its cause. Early therapy can reduce symptoms, if any, and reduce the likelihood of complications.

Medicines

Drug treatment of chronic gastritis can be symptomatic or etiological – aimed at eliminating one or another cause of the disease.If H. pylori is found in a patient with gastritis, eradication therapy is used to eradicate it. In particular, the “French method” is popular today, which involves a combination of three drugs – two antibiotics plus a proton pump inhibitor. Unfortunately, it is impossible to eliminate the infection forever, after a while the harmful microorganism again enters the body from carriers, in particular, from the patient’s relatives. Helicobacter very quickly acquires drug resistance, so you cannot prescribe the same antibiotics all the time.

In case of chemical gastritis, it is enough to eliminate its cause. For example, stopping taking medications, the side effects of which caused the disease. If it is not possible to refuse such a medicine, measures are taken to protect the stomach with the help of enveloping agents and drugs that regulate the acidity of gastric juice. The use of antacid (anti-acid) drugs helps to restore damaged mucous membranes. It should be remembered that with the disappearance of the acid, its powerful antibacterial function disappears.

The choice of therapy for autoimmune chronic gastritis depends on the severity of the inflammation. Basically, the use of medicines is aimed at reducing the acidity of gastric juice. These are proton pump inhibitors, antacids and antihistamines.

Power supply

Chronic gastritis cannot be overcome with drugs alone. Radical changes are needed in the patient’s lifestyle, diet and diet. Therefore, the gastroenterologist already at the first visit necessarily recommends a certain type of diet, depending on the acidity of gastric juice: with a reduced acidity (berries, fruits) and sokogonic products, with an increased one – those that reduce the production of hydrochloric acid.

Among the products that are not compatible with the treatment of gastritis and are categorically contraindicated:

• Spices and seasonings, especially hot,
• Fatty Meat,
• Any fried food,
• Smoked products and canned foods,
• Concentrated fruit and berry juices, especially with a high content of acids and sugars,
• Carbonated drinks.

Important ! It is recommended to limit the consumption of confectionery (never – on an empty stomach!), Rye bread, fresh wheat pastries, strong tea and coffee.

There are quite a lot of permitted foods for gastritis. By consuming them, you can easily create a varied and complete diet. Patients with gastritis are shown:

• Fermented milk products,
• Stale yeast bread,
• Lean meat, fish, soft and semi-hard cheeses,
• Soft-boiled eggs and scrambled eggs,
• Boiled cereals,
• Soups-puree,
• Boiled and baked vegetables, fruits.

Diet for patients with chronic gastritis

The diet for chronic gastritis is aimed at developing a favorable microflora in the gastrointestinal tract that regulates digestion and has a protective function.Meals should be fractional: regular meals 5-6 times a day. You should choose dishes that are boiled or steamed. Preferably boiled or baked meat, dairy products, cereals with a high fiber content, boiled or baked vegetables (Table 2).

The bulk of food should be in the first half of the day. It is necessary to avoid “snacking” high-calorie foods, eating sweet on an empty stomach.

Aids

The most recommended home remedy to alleviate the course of the disease is chamomile decoction.From exotic plants for our nature, aloe juice is used as a strong anti-inflammatory agent. For chronic gastritis, an infusion of oats is also useful, helping to restore the affected mucous membrane. Of course, traditional methods of treatment cannot replace qualified medical care and therapy.

Gastritis in children

Children usually get sick with gastritis at school age due to irregular and inappropriate nutrition, there is even such a diagnosis – “school gastritis”.Treatment in this case is aimed not only at getting rid of the disease, but also at forming healthy eating habits.

Gastritis and pregnancy

Difficulties in treating gastritis in pregnant women are associated with the possible effect of the drugs used on the fetus. When choosing a therapy, one has to weigh the possible benefits of the medication and the harm that it can cause. This primarily concerns antibiotics, many of which are categorically contraindicated in pregnancy. Proton pump inhibitors are harmful during gestation.

Forecast

As a rule, the prognosis for gastritis is positive. Among patients, only 5% go to doctors, many people do not experience any symptoms.

The treatment of any chronic disease is a long struggle with varying success. A chronic patient cannot be in the hospital for the entire period of illness. Living conditions are constantly changing, the success of treatment depends on it. A meeting with a truly professional and competent doctor who is willing and able to find and eliminate the cause of the disease can play a key role.

Prevention

Prevention of chronic gastritis is to prevent factors that can cause damage to the mucous membrane. These are hygienic measures against Helicobacter infection: thorough washing of dishes, use of their own cups, plates and cutlery by each family member. Care must be taken when handling medications and chemicals that are potentially harmful to the health of the digestive system.

If you do get sick with gastritis, it is important to take timely measures to prevent its transition to a chronic form.The main goal of prevention in this case is to maintain a favorable microbiome (microflora) of the digestive tract.

To prevent the development of the disease, follow:

• eaten often in small portions,
• avoid foods that may irritate the stomach,
• reduce or eliminate alcohol consumption,
• quit smoking,
• avoid stress.

Conclusion

Gastritis is a condition in which the stomach lining is damaged and inflammation begins in the tissues.Most people with gastritis do not feel any symptoms for a long time, except for indigestion, and therefore do not fight the disease, which threatens complications. If untreated, advanced gastritis can become a stomach ulcer. For any symptoms of gastritis, you should consult a gastroenterologist.

Sources

1. Gastroenterology: national guidelines / ed. V.T.Ivashkina, T.L. Lapina. – M .: GEOTAR-Media, 2013. – 704 p.
2. Gastroenterology and hepatology: diagnosis and treatment: guideline
3. G22 for doctors / ed.A.V. Kalinin, A.F. Loginov, A.I. Khazanova. – 3rd ed., Rev. and add. – M.: MEDpress-inform, 2013 – 848 p.
4. Tutelyan V.A. Scientific foundations of healthy eating. –M. Panorama, 2010 – 839 p.

surgery, benefits, risks and specialists

What is gastric bypass surgery?

Gastric bypass is a bariatric surgical procedure to reduce weight. In this case, the stomach is divided into a small (gastric sac, 15-25 ml) and a large part.The stomach pouch can take in very small amounts of food, so it satiates quickly. In parallel with this, the small intestine is bypassed, so that the digestive juices from the gallbladder and pancreas meet with food much later.

As a result, a significant portion of nutrients and calories are not absorbed and excreted from the body undigested. The procedure is usually performed laparoscopically (using punctures in the body) in order to reduce subsequent complications and pain, as well as the patient’s hospitalization time.In laparoscopic surgery, only a few small incisions are made and the patient recovers quickly.

When is a gastric bypass required?

Bariatric surgery is performed when conservative treatment for obesity is ineffective. Conservative therapy includes nutrition, exercise and lifestyle changes, possibly also psychological therapy.

The indication for surgical treatment, as a rule, is the BMI (body mass index) of patients.Thus, if conservative therapy is ineffective and BMI is more than 40 kg / m² or BMI is more than 35 kg / m² with secondary diseases (eg diabetes, hypertension), surgical options should be considered.

There is no standard surgical treatment that is suitable for all patients. Therefore, it is necessary to draw up an individual treatment plan. The choice of surgery option depends, among other things, on BMI, age, gender, and comorbidities.

Other options for operations on

shrinking stomach

include:

Benefits of gastric bypass surgery

Greater weight loss is achieved with bypass surgery than with gastric banding or sleeve gastrectomy.The average weight loss is 61.6%.

45% of all procedures in obesity surgery are the so-called “gastric bypass” or “Roux-Y gastric bypass.” This surgical procedure combines two weight loss methods.

The amount of food that can be taken at one time is reduced, as well as the degree of absorption of the food eaten. During this operation, the stomach is reduced by 15-25 ml of the large “residual” stomach, and the path of food passage is changed according to the Ru-Y technique, so that food and digestive juices are mixed in the middle part of the small intestine.

With later contact of food and digestive juices, nutrients are absorbed only by part of the intestine. The rest of the nutrients are excreted in the feces. This gastric bypass method results in a 60-70% loss of excess weight.

Approximately 80% of obese people experience remission (regression) of obesity-related diabetes mellitus as a result of gastric bypass surgery, which means a significant reduction in the risk of mortality. Intensive weight loss significantly improves the quality of life of the operated person.

Disadvantages of gastric bypass surgery

After surgery, obese people may develop the so-called “dumping syndrome”. There are pros and cons here. In this case, the body cannot tolerate foods high in sugar or fat. As a result, these foods cause nausea, dizziness and diarrhea. Although, for effective weight loss, such foods should be avoided anyway.

Very fatty foods cause fatty stools with an unpleasant odor. Bypassing digestive juices, unfortunately, also leads to a deficiency in the body of important vitamins and minerals, therefore, dietary supplements must be taken throughout life.

Gastric bypass surgery is more risky than other bariatric surgical procedures such as gastric banding. Imaging of the rest of the stomach and ERCP (endoscopic imaging of the biliary tract and pancreas) is no longer possible due to bypassing the digestive tract. If weight gain occurs despite bypass surgery, further surgical options are very limited or expensive.

Lifelong prevention of vitamin deficiency diseases requires follow-up by experienced physicians and nutritionists.It is recommended to consult a dietitian before and after surgery.

Which doctors and hospitals specialize in gastric bypass surgery?

Naturally, a person in need of surgical treatment for obesity wants to receive highly qualified medical care. Thus, the patient wonders where the best gastric bypass clinic can be found.

Since this question is difficult to answer objectively, and a respected doctor will never claim that he is the best, you can only rely on the experience of a specialist.The more relevant operations a doctor has performed, the more experience he has.

These are visceral surgeons who specialize in the treatment of obesity. With their experience and many years of work as a specialist in the field of bariatric surgery, these doctors are the right choice for the patient.

Sources:

Patient Information Brochure on Bariatric Surgery, Johnson & Johnson MEDICAL GmbH, Ethicon Endo-Surgery

Indications for bariatric surgery, methods of surgery and prognosis; Thomas P.Hüttl

“We are not alone in the Universe”

Conversation with cosmonaut No. 58 O.Yu. Atkov, who completed the longest space flight at that time, Doctor of Medical Sciences, Corresponding Member of the Russian Academy of Sciences.

Conversation with cosmonaut No. 58 O.Yu. Atkov, who committed
the longest space flight at that time, by doctor
medical sciences, a corresponding member of the Russian Academy of Sciences, the developer of a new
medical equipment and methods, without which it is unthinkable today
healthcare.

– Oleg Yurievich, I know that you did not plan to be an astronaut, but
were going to become a doctor. Although this also did not work out right away: you
I had to study at a medical school, work as a drug
in a medical unit at a cotton mill, and then, after
graduation from the institute, you began to examine cosmonauts at the Center
preparation, and then suddenly decided that you can do it too.
Is that how it happened?

– No, it turned out differently.Indeed, it was all –
worked as a doctor, and one year at a medical school
studied because I did not get one point then in Kuibyshevsky
medical institute. I was preparing for the university at the same time and entered the
next year to the Crimean Medical Institute, so the first year
studied in Simferopol. Then there was Kiev, and the fifth or sixth course – already
First Moscow Medical Institute, after that – residency,
postgraduate studies and smooth career growth at the institute
cardiology them. A.L. Myasnikov of the USSR Academy of Sciences, where I worked without
small for almost thirty years.

– Why cardiology? I know that you are a doctor
decided to become influenced by an aunt who was
neuropathologist.

– My beloved red-haired aunt, aunt Lena, I really am a little
pushed to this profession. And cardiology has become a matter of life,
probably because at that time a book by the famous
cardiac surgeon Nikolai Mikhailovich Amosov “Thoughts and Heart”. BUT
there was also a trilogy by Yuri German about doctors, which also produced
an indelible impression on me.A classic example of the Soviet
a child brought up on the correct literature, with good
educated parents, so there was no particular thought. Although
in the first year, your head is spinning, especially if you live in
Crimea.

And then I left for Kiev and there I met people who, in fact,
really introduced into medicine. How the madman began to engage
science in the field of pharmacology of the cardiovascular system.
I wanted to become a cardiac surgeon, and wasted all my free time for
Batu Hill, in the clinic of Nikolai Mikhailovich Amosov.There I met a number of surgeons and specialists in the field
medical cybernetics who worked on the problem of the system
artificial heart. I was eager to fight everywhere.

My first student experimental scientific work came out
just at the end of the second year of medical school, and it became
it is clear that medicine, cardiology is mine.

And then – moving to Moscow, serious work that I did under
mentored by the renowned pharmacologist Natalia Veniaminovna
Kaverina, daughter of the writer Veniamin Kaverin.Met her
spouse, Professor Khayutin, an outstanding physiologist, student
Chernigov. After classes in the fifth or sixth year, he disappeared from them
in laboratories and was happy about it.

Then – clinical residency, and I ended up at the Institute
cardiology with a wonderful, interesting cardiologist,
Professor Nurmukhamed Mukhamedovich Mukharlyamov. He was a man
lonely for that period of time, loved us all and called
children – sons and daughters. We loved him.

It so happened that among his friends there was a man with a voice,
which the whole country knew.Amazing baritone of the charismatic
the person who hosted the “Film Travelers Club” program.

– Yuri Senkevich!

– Yes, Yuri Alexandrovich Senkevich. At that time he was
Head of Department at the Institute of Biomedical Problems. AND
then one day we are sitting, working – and we were entrusted with
serious technique, an ultrasound device that was the first
in our country – and now we hear a familiar sound in the corridor
baritone.Then they call us, and he says: “So, cadets, there is one
a task designed for your knowledge, for your skill, but also for
your modesty, because this business will require that you
kept their mouths shut. ” It was 1975.

And in a week they brought us two cosmonauts who returned
from the station. It was Boris Volynov and Vitaly Zholobov.

Volynov is an absolutely legendary person who went through
a long preparation period, because it is the last of the first
the detachment flew off.The flights that he made were very, very
difficult. In the first flight, he generally remained a little alive, because
that there was an off-design entry into the atmosphere, the impact was very
strong, and he practically lost his teeth – they just flew off
from the roots. And on the second flight, when he was at the Salyut station
together with Vitaly Zholobov, Vitaly had serious
problems, chest pains, headaches, insomnia,
and it became clear that those medicines with which they
have, the situation cannot be corrected.I had to stop early
flight. But it became known later, then they reported to us: everything in
okay, the astronauts are back, feeling good.

– And what did you manage to find out about him then
condition?

– They were brought to Nur Mukhamedovich, he looked at them and said: “Well,
nothing to catch the eye, no, now my boys
will look. ” We did not find any marked changes in the heart. But
Zholobov had a reaction of the circulatory system different from that of
Volynov.As they say in scientific circles,
his tolerance was much lower, and he endured a lot of tests
worse. It became clear that he had a dysregulation and, judging
in all, the peripheral link of blood circulation was disrupted, oh
than we wrote in the conclusion. This data, apparently, was very satisfied.
everyone in the medical department of Star City, and then they
began to call and say: “It is necessary that Oleg Yuryevich still
looked, or even better – that he came to us with his
“Iron …”

– And why exactly Oleg Yurievich?

– My friend Yuri Belenkov, with whom we started together, now he
an academician, says: “Oleg, my PhD is already on the way, and
I have no time at all, let’s do it ”.I answer –
OK. In general, I sat down on two chairs. One chair is scientific
work at the Institute of Cardiology, and the second chair is work with
Star city. Appetite is known to come with eating, and
they tell me: so, they say, and so, we are your boss
we will write and transport you to Baikonur so that you can participate in
post-flight survey of all long-term expeditions. Just
long flights began. And so, starting with
the forty-nine-day flight of Volynov and Zholobov and ending
expedition of our predecessors – Berezovoy and Lebedev
lasting two hundred and eleven days, all these expeditions are your
the humble servant examined.

– And, looking at them, they decided: why not myself
try?

– No. It was like this: I look through the device at
cosmonauts, and they look at me and say: “Oleg Yurievich, here
will recruit doctors into the squadron, would you like to go through? ” You
you know, when a twenty-five-year-old young doctor does this
offer, then it is probably difficult to expect that he will refuse. I
asked: “Do you think I can get through this?” They speak:
“Well, try it, why not.”

Well, and on the sly from his beloved boss, having told only his wife,
during my postgraduate vacation, to my great surprise, I
passed the selection for medical reasons and came to surrender to the teacher
in September, when it became clear what had passed.

– How did your wife feel about this? You have it too
doctor, ophthalmologist.

– We studied together with her from the second year, from Kiev, then she
I left for Moscow, so I ended up in Moscow.We this year
have been together for half a century. Of course, she didn’t like the idea at all.
my flight into space. But she knows me so well that
did not argue. Said, “Well, this is your life, so you yourself
you will decide everything. ” She understood that it was not very good to persuade me
promising, and made it possible to fill the bumps myself.

– You were going to fly with Feoktistov for
medical supervision of the elderly
astronaut.

– Yes it is.But until he was about to fly with K.P.
Feoktistov, five years have passed. And all these five years it was necessary
keep fit, exercise, and
it was required to defend a thesis in order to comply with
work. I did not transfer to the Institute of Biomedical Problems,
although I was persistently called, because I decided that the space doctor
– this is far from only a physiologist and scientist, he must be ready for
the study of conditions during and after long flights. When
the space doctor must be not only a researcher, but also
a practical doctor.Therefore, I did not go over.

In 1982, the phone rings from the reception of my great
chief, academician Chazov, and they say: “You need, Oleg Yuryevich,
come to the director. ” He says: “You know, here is an academician for me
Glushko called and said that they needed a doctor for the flight together with
Feoktistov “.

He was an aging astronaut, experienced, flying, and he had
super task. Konstantin Petrovich was the chief designer
station and for individual systems was personally responsible,
therefore, he needed to personally verify the features on the spot
the functioning of the system that he created.And he convinced
General Designer Valentin Petrovich Glushko is that
this flight should take place. In general, the VP agreed. We decided that
a doctor should fly, and best of all a cardiologist. So they remembered
to me.

But we didn’t have time even two or three trainings, we only
Introduced to each other how Konstantin Petrovich calls me at home
and says: “Oleg Yuryevich, I need you to come urgently,
We have to talk”. His wife opens the door: “Come on, I will
I’m taking it. “I pass, I look – he is completely pale as paper.
I ask: “What happened?” He replies: “I’ve been vomiting …”
– and outlined the whole picture. So I put it down, started
palpate the abdomen, epigastrium, it is clear that bleeding, and he has
a history of gastric ulcer. “Konstantin Petrovich, judging
all over, you have bleeding. I owe you as a doctor
hospitalized, and you need to be on the surgical table, and quite
quickly, maybe even within a day. ” – “No, Oleg Yurievich, I
I’ll lie down and everything will pass. “- “No, let me invite my
friend, he is a brilliant surgeon, candidate of sciences, and let him
will look. ”

In general, my friend came, looked at it and fully confirmed
diagnosis. The next day, he was copied and decommissioned from the flight
work. Well, and, oddly enough, they left me in the general space
preparation.

A few months later he passed the exams, passed the state
commission and was officially enrolled in the squad
astronauts. Then I received an offer to
go on the longest space flight at that time.

– Have you been flying for almost eight months?

– Three days less. I answered Valentin Petrovich shortly: “Mail for
honor”. He chewed his lips (he had thin lips): “Mail for
honor … Well, well, we’ll meet with you again, all the best! ” – at
he had such a thin voice. I left to prepare further in
the composition of the crew.

And then there was preparation in Star City with all its
twists and turns, joys, delights, discoveries and so on.One
of the most memorable preparation events looked like this.
They say to me: “Well, it means that your men are duplicating Titov,
Strekalova, all of you are going to the training ground, they will sit in a straight line
connection, and you will be on the observation deck to see what it looks like
what lies ahead for you. ”

It was the same abnormal situation when the rocket caught fire, for
two or three seconds before the crash, two shooters issued a command, and from
already burning emergency rocket, which quietly began to roll,
the emergency rescue system led the ship along the trajectory along with
crew.They sat down at a distance of three to four kilometers from
launch, and the rocket exploded. Rumble, flame, fire, smoke, fire.

– You have not changed your mind about flying into space after this
spectacle?

– Immediately the command: “Everyone urgently leave with a quick step
observation deck “. We’re shifting the other way from where
arrived, and I hear two men behind me talking in
I run: “I wonder who’s next?” But no, I didn’t have any
shadows of doubt.It seems to me that I did not even become my wife about this incident.
narrate.

– Well, of course! I know that during this flight,
indeed, the longest at that time, you spent a number of
unique medical experiments. What were these
experiments?

– The flight program was compiled from ideas born in our
cardiology center. We have developed a unique
the device is an echocardiograph, which today all doctors and
the patients.And then it was a new development made by us
jointly with the staff of the Institute of Biomedical Problems.
There was an absolutely wonderful engineer Elena Pavlovna Milova,
her heavenly kingdom, and Galina Arkadyevna Fomina. We all
carried out together, and the technical execution was implemented in
one of the research institutes – SRI TP in
near Moscow Korolev. This device was supplied to Salyut-7,
which was allowed after the “six”, and the first crew, Berezova –
Lebedev tested him.I trained them myself: where to put the sensor,
how to rotate, what will be the image, what should they
see.

In general, they took off, and after a couple of months, in May, it was allocated
time for us to test and get the first
picture. Arrived at the Mission Control Center, and the astronauts say: “Doctor, we are all
forgot”. “So, let’s start by counting the edges again.
Fourth intercostal space, to the left of the sternum, remember where, the collarbone
groped? Let’s go along the intercostal spaces, ”and so on.

In general, they turned on the device, put the sensor, and quickly remembered everything.
And then a picture appeared. I say: “This is a picture of the aorta,
which is what we need. ” This was the first session of the space
teleradiology in the world. First echocardiogram image from
space was received on our device!

When I was already flying, I had this device and another,
developed by IBMP together with the French. I had it in my hands
quite a serious “weapon” that could be used.We sculpted the program for this equipment, plus a few more
experiments of the cardiological center on genetic engineering. We needed
to do electrophoresis there, and there was also the experiment “Membrane” with
washed erythrocytes. And during the flight, another idea was born: I
understood that anything can happen in space.

I thought: I should try what the effects will be
nitroglycerin during the flight. If, God forbid, it will be necessary
use nitroglycerin under some circumstances (stop,
for example, chest pain, angina attack), we must
know what to expect.I coordinated this issue with my colleagues
from MCC, from IBMP, and they supported.

We made an experiment design, I filmed indicators that
recorded blood flow to the head, brain, looked like a heart
reacts. And since nitroglycerin in a number of people causes
blood flow to the head, then I figured out how to
reduce these negative effects. Therefore, the first experience of space
clinical pharmacology is also ours. And it has a date – 1984. BUT
teleradiology is 1982.

– And what is this situation with taking blood from the very
yourself?

– It was somewhat of a gamble. I took blood from a vein from
my combat colleagues, commander and flight engineer, and examined it in
flight conditions. This was part of our program. And then one day
they began to chuckle: here you are, they say, you take blood, but from
can’t yourself? I had to prove that I can do it at home too. I say:
“Commander, take a video camera, shoot.” “And you,” I say
flight engineer, – you will dock the syringe with the needle.When you see
that there will be a drop of blood, do it quietly. ”

– You even have a space
terminology.

– Well, yes, it was necessary to dock two parts – a syringe and a needle – so,
so he doesn’t pierce my vein. So we took blood, I
he centrifuged her, and isolated the plasma. When I finished
experiment, it was necessary to send two plasmas, I had to say:
“You will receive three plasmas.” They say – who is the third? I answer:
“Then get ready, now you will watch a movie, but,
please, no emotion. “Dead silence in the MCC. Finally, they
they say: “Well, what can I say, of course, the winners are not judged, but you
I understood what you could do. ” But nothing happened.

– The MCC probably decided that you have a contact
took place with alien intelligence, hence the third test tube. I know
that you have met angel-like entities in Space. It was
is that?

– On the night of April 1, I decided to publish a wall newspaper,
because it was necessary to please the crew with something.I came up with a joke.
The joke was born late at night, somewhere after midnight. My colleagues
were already asleep. It sounded like this: dialogue astronaut
– MCC. Astronaut: “I see a dragon-like creature through the window
with three heads, a long tail and two wings in the distance
about three kilometers. What to do?”

MCC – silence. I repeat: “What to do?” They say, “We will
think, while you smile at him. ” I came up with this story and
shared with MCC. I remember very well this turn, it was over
north of the United States, there stood off the coast of Canada, near
Newfoundland, research ship “Cosmonaut Yuri
Gagarin “.

In general, in the morning my crew got up, saw a wall newspaper, I was waiting
praise. Not wait. They said: “Well, the idea is not bad, but
it was for all of us to make this newspaper together ”.

This whole story did not remain strictly between us and between us and
MCC, and, most likely, dispersed through other spheres. Year
later an American came up to me, our colleague, who flew to the moon,
and holds out the newspaper: “What can you say about this?”
I read, and there the doctor tells about angel-like creatures
Atkov.I say: “Listen, April Fool’s Day, do you know what it is?”
He says – yes, they say, I know. But he does not smile, his face is serious.
I explained everything to him again. Finally, he broadcasts: “I have always believed that
Russians cannot be trusted. ”

– That is, the Americans listened to your conversations with
MCC?

– Apparently, yes.

– Oleg Yurievich, despite the fact that this is a joke, a lot
wrote, talked about the fact that astronauts are experiencing a state
altered consciousness during long space flights.You
had to deal with this? Hallucinations, strange visions
vote?

– It is difficult to call it hallucinations or strange visions. Everything
depends, apparently, on your sensitivity. Are you capable
let’s say feel someone’s gaze. If you are intently
someone looks, and you in the back or in the back of the head, does not happen
such that you sometimes feel it?

– It happens.

– So I had this a couple of times during
flight that someone was staring at me in the back.

– Was there really no one?

– There was, of course, no one in our understanding.
I don’t know what it was. And nobody knows because they didn’t grab
did not see. But a couple of times there were such sensations. I know one thing: judging by
everything, we are not alone. But we are, apparently, terrible savages for them. what
what’s going on on earth? When we flew, there was a war between Iraq and Iran.
When the oil storage is smashed, it burns, the clubs rise
smoke, and this train stretches across the entire strait to Ceylon – this
says that we are all connected by one
chain, not very smart, quite aggressive civilization.we
we destroy each other and ourselves. Therefore, if they are, then
it is not at all necessary that “others” are aggressive. They don’t need
interfere with our lives and take our space away from us.

– They can just look at us in
back.

– They can just look us in the back, yeah. I
I think so.

– Oleg Yurievich, returning to Earth after his
long space flight, to the delight of your wife and all of your
a large family, you did not think to stop scientific work.On the contrary,
you became a doctor of sciences, a member of the Academy of Sciences …

– Returned to his cardiac
the center, where, one might say, come from. Then he wrote twice more
application to participate in two works in orbit, but I
they said “thank you”. And then one more time Valentine called me
Petrovich Glushko. He offered another eight-month flight. But
I refused.

– Why?

– If I flew, my stunt double would never fly.I decided –
let my Valery Polyakov fly. Glushko replied: “Oleg Yurievich,
I only propose once. ” I answer: “Valentine
Petrovich, I know. ”

– Didn’t regret it?

– Not. I could not block the way for the detachment. I was selected with
eight good guys who stayed at the Institute
medical and biological problems “for growth.” They all counted
fly. I thought and decided that I have no moral right for them
interfere.Well, and then a program with astronaut doctors with us
covered.

– Tell us about an important scientific
was the work done afterwards? What do you think is the most valuable? I
know that you are the state prize and the government prize
received.

– Since I am constantly interested in science, and not only
clinic, then one of the aspects that we developed, in addition to
ultrasound is telemedicine. We built it together with
good specialist, doctor and engineer Valery Stolyar.It
Head of the Department of Telemedicine and Medical Informatics at PFUR.
We have developed a telemedicine concept in order to
cover the whole country. It was the 90s, and we are running around with this idea,
like city madmen. We came to the Moscow mayor’s office, got
before the deputy of Luzhkov, I went to some rectors, quite respected
people. But they said: “No, this is not necessary either in Moscow, and
nobody needs it. ” In short, telemedicine then to officials
was not needed.

But this did not calm us down, and since I then collaborated with
International Space University in Strasbourg, and their
telemedicine issues were very interesting, and we started these things with
develop them.Conducted a very serious research
project for telemedicine support of emergency medical
states on the international space station. This was
an international project in which the French participated, we and
German University of Mainz.

And since 2002, he began to work at the Ministry of Railways,
headed the entire health care system. Since the territories
gigantic, the volumes are colossal and there are a lot of people working, you need
was to link it all up. The only sensible technology for
so that you can instill the correct methods in medicine, this
telemedicine.I had to say: “Colleagues, hospitals that
are located in Ussuriysk and on Chasovaya Street in Moscow, should
work under the same protocols and under the same standards.
Equipment, specialists and so on. ”

– That is, telemedicine is also yours
innovation?

– Yes, then we created the Russian Telemedicine Association. These
ideas were embodied in five trains, which equipped not only
medical equipment, but also telemedicine complexes.FROM
with their help it was possible to transfer information about the patient not only from
from one carriage to another, but also via satellite or fiber optic
consult a particular difficult case.

While working at Russian Railways, I drew attention to the fact that there are some things,
that affect the working person, in the form of some natural
phenomena. These are the so-called geomagnetic storms after flares on
Sun, especially in northern latitudes. And we made a special
the Faraday chamber, where electromagnetic storms were created, and at the same time
watched what would happen if we reduce the natural electromagnetic
field.Thus, we can find out what awaits a person on the moon.
or on Mars. These were very interesting studies.

– And what awaits?

– Changes in microcirculation begin already in
at the end of the first hour, there are some other problems. Then
is, the circulatory system immediately adjusts, adapts.
Probably there is a receptor that is sensitive to changes
the level of the electromagnetic field. And we did this too.

– And if Rogozin called you now, for example, and
said: “Oleg Yurievich, I have to fly for two years.