Atrophic Gastritis - Causes, Symptoms, Treatment Of Chronic Atrophic Gastritis

2024 Author: Josephine Shorter | [email protected]. Last modified: 2023-12-16 21:43

Causes, symptoms, treatment of atrophic gastritis

Content:

• What is atrophic gastritis?
• Symptoms of atrophic gastritis
• Types of atrophic gastritis
• Treatment of atrophic gastritis
• Diet for atrophic gastritis

Atrophic gastritis, the most insidious type of chronic gastritis, is a likely cause of precancerous stomach conditions. It develops more often in middle-aged and elderly men. In the onset, inflammation is asymptomatic. With depletion of compensatory mechanisms, it does not always have a vivid clinical picture.

What is atrophic gastritis?

The absence of vivid symptoms at the first stage of pathogenesis is not a favorable sign. On the contrary, a person who is not experiencing obvious discomfort does not attach importance to the problem. In vain. Let's try to explain in a simplified and accessible way the insidiousness of this ailment.

The key word in the name of the disease is atrophy. This means that the cells of the walls of the stomach, which are part of the secretory glands, undergo atrophic degeneration in the course of the disease, that is, they lose their ability to function normally, do not produce components of gastric juice. It has been proven that, first of all, the glands are transformed into simpler formations that produce mucus instead of gastric juice. Usually, atrophic gastritis occurs against a background of low stomach acidity.

However, the main danger of atrophic gastritis is not associated with a change in the acidity of gastric juice, since the pH level can be corrected. The danger lies elsewhere. Atrophic gastritis is recognized by the medical community as a provocateur of stomach cancer in humans.

So, in order. All cells of the body, including the cells of the walls of the stomach, are in cooperation with the body every second. This means that regeneration - nucleation, morphological and functional differentiation, functional load, natural cell death and their subsequent renewal are influenced by hormonal, immune, enzymatic and other regulatory factors that are still unknown to science. Until now, no one has managed to reliably and radically change the properties of mature cells of the body. Normally, all cells of the organs of the body have a strict specialization - this is an axiom of modern biological science.

Pathogenesis of atrophic gastritis

Let us simplify the task and describe the pathogenesis as a two-stage process. We agree that at the first stage of pathogenesis, the leading role is played by acid-fast bacteria, and at the second - the autoimmune processes of the body.

In many forms of gastritis, the cells of the glands of the inner walls of the stomach are attacked by the bacteria Helicobacter pylori, which damage them and locally alter the pH of the stomach walls. Bacteria are common inhabitants of the acidic environment of the stomach. They only create the soil, open the gates for the development of gastritis by atrophic and any other type of inflammation.

At the second stage of atrophic gastritis, complex autoimmune processes are involved in pathogenesis, which affect the immature forms of glandular cells, suppress their subsequent specialization. The mechanism of the origin and course of autoimmune reactions is of interest to scientists, but in this text, their disclosure is not of fundamental importance.

Suppression of cell specialization is the key word in the pathogenesis of this type of inflammation. This means that the cells of the glands of the walls of the stomach atrophy under the influence of autoimmune reactions, stop performing the difficult work of producing components of gastric juice.

The physiological process of regeneration of glandular cells of the stomach is disrupted. Regeneration means that normally the place of the glandular cells that have exhausted their vital resource is taken by new cells with similar properties. In a healthy body, the cells of the gastric mucosa are completely renewed every six days.

As a result of a violation of regeneration, glandular cells instead of hydrochloric acid begin to produce a simpler product - mucus. This mucus has protective properties, but weakly participates in digestion. Therefore, the walls of the stomach, abundantly covered with mucus, appear as healthy tissue during routine endoscopic examination. The environment of the stomach is transformed from acidic into slightly acidic, up to achilia.

Subsequently, under the influence of the autoimmune cascade of reactions, damaged cells begin to produce large numbers of immature cells similar to themselves, which are unable to develop and have finally lost the ability to acquire secretory specialization. In this case, it is pathological regeneration. Conventionally, such immature cells can be called a fashionable term now - stem cells.

Stem cells are present in any healthy person, but in a normally functioning organism they invariably acquire properties strictly specified by evolutionary memory and are transformed into mature cells: stomach, intestines, heart, lungs, other organs and tissues, and perform functions exclusively specific for each type of cells.

If scientists learn to control stem cells for sure, this will mean a revolution and will allow humanity to embark on the path of individually adjustable life expectancy. It will be possible to grow any organ or tissue, and thereby change metabolic processes, hormonal levels, and so on. So far, the work on stem cell management is at the initial stage of scientific study, and the practical application of this technique is a guaranteed risk. But back to the topic of atrophic gastritis.

The body has multilevel protection against damaging influences, therefore, even in conditions of atrophic gastritis, cancer does not always develop. It is more fair to talk about a precancerous condition here.

It is believed that the atrophy of the cells of the gastric walls cannot be completely cured. However, the correct drug exposure, adherence to the diet, the exclusion of certain types of food from the diet significantly reduce the risk of oncological processes. For diagnosis, prevention of atrophic gastritis and the possible risk of developing cancer processes, you should consult your doctor.

With a fatal coincidence, that is, a strong, external and / or internal impact, an explosive, exponentially growing growth of young (stem) cells of the stomach walls is provoked.

These cells do not carry a functional load that is useful for the body, on the contrary, they destroy it. The only function of imperfect cells that do not have a cooperative connection with the body is the constant reproduction of pathological (cancer) cells that are not regulated by the body and a negative effect on the body through metabolic products.

It should be recalled that the pathogenesis described above is a simplified idea of the true pathogenesis of atrophic gastritis. The text does not mention serious morphological damage to the glands of the stomach, changes in hormonal, vitamin and other types of metabolism, the influence of autoimmune processes on the development of pathogenesis and the influence of dystrophic processes on pathogenesis. There is no mention of the greater or lesser effect of certain strains of acid-fast bacteria and duodenogastric reflux on chronic gastritis. In a schematic, generalized form, an idea of the transformation of atrophic gastritis into a precancerous state is given.

Symptoms of atrophic gastritis

The vast majority of serious researchers indicate the absence of any significant symptoms of atrophic gastritis at the first stage of pathogenesis. Many have noticed the absence of a bright pain syndrome in atrophic gastritis, which is characteristic of hyperacid gastritis. There is no pain at all stages of atrophic gastritis.

Symptoms common to all types of gastritis are often referred to symptoms at the stage of exhaustion of the body's compensatory mechanisms. During clinical examination, patients complain of a feeling of heaviness in the solar plexus after eating, regardless of its volume.

There are also complaints about the following signs of gastrointestinal pathology:

• belching;
• nausea;
• bad breath;
• flatulence;
• overflow, rumbling;
• constipation is more frequent than diarrhea;

Symptoms not directly related to disorders of the gastrointestinal tract include:

• weight loss;
• hypovitaminosis (a clear decrease in the level of cyanocobalamin (vitamin B ₁₂), manifests itself in the form of anemia, ulceration on the oral mucosa, tingling of the tongue, headaches, yellowness of the skin);
• hormonal disorders (hypocorticism, decreased libido)

However, the main signs of atrophic gastritis are detected in laboratory, functional and instrumental studies.

It should be said that ultrasound, radiography, CT scan of the abdominal cavity without contrast agents, MRI do not provide comprehensive information about the pathology. The greatest diagnostic value is presented by the methods of endoscopy, gastroscopy and its varieties, for example, chromogastroscopy. This is a method for examining the walls of the stomach after preliminary staining of their surface.

With the help of a gastroscope, the thinning and smoothing of the walls are observed. The vessels of the gastric walls are clearly visible (normally they are not visible). Wall biopsy studies reveal dystrophy and atrophy of the stomach glands. The method of intragastric pH measurement is valuable. Almost always, a change in the pH of the stomach environment towards a neutral reaction, up to achilia, is detected. The list of mandatory methods for diagnosing atrophic gastritis includes a study of the microflora of the stomach. Many experts consider the routine detection of Helicobacter pylori bacteria an uninformative diagnostic method.

On the subject: prevention of gastritis

The most convenient, promising, non-invasive (sparing) method of blood testing for the state of the functional activity of the stomach is the gastropanel.

Gastropanel is a blood test method that is based on identifying:

• Antibodies to Helicobacter pylori;
• Pepsinogen I - a protein responsible for the production of HCL;
• Gastrin 17 - a hormone that regulates the secretion of hydrochloric acid, regeneration and wall motility.

It is believed that the gastropanel should be used in combination with histological studies of cells in the stomach wall. Comparison of their results provides very valuable diagnostic information.

Types of atrophic gastritis

In-depth laboratory, instrumental and other studies are valuable in determining the types of atrophic gastritis, depending on the location of the pathogenesis and the nature of the damage. Studies are valuable for identifying and differentiating various pathological formations in the stomach, stages and forms of its inflammation.

Acute atrophic gastritis

In this case, we should talk about the stage of exacerbation of chronic atrophic inflammation of the stomach walls. In some sources, this condition is called active gastritis. Symptoms resemble those of acute superficial inflammation of the stomach.

Laboratory and instrumental methods establish the following characteristic signs of acute atrophic gastritis:

• swelling of the walls of the organ;
• plethora of blood vessels of the walls;
• infiltration of leukocytes outside the blood vessels;
• destruction of the integumentary epithelium, rarely - erosion on the mucous membrane.

In some cases, atrophy of cells of the glandular tissue occurs under the influence of external emergency factors - strong acids, alkalis, chemical poisons, and so on. The diagnosis and treatment of acute toxic atrophy of the glandular tissue of the stomach is carried out not by gastroenterologists, but by doctors specializing in toxicology, narcology and surgery.

Symptoms of acute atrophic gastritis are varied: severe pain, vomiting, diarrhea, fever, impaired consciousness - fainting, coma. Other specific symptoms are characteristic for each specific pathological process. Exposure to the mucous membranes of strong pathogens often ends in the death of the patient due to general intoxication of the body, cardiac arrest or respiratory arrest.

Chronic atrophic gastritis

It is an independent disease, not a transformation of acute gastritis. This condition is sometimes called inactive gastritis or gastritis in remission. It is characterized by long-term, progressive atrophy of glandular tissue cells, the predominance of dystrophic processes over inflammatory ones. Pathogenesis leads to changes in secretory, motor and absorption functions. In the chronic form of atrophic gastritis, organs anatomically connected with the stomach are involved in the pathogenesis: the duodenum, the esophagus, as well as organs connected with the stomach functionally: the liver, pancreas, endocrine glands. Due to the general intoxication of the body, the process of hematopoiesis and the nervous system are involved in pathogenesis.

Pathogenesis, as a rule, develops against the background of low acidity of gastric juice. The clinical symptoms are consistent with hypoacid gastritis.

The diagnosis of acute and chronic gastritis is made on the basis of differential diagnosis data. The survey is carried out using instrumental, functional and laboratory methods. Of particular value are endoscopy and its varieties, pH-metry, histological methods of biopsy examination, laboratory blood tests - gastropanel.

In the course of diagnostic studies, chronic atrophic gastritis is manifested by the following symptoms:

• normal or thinned organ wall;
• smoothed mucous membrane;
• wide gastric dimples;
• flattening of the epithelium;
• low secretory activity of the glands;
• moderate infiltration of leukocytes outside the vessels;
• degeneration (vacuolization) of glandular cells.

Focal atrophic gastritis

It is characterized by the appearance of foci of pathologically altered tissue of the stomach walls. Acute focal gastritis in some cases occurs against a background of increased acidity of gastric juice. Probably, areas of glandular tissue not involved in pathogenesis compensate for the functions of damaged foci by increasing the secretion of hydrochloric acid. Otherwise, the symptoms of the disease practically do not differ from the symptoms of ordinary gastritis.

With a subclinical course, focal atrophic gastritis is manifested by intolerance to certain foods: usually these are dishes based on milk, fatty meat, eggs. After their use, heartburn, nausea, and sometimes vomiting begin. The differential diagnosis is made on the basis of laboratory and instrumental studies.

Moderate atrophic gastritis

According to the degree of involvement of glandular tissue in degenerative-atrophic processes, a moderate form of inflammation is sometimes distinguished in clinical practice. The designation is conditional and implies a mild, partial form of pathological transformation of cells of the gastric walls.

Moderate atrophic gastritis is detected only with histological examination of glandular cells. In this case, the number of intact cells per unit area of the gastric mucosa is determined, and the depth of microstructural changes in the glandular and degenerated tissue is analyzed, which serves as a criterion for determining this type of disease.

The clinical symptoms correspond to the usual dyspeptic disorders. The pain characteristic of acute forms of gastritis is not always fully manifested in this disease. More often, patients complain of a feeling of discomfort in the epigastrium that occurs after eating. Pain is possible only when eating heavy (spicy, salty, smoked, pickled or fatty) foods.

Superficial atrophic gastritis

According to the working classification - a harbinger of atrophic inflammation of the stomach. This is the early stage of chronic inflammation. The damage is minimal, the clinical symptoms are not expressed. Differential diagnosis is only possible with endoscopy. A detailed examination establishes:

• normal thickness of the stomach wall;
• moderate degeneration of the integumentary epithelium;
• slight hypersecretion of cells.

Antral atrophic gastritis

The antrum is located in the lower part of the stomach, closer to the exit from the organ, and is adjacent to the duodenum. The disease is characterized by scarring of the antrum. Visually, this section looks like a tube with sealed walls. The tightness and tension are called rigidity. This form of gastritis is characterized by moderately pronounced clinical signs of dyspepsia - dull pain in the solar plexus, as well as:

• nausea in the morning;
• belching after eating;
• decreased appetite;
• decrease in body weight;
• general weakness.

When measuring the pH level, its normal value is rarely set - more often a decrease in the slightly acidic side. An instrumental examination of the mucous membranes reveals deformation, pronounced macroscopic changes on the inner walls of the organ, a decrease in wall peristalsis due to their rigidity. Macroscopic changes are often diagnosed as tumors on the mucous membrane. In the antrum of the stomach, ulcerative processes are often diagnosed.

Diffuse atrophic gastritis

Means the absence of serious dystrophic changes. This form of inflammation is an intermediate link, a transitional stage between superficial and degenerative damage to the walls. The main sign of diffuse gastritis is the presence of local foci of degeneration of the glands of the walls of the stomach, as well as immature cells with signs of impaired secretory activity.

Other signs of diffuse atrophic gastritis:

• rollers on the walls of the stomach;
• deepened gastric fossa;
• microstructural damage to gland cells.

Treatment of atrophic gastritis

Due to the variety of microstructural manifestations of atrophic gastritis and scanty clinical symptoms, there is no single approach to the treatment of this disease. It is recognized that the formed atrophic process does not lend itself to correction. That is, the degenerated cells cannot be transformed back into glandular cells.

Meanwhile, effective drug treatment regimens for atrophic gastritis in various forms and at different stages have been proposed and exist, preventing the further development of pathogenesis.

All treatment regimens are based on the results of an in-depth study of the body. This is very important, as different data suggests different therapeutic approaches. In this article, we will not concretize treatment methods. Let the attending physician do this, based on the specific conditions, the state of the patient's body, the involvement of various links in the chain in the pathogenesis.

Meanwhile, the traditional treatment regimen for atrophic gastritis includes:

1. Eradicate Helicobacter pylori if acid-fasting bacteria have a significant effect on pathogenesis. Helicobacter pylori eradication methods are constantly being improved.

   Eradication tasks:

   • suppressing the development of bacteria and preventing the formation of their resistance to antibiotics;
   • the use of proton pump inhibitors to improve well-being;
   • shortening the duration of treatment;
   • reducing the number of drugs, which significantly reduces the number of side effects from treatment;

   Usually, three- and four-component eradication schemes are used:

   • As a means of suppressing the activity of bacteria, antibiotics (tetracycline, penicillin series), as well as the antibacterial drug metronidazole (Trichopol), are used. The dosage and frequency is indicated by the doctor.
   • Omeprazole, Lansoprazole, Esomeprazole, Rabeprazole, Pantoprazole, Ranitidine, bismuth citrate and others are used as proton pump inhibitors.
2. They have not yet fully learned how to influence the development of autoimmune processes in atrophic gastritis. The use of hormonal drugs and other immunocorrectors in most cases is not justified.

3. Pathogenetic therapy of atrophic gastritis involves the complex use of drugs of various groups, among them:

   • agents that facilitate gastric digestion - preparations of hydrochloric acid and gastric acid enzymes.
   • in conditions of deficiency of vitamins of group B _12, appropriate vitamin preparations are used in the form of parenteral injections.
   • means influencing the production of hydrochloric acid in the form of mineral waters (Essentuki 4.17 and others). Although they are not drugs, in some cases they show high therapeutic activity.
   • drugs that reduce inflammation - plantain juice or granular pharmacological preparation from plantain (Plantaglucid).
   • In recent years, Riboxin has been increasingly used in the treatment of gastrointestinal inflammation. This drug has properties useful in the treatment of atrophic gastritis.
   • to protect the mucous membrane, preparations of bismuth or aluminum are used (Bismuth nitrate basic, Vikalin, Vikair or Rother, Kaolin).
   • means that regulate the motor function of the stomach. Among the drugs of this pharmacological group, Domperidone and Cisapride are most often used.

All of the above drugs are prescribed during the active phase of stomach inflammation with symptoms of atrophy. During the period of remission, the main principle of treatment is the replenishment of substances that are missing for full digestion.

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Diet for atrophic gastritis

Diet nutrition is an integral part of the treatment of all types of gastritis. Treatment of atrophic gastritis (AH) is associated with some difficulties in the organization of nutrition. Depending on the objectives of the therapy, four types of diets are recommended, developed by the nutritionist M. I. Pevzner.

1. The basic diet for atrophic gastritis is diet No. 2. It assumes adequate nutrition of the patient and stimulation of functional glands. The recommended dishes must be boiled, easily fried, stewed, baked. Chilled products with a coarse structure are not used. The diet allows the use of a variety of dishes: meat, fish. Fermented milk, flour products, hard-boiled eggs and in the form of an omelet are allowed. Vegetables and fruits are widely used. In total, more than thirty types of various products are allowed, allowing you to organize high-quality and varied meals.
2. With severe pain syndrome, a different diet is prescribed. It is designated No. 1a and is prescribed in the first days of the disease. This diet provides minimal digestive stress. The task of the diet is to reduce the reflex excitability of the gastric mucosa. Foods that have a stimulating effect on stomach receptors are excluded from the diet. Food is allowed only in the form of liquid or puree, steamed, boiled, mashed. The diet consists of nine main recommended dishes, mostly puree soups. Dairy products are also allowed, provided they are well tolerated - whole milk, cream, cottage cheese.
3. Diet number 1 is prescribed after the symptoms of inflammation have subsided. It is used to accelerate the recovery of the inflamed gastric mucosa. This diet helps to normalize the secretory and motor function of the stomach. Hot and chilled dishes are excluded from the menu. Fiber-rich foods are not recommended. The diet list includes about eleven types of dishes.
4. Diet No. 4 is prescribed for severe enteral syndrome, when there is an individual intolerance to milk and other products. The purpose of this diet is to normalize the functioning of the stomach by reducing inflammation in the gastric mucosa. The diet is fractional. After the inflammation subsides, they always return to good nutrition. With atrophic gastritis, this is diet number two.

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The author of the article: Gorshenina Elena Ivanovna | Gastroenterologist

Education: Diploma in the specialty "General Medicine" received at the Russian State Medical University named after N. I. Pirogova (2005). Postgraduate studies in the specialty "Gastroenterology" - educational and scientific medical center.