Atrophic gastritis
The content of the article:
- Causes and risk factors
- Symptoms
- Diagnostics
- Treatment
- Possible complications and consequences
- Forecast
- Prevention
Atrophic gastritis is a type of chronic inflammation of the gastric mucosa, manifested by its atrophic changes (thinning, a decrease in the number of glands and their secretory insufficiency).
Changes in the gastric mucosa with atrophic gastritis
The prevalence of the disease in the population is not precisely confirmed: according to various sources, every third adult inhabitant of the Earth suffers from chronic gastritis, no more than 10-15% seek medical help. The bulk of gastritis (up to 90%) is represented by a chronic disease associated with the bacterium Helicobacter pylori, slightly less than 10% of cases in the morbidity structure belong to autoimmune gastritis.
The true prevalence of atrophic changes in the gastric mucosa is unknown, but based on the assumption that it is the outcome of Helicobacter pylori gastritis or a manifestation of autoimmune gastritis, it is believed that the incidence of the atrophic form of the disease can reach 50-60%.
In half of the cases, atrophic gastritis is combined with elements of structural rearrangement of the mucous membrane (intestinal metaplasia, pyloric metaplasia of the fundic glands, villous metaplasia, pancreatic metaplasia, dysplasia or epithelial neoplasia).
Causes and risk factors
The disease is multifactorial. There are several reasons that can lead to mucosal atrophy and functional stomach failure:
- gross errors in the diet;
- taking certain medications;
- exposure to toxic substances;
- duodenal reflux (throwing the contents of the small intestine into the stomach);
- chronic pathological processes;
- age-related degenerative changes in the gastric mucosa;
- genetically determined atrophy.
Nevertheless, the main causes of atrophic gastritis are currently considered Helicobacter pylori and autoimmune gastritis.
Atrophic gastritis, which occurs against the background of infection with Helicobacter pylori bacteria, is explained by the prolonged massive colonization of the stomach wall by microorganisms in the absence of adequate therapy, which leads to thinning and depletion of the mucous membrane with subsequent atrophy.
One of the reasons for the development of atrophic gastritis is the defeat of the bacterium Helicobacter pylori
During the autoimmune process, the body produces protective antibodies against its own structures - parietal cells of the stomach and internal Castle factor. Antibodies bind to the microvilli of parietal cells, damaging them (progressive atrophy of these cells develops in the body and fundus of the stomach), and block the connection of the Castle factor with the inactive form of vitamin B12, provoking the development of pernicious anemia.
Symptoms
The main manifestations of atrophic gastritis are due to functional insufficiency of the stomach, which develops against the background of changes in the mucous membrane. Among such manifestations:
- dyspeptic syndrome (indigestion syndrome) - decreased or complete lack of appetite, belching with air or rotten food, nausea, a feeling of heaviness and fullness in the epigastric region, putrid breath, bad taste in the mouth;
- bacterial overgrowth syndrome - rumbling in the abdomen, increased gas production, unstable stools;
- anemic syndrome - characteristic changes in the general blood test in combination with rapid fatigue, deterioration in the tolerance of habitual physical activity, drowsiness, apathy;
- pain syndrome - dull aching pains, aggravated after eating, due to overstretching of the walls of the stomach;
- dystrophic syndrome is the result of a violation of the absorption of vitamins and the digestion of nutrients.
With atrophic gastritis, dull pain in the stomach occurs, aggravated after eating
Diagnostics
With an objective examination of the patient, it is usually not possible to reliably diagnose atrophic gastritis because of the meager and nonspecific symptoms.
To make a correct diagnosis, it is necessary to conduct a number of the following additional studies:
- determination of the content of pepsinogen I, pepsinogen II and gastrin-17 in blood serum as markers of atrophy of the gastric mucosa;
- determination of the presence of anti-parietal antibodies and antibodies to the internal Castle factor in the blood serum;
- determination of serum gastrin levels;
- detection of Helicobacter pylori by direct or indirect methods;
- gastroscopy;
- histological examination of a biopsy specimen of the gastric mucosa;
- Ultrasound of the abdominal organs;
- pH-metry of gastric juice;
- determination of pepsin activity or general proteolytic activity of stomach contents.
Biopsy of the gastric mucosa
Treatment
Treatment of atrophic gastritis, as a rule, begins with the elimination of the causative factors. In the case of the Helicobacter pylori nature of the disease, eradication treatment and antibiotic therapy are required. It is almost impossible to neutralize the autoimmune mechanisms of atrophic gastritis today. The appointment of glucocorticosteroid hormones is indicated only in severe pernicious anemia; in other cases, the side effects of corticosteroids will prevail over their clinical efficacy.
In addition to etiotropic, treatment is carried out in several other areas:
- diet therapy in compliance with the principles of mechanical, thermal and chemical sparing;
- replacement therapy with hydrochloric acid preparations, enzyme preparations;
- stimulation of the secretion of hydrochloric acid (mineral waters, medicinal preparations, citric and succinic acids, etc.);
- protection of the gastric mucosa with gastroprotectors;
- the use of regenerants and reparants to restore the mucous membrane;
- the use of coating and astringent preparations;
- increased gastric motility (prokinetics);
- physiotherapy treatment.
Antibiotic therapy is effective for atrophic gastritis of Helicobacter pylori nature
Possible complications and consequences
Chronic atrophic gastritis is a precancerous condition. Of particular concern in terms of an unfavorable prognosis is atrophic gastritis with low acidity: according to statistics, the probability of malignant degeneration in this disease is approximately 15% (5 times higher than in the non-atrophic process).
Forecast
With timely complex treatment, the prognosis is favorable. In 2002, Japanese scientists proved the possibility of reverse development of precancerous changes in the gastric mucosa after the eradication (destruction) of Helicobacter pylori bacteria. With the help of chromoscopy, it was found that within five years after successful anti-Helicobacter pylori therapy, the size of the foci of intestinal metaplasia decreased almost 2 times compared to the initial ones.
Complete restoration of the structure of the mucous membrane in severe atrophy takes a long time, and in some cases it is most likely impossible. If the precancerous processes do not undergo a reverse development, but, on the contrary, progress, radical methods of treatment are used up to resection of the gastric mucosa.
Prevention
Preventive measures should be comprehensive:
- timely full treatment of chronic gastritis (with mandatory antibiotic therapy);
- systematic dispensary observation;
- the development of a rational food stereotype - limiting the use of canned, pickled and smoked products, quitting smoking and drinking alcoholic beverages (especially in combination with fatty, fried, smoked and salty foods), overeating.
The development of a rational food stereotype is an important stage in the prevention of atrophic gastritis
In the developed countries of Europe and the USA, active promotion of a healthy lifestyle has led to a decrease in the incidence of stomach cancer by several times, up to 3% of the total mass of malignant neoplasms. In Russia, stomach cancer ranks second in terms of frequency of occurrence among malignant tumors.
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Olesya Smolnyakova Therapy, clinical pharmacology and pharmacotherapy About the author
Education: higher, 2004 (GOU VPO "Kursk State Medical University"), specialty "General Medicine", qualification "Doctor". 2008-2012 - Postgraduate student of the Department of Clinical Pharmacology, KSMU, Candidate of Medical Sciences (2013, specialty "Pharmacology, Clinical Pharmacology"). 2014-2015 - professional retraining, specialty "Management in education", FSBEI HPE "KSU".
The information is generalized and provided for informational purposes only. At the first sign of illness, see your doctor. Self-medication is hazardous to health!
