Atrophy of the gastric mucosa

Atrophy of the gastric mucosa (in the medical literature - atrophic gastritis) is a kind of chronic gastritis, manifested in progressive pathological changes in the gastric mucosa and the destruction of glands that produce gastric juice.

The danger of pathology lies in the fact that it is attributed to precancerous diseases, so the main goal of treatment is to prevent atrophic changes.

[1], [2], [3], [4], [5], [6], [7], [8], [9]

Causes of atrophy of the gastric mucosa

In the prevailing majority of cases, atrophy of the gastric mucosa develops in people in old age, as a consequence of bacterial gastritis. The causative agent of the latter is the bacterium Helicobacter pylori. However, finding the infection the only possible cause is mistaken, since cases of atrophic gastritis are known without binding to bacterial, and as a consequence, autoimmune mechanisms. This form is called autoimmune atrophic gastritis. The cause of atrophy of the gastric mucosa in this case is the erroneous pathological development of autoimmune bodies against healthy cells of the patient's mucosa. Deformations of the latter come, atrophy of their own glands, hypochlorhydria - a decrease in the degree of concentration of hydrochloric acid, or achlorhydria - its complete absence in gastric juice.

There is a spectrum of factors that aggravate the mucosal state, acting in combination. Such factors can be a pathological process, age-related changes in the body, and also do not exclude a possible genetic predisposition. The systematic violation of the foundations of healthy nutrition, addiction to alcohol and the use during the long period of drugs that form gastritis, for example, potassium chloride, inevitably provoke a deterioration in the mucosa.

It has been scientifically proven that the appearance of atrophy of the gastric mucosa is affected by such factors as: persistent nervous experiences, consequences of endocrine system diseases (diabetes mellitus and thyrotoxicosis), deficiency in the body of vitamin B12 and iron, and hypoxia in pulmonary and cardiac failure.

[10], [11], [12], [13], [14], [15], [16], [17], [18], [19], [20]

Symptoms of atrophy of the gastric mucosa

With atrophic gastritis, the functionality of the stomach deteriorates, so the leading symptom of it can be called a syndrome of dispersion: a decrease in appetite in the patient, belching, which has a characteristic smell of rotten food, the appearance of nausea. The patient is often concerned about the feeling of heaviness in the stomach after eating, salivation and an unpleasant aftertaste in the mouth. Rumbling, bloating and acute intolerance to sour-milk products and diarrhea accompany the emerging dysbacteriosis. Painful sensations during atrophy, if they arise, are characterized as blunt, aching, without tangible localization. For atrophy of the gastric mucosa is not characteristic of soreness in palpation of the abdomen.

Focal atrophy of the gastric mucosa

The danger of focal atrophy of the gastric mucosa lurks in its symptomatic non-manifestation until the pathology develops into a more dangerous form and does not affect the entire area of the gastric mucosa. The foci are of different shapes and sizes, located at different stages of the course of the disease. Timely diagnosis allows you to begin treatment at an early stage, which gives a positive result.

[21], [22], [23], [24], [25], [26]

Atrophy of the antrum of the stomach

The antral part of the stomach is its distal part, which mixes and grinds the food, and then slowly pushes it through the pyloric sphincter. In normal operation, the acidity in it is lowered.

Anthral focal gastritis is a type of pathology in which loss of glands occurs, responsible for the production of hydrochloric acid and pepsin. There is a lack of mucus, which protects the walls of the stomach from its own acid, increases the possibility of inflammation of other parts.

A neglected disease carries the threat of transition to a chronic form and reproduction in the stomach of a variety of bacteria for which a medium with a low acidity is an optimal condition for life. Symptoms worsen, there is a persistent pain syndrome. During chronic atrophy of the mucous antral part of the stomach, dysbacteriosis, pancreatitis and anemia can develop. In addition, ignoring the disease invariably leads to disruption of the duodenum, and as a result, the development of duodenitis and peptic ulcer.

[27], [28], [29], [30], [31], [32]

Moderate atrophy of the gastric mucosa

Atrophy of the gastric mucosa by the severity criterion can be defined as mild, moderate or severe. For weak atrophy, a small shortening of the main glands is typical, a moderate increase in the number of additional glandulocytes is noticeable, some parietal glandulocytes are replaced by mucoidal ones, but the main ones are preserved. With severe atrophy, extensive sclerosis fields are visible in places where the gland has a polymorphic cell infiltrate. The remaining glands are short, parietal cells are replaced by mucus. Moderate atrophy, as a rule, is an intermediate phenomenon: simultaneously with the remaining fundal glands, there are also those that are represented only by additional cells.

Diagnosis of atrophy of the gastric mucosa

The most important task that the doctor faces at the stage of diagnosis is differentiation of the disease from stomach cancer. This is quite difficult, because there are no specific symptoms by which stomach cancer can be distinguished from chronic mucosal atrophy.

The basis of diagnosis of atrophic gastritis are:

• general clinical study: blood, urine and feces analysis. Atrophy of the gastric mucosa, combined with In the ₁₂ -scarce anemia, a blood test can determine the decrease in the level of hemoglobin in a patient;
• Diagnosis of Helicobacterial Infection with the help of laboratory tests: rapid cut test, breath test or morphological methods;
• endoscopic examination - careful examination of the stomach, duodenum and esophagus with the help of an endoscope;
• histological examination of materials obtained during a biopsy, - pieces of the mucosa, in order to determine the type of pathomorphological changes;
• pH-metry, which evaluates the secretory function of the patient's stomach;
• examination of the pancreas, liver and gallbladder with the help of ultrasound (ultrasound), which provides an opportunity to find out the presence in them of negative changes, usually accompanying atrophy of the gastric mucosa.

[33], [34], [35], [36], [37], [38], [39]

Treatment of atrophy of the gastric mucosa

The effectiveness of treatment of atrophy of the gastric mucosa depends on the correctness of the answer to the question of its cause. After all, it can become both chronic gastritis caused by the bacterium Helicobacter pylori, and the effect of autoimmune mechanisms.

For the first case, eradication therapy is applicable - the destruction of Helicobacter pylori bacteria. Before deciding on the choice of drugs, a daily pH-metry is performed. Depending on its results, the doctor prescribes proton pump inhibitors (at pH less than 6) or only antibiotics (at a pH equal to 6 or more): clarithromycin and amoxicillin. The duration of such therapy is usually not less than seven days.

Regardless of the root cause of the pathology, the doctor prescribes the drugs of the following groups:

• Substitutes: natural gastric juice - 1 tablespoon 3 times a day during meals; Acidin-pepsin - 1 tablet 3 times a day, with half a glass of water (hydrochloric acid is formed when dissolved in water); preparations of gastric enzymes: pancreatin, festal, panzinorm and others; if B12 deficiency anemia is present, injections of vitamin B12 are also included;
• stimulants of hydrochloric acid production. The most popular is plantaglucid: thanks to the extract of plantain leaves, it increases secretion, has antispasmodic and anti-inflammatory effect. It is taken half an hour before meals. A beneficial effect also gives the use of mineral waters, decoction of rose hips and limonar.

Self-medication atrophy of the gastric mucosa is highly contraindicated, given the possibility of further asymptomatic development of the disease, as well as its transformation into peptic ulcer or stomach cancer. Drugs prescribed by a doctor should be taken with strict observance of their quantity and regimen.

Diet with atrophy of the gastric mucosa

The purpose of the diet is to eliminate damage to the mucous membrane during gastric processing of food. As an independent therapeutic measure, the diet is not used, but plays an important role in the treatment of pathology.

Principles of treatment regimen:

1. Strict adherence to the diet - the rejection of products that damage the mucous, namely: from acute, acidic, salty, smoked, fried and pickled food, spices and canned food. All food consumed by the patient must be cooked, chopped and served at room temperature. Taboo is installed on carbonated drinks, strong tea, coffee and, of course, alcohol. They need to be completely replaced with weak tea or broth of dog rose, cocoa and mineral waters. Confectionery and milk are also excluded. The food for the patient atrophy of the gastric mucosa should be eaten in small portions and often.
2. Smoking patients should preferably abandon their addiction.
3. Taking drugs that have a devastating effect on the gastric mucosa (aspirin and ibuprofen), it is worth stopping and refraining from them in the future.

[40], [41], [42], [43], [44], [45], [46]

Prevention of atrophy of the gastric mucosa

The main measure of prevention of atrophy of the gastric mucosa is the timely treatment of gastritis caused by Helicobacter pylori infection. An important role in the prevention of healthy food, because, following its principles, you can significantly reduce the risk of atrophy of the stomach and its cancer consequences. Of fundamental importance is the constant monitoring of patients with chronic gastritis: follow-up and at least twice a year of endoscopic examination with histological evaluation, taken with a biopsy, pieces of mucous.

Prognosis of atrophy of the gastric mucosa

Chronic atrophic gastritis in modern medicine is recognized as a precancerous disease due to possible complications by malignancy processes. The greatest danger is borne by the consequences of the disturbance of the acid-forming function of the patient's stomach, as the antitumor protection of the mucosa decreases, optimal conditions for the harmful effects of carcinogens occur. Only timely diagnosis and treatment with effective methods of gastric mucosal atrophy give a favorable prognosis and prevent development of oncological changes.