Atrophy of the gastric mucosa

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

The danger of this pathology lies in the fact that it is classified as a precancerous disease, so the main goal of treatment is to prevent atrophic changes.

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Causes of gastric mucosa atrophy

In the overwhelming majority of cases, gastric mucosa atrophy develops in elderly people as a result of bacterial gastritis. The causative agent of the latter is the bacterium Helicobacter pylori. However, it is wrong to find infection as the only possible cause, since there are known cases of atrophic gastritis not related to bacterial, but as a result of autoimmune mechanisms. This form is called autoimmune atrophic gastritis. The cause of gastric mucosa atrophy in this case is the erroneous pathological production of autoimmune bodies against healthy cells of the patient's mucous membrane. Deformation of the latter, atrophy of the patient's own glands, hypochlorhydria - a decrease in the concentration of hydrochloric acid, or achlorhydria - its complete absence in the gastric juice occur.

There is a range of factors that aggravate the condition of the mucous membrane, acting in combination. Such factors may be a pathological process, age-related changes in the body, and one should not exclude a possible genetic predisposition. Systematic violation of the principles of healthy eating, addiction to alcohol and the use of drugs for a long period that form gastritis, for example, potassium chloride, inevitably provoke a deterioration in the condition of the mucous membrane.

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

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Symptoms of gastric mucosa atrophy

With atrophic gastritis, the functionality of the stomach deteriorates sharply, so its leading symptom can be called dispersion syndrome: decreased appetite in the patient, belching with a characteristic smell of rotten food, the appearance of nausea. The patient is often bothered by a feeling of heaviness in the stomach after eating, salivation and an unpleasant taste in the mouth. Rumbling, bloating and acute intolerance to fermented milk products and diarrhea accompany the emerging dysbacteriosis. Painful sensations with atrophy, if they occur, are characterized as dull, aching, without noticeable localization. Pain during palpation of the abdomen is not characteristic of atrophy of the gastric mucosa.

Focal atrophy of the gastric mucosa

The danger of focal atrophy of the gastric mucosa is hidden in its symptomatic inexpressibility until the pathology develops into a more dangerous form and affects the entire area of the gastric mucosa. The lesions can be of different shapes and sizes, and be at different stages of the disease. Timely diagnosis allows treatment to begin at an early stage, which gives a positive result.

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Atrophy of the antral gastric mucosa

The antrum is the distal part of the stomach that mixes and grinds food and then slowly pushes it through the pyloric sphincter. When functioning normally, it has low acidity.

Antral focal gastritis is a type of pathology in which the glands responsible for the production of hydrochloric acid and pepsin are lost. There is a shortage of mucus that protects the walls of the stomach from its own acid, and the possibility of inflammation of the remaining sections increases.

An advanced disease carries the risk of becoming chronic and multiplying in the stomach many bacteria, for which an environment with low acidity is an optimal condition for life. Symptoms become more acute, persistent pain syndrome occurs. During chronic atrophy of the mucous membrane of the antral part of the stomach, dysbacteriosis, pancreatitis and anemia may develop. In addition, ignoring the disease invariably leads to disruption of the duodenum, and, as a consequence, to the development of duodenitis and peptic ulcer disease.

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Moderate atrophy of the gastric mucosa

Atrophy of the gastric mucosa can be defined as weak, moderate or severe according to the severity criterion. Mild atrophy is characterized by slight shortening of the main glands, a moderate increase in the number of accessory glandulocytes is noticeable in them, some parietal glandulocytes are replaced by mucoid ones, but the main ones are generally preserved. With severe atrophy, extensive fields of sclerosis are noticeable in places where the glands were, a polymorphic cell infiltrate is observed. The remaining glands are short, parietal cells are displaced by mucus-forming ones. Moderate atrophy, as a rule, is an intermediate phenomenon: simultaneously with the remaining fundic glands, there are also those that are represented only by accessory cells.

Diagnosis of gastric mucosal atrophy

The most important task that a doctor faces at the diagnostic stage is differentiating this disease from stomach cancer. This is quite difficult, because there are no specific symptoms by which one could differentiate stomach cancer from chronic mucosal atrophy.

The basis for diagnosing atrophic gastritis is:

• General clinical examination: blood, urine and stool analysis. In case of gastric mucosal atrophy, combined with B12 _- deficiency anemia, a blood test can determine a decrease in the patient's hemoglobin level;
• diagnostics of Helicobacter pylori infection using laboratory tests: rapid abbreviated test, breath test or morphological methods;
• endoscopic examination – a careful examination of the stomach, duodenum and esophagus using an endoscope;
• histological examination of materials obtained during a biopsy – pieces of mucous membrane, in order to determine the type of pathomorphological changes;
• pH-metry, which is used to assess the secretory function of the patient's stomach;
• examination of the pancreas, liver and gallbladder using ultrasound (US), which makes it possible to determine the presence of negative changes in them, usually associated with atrophy of the gastric mucosa.

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Treatment of gastric mucosa atrophy

The effectiveness of treatment of gastric mucosa atrophy depends on the correctness of the answer to the question about its cause. After all, it can be either chronic gastritis caused by the bacterium Helicobacter pylori or the action of autoimmune mechanisms.

For the first case, eradication therapy is applicable – destruction of Helicobacter pylori bacteria. Before deciding on the choice of drugs, daily pH-metry is performed. Depending on its results, the doctor prescribes proton pump inhibitors (at a pH of less than 6) or only antibiotics (at a pH of 6 or more): clarithromycin and amoxicillin. The duration of such therapy is usually at least seven days.

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

• replacement: natural gastric juice - 1 tablespoon 3 times a day during meals; acidin-pepsin - 1 tablet 3 times a day, washed down with half a glass of water (hydrochloric acid is formed when dissolved in water); gastric enzyme preparations: pancreatin, festal, panzinorm and others; if there is B12-deficiency anemia, injections of vitamin B12 are also included;
• stimulators of hydrochloric acid production. The most popular is plantaglucid: thanks to the extract of plantain leaves, it increases secretion, has an antispasmodic and anti-inflammatory effect. It is taken half an hour before meals. Useful effect is also given by drinking mineral waters, rosehip decoction and limontar.

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

Diet for gastric mucosa atrophy

The purpose of the diet is to eliminate damage to the mucous membrane during the stomach's processing of food. The diet is not used as an independent treatment measure, but it plays an important role in the treatment of pathology.

Principles of the treatment regime:

1. Strict adherence to the diet - refusal of products that damage the mucous membrane, namely: spicy, sour, salty, smoked, fried and pickled food, spices and canned food. All food consumed by the patient should be steamed, chopped and served at room temperature. A taboo is imposed on carbonated drinks, strong tea, coffee and, of course, alcoholic beverages. They should be completely replaced with weak tea or rosehip infusion, cocoa and mineral waters. Confectionery and milk are also excluded. The patient with gastric mucosa atrophy should eat food in small portions and often.
2. It is advisable for smoking patients to give up their bad habit.
3. You should stop taking medications that have a destructive effect on the gastric mucosa (aspirin and ibuprofen) and refrain from them in the future.

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Prevention of gastric mucosa atrophy

The main measure for preventing gastric mucosa atrophy is timely treatment of gastritis caused by Helicobacter pylori infection. Healthy nutrition plays an important role in prevention, because following its principles, you can significantly reduce the risk of gastric mucosa atrophy and its oncological consequences. Of fundamental importance is constant monitoring of patients with chronic gastritis: dispensary observation and conducting an endoscopic examination with histological assessment of biopsy samples of the mucosa at least twice a year.

Prognosis of gastric mucosal atrophy

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