Chronic gastritis of the antral part of the stomach: erosive, focal, diffuse, superficial, atrophic

When a doctor reads a diagnosis - chronic antral gastritis - many patients immediately have a lot of questions:

• What does antral mean?
• Than such gastritis differs from usual gastritis?
• Is this a dangerous disease?

Let's say at once: this diagnosis indicates that there is an inflammatory reaction with a chronic course in a certain gastric department (namely, in the antrum, where the food lump is formed).

The disease occurs with a violation of the secretory function of the stomach and with internal damage to the stomach walls.

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

Epidemiology

Gastritis is considered a very common pathology in the world. For example, chronic gastritis affects about half of the world's population. In this case, antral gastritis is found more often than the basal gastritis (approximately in 50% of cases).

The overwhelming number of chronic gastritis is caused by Helicobacter bacteria (in 80% of cases).

[8], [9], [10], [11], [12], [13], [14]

Causes of the chronic antral gastritis

The appearance of chronic antral gastritis may be due to the influence of certain factors. The following risk factors can be identified:

• infection with the pathogenic microorganism Helicobacter pylori;
• long-term use of non-steroid anti-inflammatory drugs, or other drugs aggressive for the stomach;
• heavy smoking;
• abuse of alcohol-containing beverages;
• regular use of too hot or too sharp dishes;
• frequent or severe stress, psycho-emotional failures;
• vascular disease - in particular, the vascular system of the digestive tract;
• burn disease;
• fungal, viral infections, AIDS;
• helminthic invasions;
• diseases of an autoimmune nature.

The most common cause of chronic antral gastritis is the infection of a gram (-) microorganism - Helicobacter, which, upon ingestion into the digestive system, causes the development of inflammatory and even ulcerative processes.

[15], [16], [17], [18], [19], [20]

Pathogenesis

Under the influence of any of the above factors, the immune defense of the walls of the stomach decreases (at the local level). As a result, the internal walls are damaged by hydrochloric acid of gastric juice, and with prolonged flow the process passes into a chronic form.

When Helicobacter infection is infected, the pathogenesis looks a bit different:

• the pathogenic microorganism enters the digestive tract and lingers in it, adhering to the walls of the epithelium;
• the vital activity of the microorganism leads to the fact that urea is transformed into ammonia compounds, as a result of which the acid balance in the stomach is disturbed;
• micro-organisms begin to multiply in a favorable environment for them;
• epithelial cells die, an inflammatory reaction develops, which can be accompanied by the formation of ulcers.

[21], [22], [23], [24], [25], [26], [27]

Symptoms of the chronic antral gastritis

The onset of the development of chronic antral gastritis often goes unnoticed.

The first signs of the disease grow gradually, as the inflammatory process spreads and the secretion of gastric juice changes, when the food lump does not have time to change the acid reaction to an alkaline one and gets into the intestine undigested. Disrupted digestive processes lead to irritation of the gastrointestinal tract - and only then the person begins to feel the symptoms of malaise:

• painful spasms in the abdomen, often on an empty stomach;
• uncomfortable feeling in the stomach (feeling of squeezing, overcrowding);
• a periodical unpleasant eructation, a sour taste in the mouth, bouts of nausea;
• unstable stool, increased gassing;
• deterioration in the digestion of food, a prolonged sense of discomfort after eating.

If at this stage there is no appropriate treatment, complications that aggravate the clinical picture of antral gastritis can develop.

[28], [29], [30]

Forms

Doctors distinguish several varieties of chronic antral gastritis. Next, we will consider a brief description of the most common of its species.

• Chronic erosive antral gastritis is a complex disease that is caused by infection of the digestive system Helicobacter pylori. As a result of the vital activity of the pathogenic microorganism, peculiar sores are formed on the gastric walls - erosion. If such erosions begin to bleed (and this can be determined by the presence of blood in vomit masses and feces), then this species is already called hemorrhagic antral gastritis.
• Chronic non-atrophic antral gastritis occurs without atrophy - necrosis, necrosis - mucous, and this is a good sign for further prognosis of the disease. Such a gastritis is quite easy to treat, if the disease does not start.
• Chronic focal anthral gastritis - this diagnosis is established if the inflammation does not damage the entire antrum mucosa, but only its individual site. This pathology has all the signs of an ordinary gastritis, and only diagnostic procedures allow it to be detected.
• Chronic diffuse antral gastritis, in contrast to focal, provides for the defeat of the entire mucous antral section. If a patient with such a diagnosis does not show atrophy and erosion, then treatment is usually successful.
• Chronic antral subatrophic gastritis - this term indicates that the inflammatory process that occurs in the antrum of the stomach, struck layers of tissue that are under the mucous layer. In such a situation, the cell's ability to regenerate drops sharply, and damaged tissues are replaced by a connective tissue.
• Chronic superficial antral gastritis is perhaps the easiest version of the course of antral gastritis. In this case, the inflammation affects only the upper, superficially located tissues, and therefore there is no abnormality of the glands and scarring is not formed.
• Chronic antral hyperplastic gastritis is characterized by the primary growth of the epithelial tissue of the stomach. This is a fairly rare pathology, the development mechanism of which has not been adequately studied at the moment.
• Chronic antral catarrhal gastritis is, one might say, a synonym for the diagnostic term "chronic superficial antral gastritis". The disease is not severe and, after a short treatment, patients usually recover.
• Chronic antral helicobacter pylori - this can be any form of chronic antral gastritis, which is provoked by an infection - Helicobacter pylori.

[31], [32], [33], [34]

Complications and consequences

Complications of chronic antral gastritis can be:

• ulcer of antral stomach;
• erosion of the antrum of the stomach;
• cancerous processes in the antrum of the stomach.

In addition, gastritis can in a short time pass into an atrophic form, in which tissue necrosis areas appear, the infection joins, and the disease spreads to all walls of the gastric cavity and to the 12-colon.

The listed consequences can be avoided if one seeks a doctor in time and carries out adequate treatment of the disease.

[35], [36], [37], [38], [39], [40], [41]

Diagnostics of the chronic antral gastritis

To correctly diagnose a number of different methods are used, which are appointed, depending on the situation and individual characteristics of the patient.

First and foremost, the doctor will pay attention to the patient's complaints - the symptoms in most cases can indicate a chronic course of gastritis.

Additionally, tests can be assigned:

• a general blood test - will show a slight increase in the number of neutrophils;
• biochemistry of blood - sometimes used as an auxiliary method for diagnosing background diseases;
• analysis of feces for the presence of hidden blood - helps to detect the bleeding of the affected walls of the stomach;
• enzyme immunoassay - used to detect a pathogenic microorganism Helicobacter pylori.

Instrumental diagnosis usually includes:

• Fibrogastroduodenoscopy - application of a special device for examination of mucous tissues of the digestive tract;
• X-ray examination of the stomach with the use of a special contrast agent - allows to detect mucosal lesions, tumor processes, scars and folds;
• Ultrasound is usually used to assess the condition of other organs located in the abdominal cavity;
• CT is a computer tomogram based on X-ray radiation, which makes it possible to obtain a layered image of the organ under examination;
• gastric pH-meter - measurement of the degree of acidity inside the stomach.

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

Differential diagnosis

Differential diagnostics can be performed with other types of gastritis, with pancreatitis and cholecystitis, with peptic ulcer of the stomach and duodenum, and with tumor processes in the digestive tract.

Treatment of the chronic antral gastritis

The treatment regimen, which is used for chronic antral gastritis, practically does not differ from that for other types of inflammation of the gastric mucosa. A strict diet should be prescribed, which should be observed against the background of drug treatment, which includes:

• taking proton pump inhibitor drugs that stabilize gastric secretion (omez, de-nol);
• taking antacids - in case of increased acidity (Almagel, Maalox);
• reception of antibiotics - to inhibit the development of Helicobacter pylori (amoxicillin);
• taking spasmolytic drugs - to eliminate spasms and pain in the stomach (no-shpa);
• the use of enzyme preparations - to facilitate the processes of digestion of food (kreon, pancreatin);
• reception of regenerating drugs, which improve blood circulation and nutrition of stomach tissues (actovegin, riboxin).

Medications are usually prescribed in combination with each other, in order to achieve the best effect. In addition, the doctor can recommend the use of sedatives (for example, based on valerian root or lemon balm), as well as vitamin therapy.

	Dosage and route of administration	Side effects	Special instructions
De-naught	Assign 1 tab. 4 times a day, half an hour before meals and at bedtime.	Nausea, frequent stools or constipation.	De-nol can not be taken more than 2 months in a row.

	Dosage and route of administration	Side effects	Special instructions
Maalox	Assign 15 ml an hour after eating and before going to bed, or when there is heartburn or stomach pain.	Sometimes - hypersensitivity, constipation.	The daily dosage of the drug should not be above 90 ml of the suspension, and the total course of therapy should not exceed 2 months.

	Dosage and route of administration	Side effects	Special instructions
Amoxicillin	The amount of the drug is determined individually.	Dizziness, convulsions, nausea, hepatitis.	Do not take amoxicillin for people younger than 18 years.

	Dosage and route of administration	Side effects	Special instructions
Creon	Dosage is adjusted individually.	Indigestion, abdominal pain, hypersensitivity.	Creon is not used for acute pancreatitis.

Vitamins

Chronic inflammatory process in the antral gastric department almost always leads to a deterioration in the absorption of nutrients and vitamins obtained from food. To fill the deficit of vitamins in the body, the doctor can prescribe to the patient special preparations that include vitamins of group B, vitamin C, nicotinic acid.

If the patient has anemia in the course of diagnosis, then an additional intake of cyanocobalamin, folic acid, as well as special preparations containing iron - for example, ferrum-lek or sorbifer-durulex - is shown.

Vitamins of group B in the period of exacerbation are appointed in the form of intramuscular injections, and only in the absence of obvious signs of gastritis such drugs are allowed to take inside.

Physiotherapeutic treatment

Treatment with the use of physiotherapy can be used outside the exacerbation of chronic antral gastritis, to prevent subsequent exacerbations.

A qualitative therapeutic effect can be expected from mud treatment, from the use of paraffin and ozocerite on the epigastric zone. Similar procedures are used with normal or increased acidity of the stomach. At low acidity, such treatment is not recommended.

Chronic gastritis is an indication for the use of galvanization sessions, phonation and electrophoresis procedures, UHF therapy.

Balneotherapy involves the use of baths with pine needles, radon, medicinal herbs, mineral waters.

Alternative treatment

Alternative treatment includes the use of several common recipes that help alleviate stomach pain and promote the fastest healing of the inflamed mucous antrum.

• It is useful to consume 150 ml of potato juice, 30-40 minutes before breakfast, daily. This recipe is especially recommended when the acidity is increased.
• If you eat before each meal 1 tsp. Sea buckthorn oil, it is possible to prevent repeated exacerbation of gastritis.
• Instead of sea buckthorn oil, you can drink fresh juice obtained from plantain. The medicine is taken for 1 tbsp. L. In 50 ml of water.
• Propolis oil is taken every day for a week for 1 tsp. Before meals, but no more.

Herbal Treatment

The success in the treatment of chronic gastritis largely depends on how complete it was. For example, often doctors recommend to include in the therapeutic scheme herbal preparations, prepared on the basis of medicinal plants, the action of which mutually complement each other.

Such a useful action is possessed by:

• rhizome of althea;
• chamomile color;
• rhizome of licorice;
• mint leaves.

If you take the same proportions of the listed herbs, mix and pour 1 tsp. 200 ml of boiling water, withstood in a thermos for 2 hours, then this medicine will help reduce even the most negative manifestations of gastritis. Infusion take 50 ml to 4 times a day an hour after eating.

With a decrease in acidity, the rhizome of calamus will help: use 1 tsp. Raw materials for a cup of boiling water, insist half an hour, filter and drink a quarter cup four times a day, before eating.

To restore the damaged mucous antral part of the stomach, you can prepare a collection of one tablespoon of calendula and two tablespoons of mother-and-stepmother. The collection is brewed like ordinary tea, and is drunk during the day between meals. To improve the taste, you can add 1 tsp. Sugar or honey.

Homeopathy

Homeopaths argue that there are drugs that can qualitatively bring the digestive system in order, and at the same time have virtually no side effects. Such drugs are called "homeopathic".

With antral gastritis accompanied by vomiting and diarrhea, the drug Acidum sulfuricum, in an individually selected dosage, will help.

Feeling of heaviness and raspiraniya in the stomach, violations of appetite successfully stopped by the application of Antimonium krudum (sulfurous antimony), in breeding 3 or 6.

With the concomitant defeat of the liver, the drug Gepar sulfur, in the dilution of 3 and 12, will help.

But it is especially recommended for chronic gastritis to take homeopathic remedy Phosphoricum, in dilutions 3, 6, 12. This drug will have a positive effect for heartburn, acidic eructations and recurrent vomiting.

Operative treatment

Indications for surgical intervention with chronic antral gastritis are rare. This can happen only after the development of certain complications - for example, with a bleeding ulcer of the stomach, with the growth of a cancerous tumor, as well as during perforation of the ulcer.

In the standard scheme of treatment of chronic antral gastritis, surgical operations are not included.

Diet with chronic antral gastritis

For most patients with chronic antral gastritis in the stage of exacerbation is shown the dietary table number 1, which provides the following changes in diet:

• set the mode of food intake 6 times a day, but in small quantities;
• Preference is given to grated delicate soups, boiled liquid porridge, low-fat broth, dried bread, jelly, jelly.

Only after the acute symptoms subsided, the diet can be somewhat varied, but here also the basic principles of nutrition with antral gastritis are present:

• introduces taboo on spicy spices, fried foods, smoked products, conservation in some form, soda, semi-finished products;
• for cooking, it is desirable to use a steamer, you can also cook and stew foods;
• vegetable food before cooking should be processed - for example, boil, as raw fruits and vegetables for a while will have to be excluded;
• under the ban fall hot and cold dishes (ideally use products with a temperature of about 45 ° C);
• if there are no problems with the kidneys and the cardiovascular system, it is necessary to increase the amount of water consumed per day - about 2 liters daily;
• if the product is not shredded, then it must be thoroughly chewed when used;
• Do not overeat and eat "on the run";
• Strict prohibition is imposed on alcohol and smoking.

[47], [48], [49], [50], [51], [52]

Prevention

The standard preventive measures aimed at preventing the development of antral gastritis include:

• refusal from bad habits (in this case, from smoking and drinking alcohol);
• adherence to the rules of proper healthy eating (fractional food intake, reduction of the number of sharp, fatty and fried dishes, refusal to eat dry foods, etc.);
• compliance with personal hygiene (regular washing of hands, use of individual appliances and cups);
• refusal of self-treatment of any diseases, especially if the treatment is performed with non-steroidal anti-inflammatory drugs or other means that irritate the stomach.

The conduct of an active way of life, the rational distribution of the period of work and rest, the development of stress-resistance are encouraged.

If possible, it is recommended to undergo periodic sanatorium-preventive treatment periodically, with a course reception of mineral waters.

[53], [54], [55], [56]

Forecast

The prognosis for patients diagnosed with "chronic antral gastritis" is mostly favorable, but only on the condition that the treatment is started on time, and the patient observed all the prescriptions and recommendations of the doctor. Otherwise, the disease can be complicated by the development of a diffuse (widespread) form and the formation of a ulcerative or even a tumor process.

[57], [58], [59], [60], [61], [62]