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

When the doctor announces the diagnosis – chronic antral gastritis – many patients immediately have a lot of questions:

• What does antral mean?
• How does this gastritis differ from regular gastritis?
• Is this disease dangerous?

Let's say right away: this diagnosis indicates that in a certain part of the stomach (namely, in the antrum, where the formation of the food bolus occurs) there is an inflammatory reaction with a chronic course.

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

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Epidemiology

Gastritis is considered a very common pathology in the world. For example, chronic gastritis affects about half of the world's population. At the same time, antral gastritis is detected more often than fundal gastritis (in about 50% of cases).

The overwhelming majority of chronic gastritis is caused by the Helicobacter bacterium (in 80% of cases).

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Causes chronic antral gastritis

The occurrence 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-steroidal anti-inflammatory drugs or other medications that are aggressive to the stomach;
• heavy smoking;
• abuse of alcoholic beverages;
• regular consumption of foods that are too hot or too spicy;
• frequent or severe stress, psycho-emotional breakdowns;
• vascular diseases - in particular, diseases of the vascular system of the digestive tract;
• burn disease;
• fungal, viral infections, AIDS;
• helminthic infestations;
• autoimmune diseases.

The most common cause of chronic antral gastritis is considered to be infection with a gram-negative microorganism – Helicobacter, which, when it enters the digestive system, causes the development of inflammatory and even ulcerative processes.

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Pathogenesis

Under the influence of any of the above factors, the immune defense of the stomach walls (at the local level) decreases. As a result, the internal walls are damaged by hydrochloric acid of the gastric juice, and if the process continues for a long time, it becomes chronic.

When infected with Helicobacter, the pathogenesis looks a little different:

• the pathogenic microorganism enters the digestive tract and remains there, attaching to the walls of the epithelium;
• the vital activity of the microorganism leads to the transformation of urea into ammonia compounds, which results in a disruption of the acid balance inside the stomach;
• microorganisms begin to multiply in an environment favorable for them;
• epithelial cells die, an inflammatory reaction develops, which can be accompanied by the formation of ulcers.

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Symptoms chronic antral gastritis

The onset of chronic antral gastritis often goes unnoticed.

The first signs of the disease increase gradually, as the inflammatory process spreads and the secretion of gastric juice changes, when the food lump does not have time to change its acidic reaction to alkaline and enters the intestines undigested. Disrupted digestive processes lead to irritation of the gastrointestinal tract tissues - and only then does a person begin to feel symptoms of malaise:

• painful spasms in the abdomen, more often on an empty stomach;
• an uncomfortable feeling in the stomach (a feeling of squeezing, fullness);
• periodic unpleasant belching, sour taste in the mouth, bouts of nausea;
• instability of stool, increased gas formation;
• impaired digestion of food, prolonged feeling of discomfort after eating.

If appropriate treatment is not carried out at this stage, complications may develop that worsen the clinical picture of antral gastritis.

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Forms

Doctors distinguish several types of chronic antral gastritis. Below we will consider a brief description of its most common types.

• Chronic erosive antral gastritis is a complex disease caused by infection of the digestive system with Helicobacter pylori. As a result of the vital activity of the pathogenic microorganism, peculiar ulcers - erosions - are formed on the stomach walls. If such erosions begin to bleed (and this can be determined by the presence of blood in vomit and feces), then this type is already called hemorrhagic antral gastritis.
• Chronic non-atrophic antral gastritis occurs without atrophy - necrosis - of the mucous membrane, and this is a good sign for the further prognosis of the disease. Such gastritis is quite treatable if the disease is not neglected.
• Chronic focal antral gastritis – this diagnosis is established if the inflammation damages not the entire mucous membrane of the antral section, but only a separate section. This pathology has all the signs of ordinary gastritis, and only diagnostic procedures allow it to be detected.
• Chronic diffuse antral gastritis, unlike focal gastritis, involves damage to the entire mucous membrane of the antral section. If a patient with such a diagnosis does not have atrophy and erosions, then treatment is usually successful.
• Chronic antral subatrophic gastritis - this term indicates that the inflammatory process occurring in the antral part of the stomach has affected the layers of tissue that are under the mucous layer. In such a situation, the ability of cells to regenerate drops sharply, and damaged tissues are replaced by connective tissue.
• Chronic superficial antral gastritis is perhaps the mildest form of antral gastritis. In this case, inflammation affects only the upper, superficial tissues, and therefore there is no disruption of the glands' function and no cicatricial changes.
• Chronic antral hyperplastic gastritis is characterized by primary proliferation of epithelial tissue of the stomach. This is a fairly rare pathology, the mechanism of development of which is currently not sufficiently studied.
• 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 gastritis - this can be any form of chronic antral gastritis, which is caused by an infection - Helicobacter pylori.

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Complications and consequences

Complications of chronic antral gastritis may include:

• antral ulcer;
• erosions of the antral part of the stomach;
• cancerous processes in the antral part of the stomach.

In addition, gastritis can quickly develop into an atrophic form, in which areas of tissue necrosis appear, an infection occurs, and the disease spreads to all the walls of the gastric cavity and the duodenum.

The listed consequences can be avoided if you consult a doctor in time and undergo adequate treatment for the disease.

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Diagnostics chronic antral gastritis

To make a correct diagnosis, a number of different methods are used, which are prescribed depending on the situation and individual characteristics of the patient.

First of all, the doctor will pay attention to the patient’s complaints – symptoms in most cases may indicate chronic gastritis.

Additionally, the following tests may be prescribed:

• General blood test – will show a slight increase in the number of neutrophils;
• blood biochemistry – sometimes used as an auxiliary method for diagnosing underlying diseases;
• stool analysis for the presence of occult blood - helps to detect bleeding from the affected stomach walls;
• Enzyme immunoassay – used to detect the pathogenic microorganism Helicobacter pylori.

Instrumental diagnostics usually includes:

• fibrogastroduodenoscopy – the use of a special device for examining the mucous tissues of the digestive tract;
• X-ray examination of the stomach using a special contrast agent – allows detection of damage to the mucous membranes, tumor processes, scars and folds;
• Ultrasound is usually used to assess the condition of other organs located in the abdominal cavity;
• CT – computed tomography based on X-ray radiation, which allows obtaining a layered image of the organ being examined;
• Gastric pH-metry – measurement of the degree of acidity inside the stomach.

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Differential diagnosis

Differential diagnostics can be carried out with other types of gastritis, with pancreatitis and cholecystitis, with gastric ulcer and duodenal ulcer, as well as with tumor processes in the gastrointestinal tract.

Treatment chronic antral gastritis

The treatment regimen used for chronic antral gastritis is practically no different from that for other types of gastric mucosal inflammation. A strict diet is mandatory, which should be followed against the background of drug treatment, including:

• taking proton pump inhibitors, which stabilize gastric secretion (omez, de-nol);
• taking antacid drugs - in case of increased acidity (Almagel, Maalox);
• taking antibiotics – to suppress the development of Helicobacter pylori (amoxicillin);
• taking antispasmodic drugs – to relieve spasms and pain in the stomach (no-shpa);
• use of enzyme preparations – to facilitate the digestion process (Creon, pancreatin);
• taking regenerating drugs that improve blood circulation and nutrition of stomach tissues (actovegin, riboxin).

Medicines are usually prescribed in combination with each other to achieve the best effect. Additionally, the doctor may recommend taking sedatives (for example, based on valerian root or lemon balm), as well as vitamin therapy.

	Dosage and method of administration of drugs	Side effects	Special instructions
De-nol	Prescribed 1 tablet 4 times a day, half an hour before meals and before bed.	Nausea, frequent bowel movements or constipation.	De-nol should not be taken for more than 2 months in a row.

	Dosage and method of administration of drugs	Side effects	Special instructions
Maalox	Prescribed 15 ml one hour after meals and before bedtime, or when heartburn or stomach pain occurs.	Sometimes – manifestations of hypersensitivity, constipation.	The daily dosage of the drug should not exceed 90 ml of suspension, and the total course of therapy should not exceed 2 months.

	Dosage and method of administration of drugs	Side effects	Special instructions
Amoxicillin	The amount of the drug is determined individually.	Dizziness, convulsions, nausea, hepatitis.	Amoxicillin should not be given to anyone under 18 years of age.

	Dosage and method of administration of drugs	Side effects	Special instructions
Creon	The dosage is adjusted individually.	Indigestion, abdominal pain, hypersensitivity reactions.	Creon is not used in acute pancreatitis.

Vitamins

Chronic inflammation in the antral part of the stomach almost always leads to a deterioration in the absorption of nutrients and vitamins obtained from food. To compensate for the vitamin deficiency that is forming in the body, the doctor may prescribe special medications to the patient, including B vitamins, vitamin C, and nicotinic acid.

If anemia is detected in the patient during the diagnostic process, then additional intake of cyanocobalamin, folic acid, and special preparations containing iron are indicated - for example, ferrum-lek or sorbifer-durulex.

During periods of exacerbation, B vitamins are prescribed in the form of intramuscular injections, and only in the absence of obvious signs of gastritis are such drugs allowed to be taken orally.

Physiotherapy treatment

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

A high-quality therapeutic effect can be expected from mud therapy, from the use of paraffin and ozokerite on the epigastric zone. Such procedures are used with normal or increased acidity of the stomach. With low acidity, such treatment is not recommended.

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

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

Folk remedies

Traditional medicine includes the use of several common recipes that help relieve stomach pain and promote rapid healing of the inflamed mucous membrane of the antral region.

• It is useful to drink 150 ml of potato juice, 30-40 minutes before breakfast, daily. This recipe is especially recommended for increased acidity.
• If you consume 1 teaspoon of sea buckthorn oil before each meal, you can prevent recurrence of gastritis.
• Instead of sea buckthorn oil, you can drink fresh juice obtained from plantain. The medicine is taken 1 tbsp. in 50 ml of water.
• Propolis oil is taken every day for a week, 1 teaspoon before meals, but no more.

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Herbal treatment

Success in treating chronic gastritis largely depends on how complete it is. For example, doctors often recommend including herbal infusions in the therapeutic regimen, prepared on the basis of medicinal plants, the action of which complements each other.

The following have such a beneficial effect:

• marshmallow rhizome;
• chamomile flower;
• licorice rhizome;
• mint leaves.

If you take equal proportions of the listed herbs, mix and pour 1 teaspoon of 200 ml of boiling water, keeping in a thermos for 2 hours, then such a medicine will help reduce even the most negative manifestations of gastritis. The infusion is taken 50 ml up to 4 times a day an hour after meals.

Calamus rhizome will help reduce acidity: use 1 teaspoon of raw material per cup of boiling water, leave for half an hour, filter and drink a quarter cup 4 times a day before meals.

To restore the damaged mucous membrane of the antral part of the stomach, you can prepare a mixture of one tablespoon of calendula flowers and two tablespoons of coltsfoot. The mixture is brewed like regular tea and drunk throughout the day between meals. To improve the taste, you can add 1 teaspoon of sugar or honey.

Homeopathy

Homeopaths claim that there are drugs that can effectively restore the digestive system to order, and at the same time have virtually no side effects. Such drugs are called "homeopathic".

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

The feeling of heaviness and distension in the stomach, loss of appetite are successfully relieved by the use of Antimonium Crudum (antimony sulphide), in a dilution of 3 or 6.

In case of concomitant liver damage, the drug Hepar sulfur, in dilutions of 3 and 12, will help.

But for chronic gastritis it is especially recommended to take the homeopathic remedy Phosphoricum, in dilutions of 3, 6, 12. This drug will have a positive effect on heartburn, sour belching and periodic bouts of vomiting.

Surgical treatment

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

The standard treatment regimen for chronic antral gastritis does not include surgical procedures.

Diet for chronic antral gastritis

For most patients with chronic antral gastritis in the acute stage, dietary table No. 1 is indicated, which provides for the following changes in nutrition:

• a meal regimen is established 6 times a day, but in small quantities;
• Preference is given to pureed delicate soups, boiled liquid porridges, low-fat broths, dried bread, jelly, and kissel.

Only after the acute symptoms have subsided can the diet be somewhat diversified, but even here the basic principles of nutrition for antral gastritis are present:

• a taboo is introduced on hot spices, fried foods, smoked foods, canned foods of any kind, carbonated drinks, and semi-finished products;
• for cooking it is advisable to use a steamer, you can also boil and stew food;
• plant foods must be processed before cooking - for example, boiled, since raw fruits and vegetables will have to be excluded for some time;
• hot and cold dishes are prohibited (ideally, it is better to eat foods with a temperature of about 45°C);
• if there are no problems with the kidneys or cardiovascular system, it is necessary to increase the amount of water you drink per day – up to approximately 2 liters daily;
• If the product is not served crushed, it must be chewed thoroughly when consumed;
• overeating and eating on the run should be avoided;
• A strict ban is imposed on alcoholic beverages and smoking.

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Prevention

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

• giving up bad habits (in this case, smoking and drinking alcohol);
• adherence to the rules of proper healthy eating (eating in small portions, reducing the amount of spicy, fatty and fried foods, avoiding dry food, etc.);
• compliance with personal hygiene rules (regular hand washing, use of individual utensils and cups);
• refusal to self-medicate any diseases, especially if the treatment is carried out with non-steroidal anti-inflammatory drugs or other agents that irritate the stomach.

An active lifestyle, rational distribution of work and rest periods, and development of stress resistance are encouraged.

If possible, it is recommended to periodically undergo preventive treatment at a health resort, with a course of mineral waters.

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Forecast

The prognosis for patients diagnosed with chronic antral gastritis is generally favorable, but only if treatment is started on time and the patient follows all the doctor's instructions and recommendations. Otherwise, the disease may be complicated by the development of a diffuse (widespread) form and the formation of an ulcerative or even tumor process.

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