Endoscopic signs of gastric erosions

Erosive and ulcerative lesions of the stomach affect people of active age. Over the years, there has been an increase in the incidence rate in our country. The age range is expanding. Women are ill on average 4 times less often than men. Young women, unlike men, are ill less often than older women.

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Gastric erosions

Erosion is a small superficial defect of the mucous membrane, white or yellow in color, with smooth edges. It captures the proper plate of the mucous membrane, without penetrating to the muscular plate. The shape is linear or round, the demarcation from the surrounding mucous membrane is unclear. First described by Findler in 1939. Erosions appear as a result of hemorrhages in the neck of the glands with the development of hypoxia in this area and complete rejection of the superficial epithelium. They most often occur against the background of superficial or hyperplastic gastritis. They can bleed, in which case the term "erosion" is used only when the mucous membrane is visible, not covered by a blood clot. Erosions can cause profuse bleeding.

The term "aphthous erosion" is often used to describe erosions due to the aphthous-like base (an aphtha is a yellow or white spot with a red border) on which they are located - fibrinous exudate.

Classification of gastric erosions

1. Hemorrhagic erosions.
2. Incomplete erosions (flat).
3. Complete erosions:
   • mature type,
   • immature type.

Hemorrhagic and incomplete erosions are a consequence of an acute inflammatory process in the gastric mucosa, while complete erosions are a consequence of a chronic inflammatory process.

Hemorrhagic erosions are observed in hemorrhagic erosive gastritis. The latter can be diffuse and focal. Focal hemorrhagic erosive gastritis is more common in the fornix and antral section. During endoscopic examination, hemorrhagic erosions look like small-point defects of the mucous membrane, resembling a pinprick or needle prick, up to 0.1 cm in diameter, they can be superficial and deep, the color of the erosions ranges from bright red to cherry. Erosion is usually surrounded by a rim of hyperemia, often larger than the erosion itself - up to 0.2 cm. Erosions can be covered with blood or hemorrhagic plaque. As a rule, the edges of erosions bleed. The mucous membrane around is edematous, can be covered with bloody mucus. The stomach is well straightened with air, peristalsis is preserved in all sections.

Biopsy: severe microcirculation disorder, hemorrhage in the area of the glandular neck with rejection of the surface epithelium and blood flowing to the surface of the mucous membrane.

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Incomplete erosions of the stomach

During endoscopic examination, incomplete erosions look like flat defects of the mucous membrane of various sizes and shapes - round or oval, with a diameter of 0.2 to 0.4 cm. The bottom may be clean or covered with fibrin, the edges are smoothed. The mucous membrane around is edematous, hyperemic in the form of a small narrow rim. They can be single or multiple. They are most often localized along the lesser curvature of the cardiac section and body of the stomach. They usually epithelialize within 1-2 weeks, leaving no trace on the mucous membrane. They often appear against the background of chronic atrophic gastritis, combined with a gastric ulcer, a hernia of the esophageal opening of the diaphragm, and reflux esophagitis.

Biopsy: at the bottom and at the edges there is a small area of necrotic tissue, deeper there is a small area of leukocyte infiltration.

Complete erosions of the stomach

Endoscopic examination reveals cone-shaped polypoid formations on the mucous membrane with central depressions and ulcerations or a round or oval defect. The defect is covered with fibrin, often dark brown or black (hydrochloric hematin). Erosions are located along the tops of the folds. When air is insufflated, the folds straighten out completely, but the erosions remain. Sizes range from 0.1 to 1.0 cm (usually 0.4-0.6 cm). The mucous membrane in the erosion zone may be moderately edematous, hyperemic or almost unchanged. The leading role in the formation of these erosions belongs to changes in the vascular and connective tissue apparatus of the mucous and submucous layer, which leads to pronounced edema and impregnation of the mucous membrane in the erosion zone with fibrin. As a result, the erosion seems to bulge into the lumen of the stomach on an edematous-inflammatory basis. They can be single, but more often multiple. Multiple erosions can be located along the tops of folds in the form of "octopus suckers".

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Chronic erosions of the stomach

Mature type. Polypoid formations have clear contours, a regular round shape, reminiscent of a volcanic crater. They exist for years. Nowadays, such chronic erosions are commonly called papules.

Immature type. Polypoid formations have unclear contours: they look slightly "corrugated" or "eaten away". They heal within a few days.

Biopsy: mature erosions differ from immature ones in their histological picture.

Immature type: pseudohyperplasia due to epithelial edema.

Mature type: fibrous changes in tissues, erythrocyte stasis in the vessels in the gland neck area leads to pronounced edema and fibrin impregnation of the mucous membrane in the erosion area, as a result of which the erosion bulges into the lumen on an edematous-inflammatory basis. When complete erosion heals, it is difficult to conduct differential diagnostics with a gastric polyp - a biopsy must be taken.

Localization. Hemorrhagic erosions can be localized in any part of the stomach, incomplete ones are observed more often in the fundus area, complete ones - in the distal parts of the body of the stomach and antrum.

Incomplete and hemorrhagic erosions, with rare exceptions, epithelialize quickly (usually within 5-14 days), leaving no significant (macroscopic) traces. Some complete erosions also epithelialize completely (sometimes over a long period of time - up to 2-3 years or more), after which the mucosal bulges at the site of the erosion disappear. However, most erosions of this type become recurrent. In these cases, they periodically worsen and heal, but the mucosal bulge at the site of the erosion remains constant due to the developed tissue fibrosis and pronounced productive inflammation. In these areas, histological examination clearly reveals a predisposition to hyperplasia of the integumentary epithelium. Occasionally, hyperplasia of the glandular apparatus of the gastric mucosa is also determined. When erosions of this form heal, it is impossible to distinguish them from true polyposis during endoscopic examination without studying the histological material. With the emerging tendency towards hyperplasia, a chain of successive transformations cannot be ruled out: erosion - glandular polyp - cancer. In this regard, dynamic observation of these patients is required due to the risk of developing malignant neoplasms.

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