Endoscopic signs of gastritis

Gastritis is a lesion of the gastric mucosa with predominantly inflammatory changes in the acute course and with phenomena of disregeneration, structural reorganization, with progressive changes in the mucosa in the chronic course, accompanied by dysfunction of the stomach and other organs and systems. Signs of gastritis are present in 60% of the entire population. With age, the number of patients increases.

Classification of gastritis:

1. Acute gastritis.
2. Chronic gastritis.
   1. Superficial gastritis.
   2. Atrophic gastritis.
   3. Hypertrophic gastritis:
      1. grainy,
      2. warty,
      3. polypoid.
   4. Mixed gastritis.

Chronic gastritis is also divided into active (histologically with polynuclear cells) and inactive (histologically with mononuclear cells).

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Endoscopic signs of acute gastritis

Acute gastritis has a dual definition. In clinical medicine, this diagnosis is made for digestive disorders associated with food intake and manifested by pain or discomfort in the epigastric region, nausea, and vomiting. In endoscopic and histological studies, signs of gastritis do not correspond to these symptoms. True acute gastritis is most often a consequence of exposure to chemical, toxic, bacterial or medicinal factors, and can also be the result of allergic reactions. In this case, as a rule, there are no acute symptoms of digestive disorders, but only appetite disorders.

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Endoscopic signs of chronic gastritis

The term chronic gastritis was first used by Broussais at the beginning of the 19th century. According to many gastroenterologists of the present time, chronic gastritis is asymptomatic in most cases. Visual assessment together with targeted biopsy makes it possible to correctly determine the form of chronic gastritis in 100% of cases, without biopsy - in 80% of cases.

Endoscopic signs of chronic gastritis

1. The folds of the mucous membrane are usually easily straightened with air, and only in cases of severe edema do they have a slightly thickened appearance at the beginning of insufflation.
2. Color of the mucous membrane. Normally, the mucous membrane is pale or pale pink. When inflamed, the color is bright, of various shades. If areas of normal mucous membrane are mixed with areas of inflammation, it is a motley mosaic appearance.
3. On the mucous membrane, there are often formations protruding above the surface, from 0.1 to 0.5 cm in diameter. They can be single or multiple.
4. Vascular pattern. Normally not visible. May be visible against the background of thinned mucous membrane.
5. Mucus deposits indicate inflammation. It can be foamy, transparent, white, with an admixture of bile, and sometimes difficult to wash off with water.

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Endoscopic signs of superficial gastritis

It is common. It accounts for 40% of all gastritis. The mucosa is shiny (a lot of mucus). The mucosa is moderately edematous, hyperemic from moderately red to cherry-colored. Hyperemia can be confluent and focal. When insufflated with air, the folds straighten out well - a striped appearance. At high magnification, it is visible that due to edema, the gastric fields flatten out, the gastric pits are compressed, the grooves become narrow, small, filled with inflammatory secretion (exudate). Superficial gastritis is most often manifested in the body of the stomach and in the antral section. Total damage to the stomach is possible. Peristalsis is active. The stomach straightens out well with air.

Biopsy: flattening of the integumentary epithelium, cells acquire a cubic shape, the boundaries between them lose their clarity, and the cytoplasm loses its transparency. The nuclei in the cells shift to the surface, their shape and degree of transparency become uneven.

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Endoscopic signs of atrophic gastritis

The stomach is well straightened by air. Peristalsis is somewhat reduced, but can be seen in all sections. Localization: anterior and posterior walls, less often the lesser curvature of the body of the stomach. The relief of the mucous membrane is smoothed. The mucous membrane is thinned, and the vessels of the submucous layer can be seen through it. A distinction is made between focal and diffuse atrophic gastritis.

In focal atrophic gastritis, the mucosa has a finely spotted appearance: on a pink background of preserved mucosa, round or irregularly shaped grayish-whitish areas of atrophy are visible (looks like sunken or retracted). Against the background of mucosal atrophy, there may be foci of hyperplasia.

In diffuse (confluent) atrophic gastritis, the mucous membrane is grayish-whitish or simply gray. It is dull, smooth, thin. Folds of the mucous membrane are preserved only on the greater curvature, they are low and narrow, not twisted. The vessels of the submucous layer are clearly visible, can be linear and tree-like, bulging in the form of bluish or whitish ridges.

Biopsy: the main and additional cells, the depressions of the gastric pits, which have a corkscrew-like appearance, are reduced, sometimes significantly.

The epithelium is flattened and in some places it can be replaced by intestinal epithelium - intestinal metaplasia.

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Endoscopic signs of hypertrophic (hyperplastic) gastritis

Hypertrophic folds of the stomach are those folds that do not straighten out during air insufflation during endoscopic examination. Radiologically enlarged folds of the stomach are those folds that are more than 10 mm wide (during fluoroscopy of the stomach with barium suspension). Hypertrophic gastritis is a primarily radiological concept, so it is more correct to talk about hyperplastic gastritis. Large rigid folds of the mucosa often fit tightly to each other. The furrows between the folds are deep, the folds are raised. The relief of the mucosa resembles "brain convolutions", "cobblestone pavement". The surface of the mucosa is uneven due to proliferative processes. The mucosa is inflammatoryly altered: edema, hyperemia, intramucosal hemorrhages, mucus. During air insufflation, the stomach straightens out. The folds are altered in height and width, have an ugly configuration, are enlarged, and move away from each other. Between them, accumulations of mucus are formed, which, with pronounced hyperemia of the mucous membrane, can sometimes be mistaken for an ulcerative crater.

According to the nature of the proliferative processes, hypertrophic gastritis is divided into the following types:

1. Granular hyperplastic gastritis (granular).
2. Warty hyperplastic gastritis (verrucous).
3. Polypoid hypertrophic gastritis.

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Endoscopic signs of granular hyperplastic gastritis

First described by Frick. The mucous membrane is strewn with minor elevations from 0.1 to 0.2 cm, velvety, rough in appearance, semi-oval in shape. The folds are rough, tortuous. Localization is often focal in the antral section, less often on the posterior wall.

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Endoscopic signs of warty hyperplastic gastritis

Growths on the mucous membrane from 0.2 to 0.3 cm. Formations of a hemispherical shape, joining, they form a surface in the form of a "cobblestone pavement" ("honeycomb pattern"). Most often in the antral section closer to the pylorus and greater curvature.

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Endoscopic signs of polypoid hyperplastic gastritis

The presence of polypoid formations on a wide base on thickened walls. The color above them does not differ from the surrounding mucosa. Sizes from 0.3 to 0.5 cm. Most often multiple, less often - single. Can be diffuse and focal. Most often on the anterior and posterior walls of the body, less often - the antral section.

In true polyps, the mucosal relief is not changed, but in hyperplastic gastritis it is changed due to thickened convoluted folds. In all types of hyperplastic gastritis, targeted biopsy should be used to exclude a malignant process.

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Endoscopic signs of Menetrier's disease

Menetrier's disease (1886) is a rare disorder, one of the signs of which is giant gross hypertrophy of the folds of the gastric mucosa. Changes may also affect the submucosal layer. Excessive growth of the mucosa is a manifestation of metabolic disorders, most often protein-related. Patients experience weight loss, weakness, edema, hypoalbuminemia due to increased secretion of albumin into the lumen of the stomach, iron deficiency anemia, and dyspepsia. Endoscopic examination reveals sharply thickened, tortuous folds (can be up to 2 cm thick). The folds are frozen, unlike hypertrophic gastritis, located along the greater curvature with a transition to the anterior and posterior walls of the stomach. The folds do not straighten out even with increased air insufflation. Multiple polypoid protrusions, erosions, and submucosal hemorrhages may be present at the tops of the folds.

Biopsy: pronounced hyperplasia of the surface epithelium, restructuring of the glandular apparatus.

Differential diagnosis should be made with infiltrative gastric cancer. Control at least twice a year.

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Endoscopic signs of rigid antral gastritis

The outlet of the stomach is affected in isolation, which, due to hypertrophic changes, edema and spastic contractions of the muscles, is deformed, turning into a narrow tubular canal with dense walls. This lesion is based on a chronic inflammatory process that affects all layers of the stomach wall, including the serous layer. Persistent dyspepsia and achlorhydria are characteristic. Endoscopic examination reveals a narrowing of the antral section, its cavity has the appearance of a tube, does not straighten out with air at all, peristalsis is sharply weakened. The mucosa is sharply edematous, swollen, with areas of pronounced hyperemia and mucus deposits. With the progression of the disease - a violation of motor-evacuation activity (a sharp weakening of peristalsis), sclerosis of the submucosal and muscular layers develops - persistent rigid deformation with a significant shortening of the antral section of the stomach develops.

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Endoscopic signs of hemorrhagic gastritis

It is characterized by all the signs of gastritis, and more specifically, chronic gastritis, but more pronounced. There are hemorrhages in the mucous membrane from small purple to large spots. The mucous membrane is edematous, hyperemic, with fibrin deposits. By prevalence, it can be:

• localized,
• generalized.

In the localized form, the bottom and body of the stomach are most often affected. With a small degree of anemia, hemorrhages in the form of petechiae. With a moderate and severe degree, the mucous membrane is pale, the microrelief of the stomach cannot be assessed - it seems to be crying "bloody tears". Generalized hemorrhagic gastritis can be complicated by severe bleeding.

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Endoscopic signs of plastic gastritis, true sclerosing gastritis

The wall thickens sharply and connective tissue forms in it.

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