Endoscopic signs of gastritis

Gastritis is a lesion of the gastric mucosa with predominantly inflammatory changes in acute course and with the phenomena of dysregeneration, structural adjustment, with progressive changes in the mucosa in chronic course, accompanied by a disturbance of the function of the stomach and other organs and systems. Signs of gastritis are found in 60% of the total 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 classified as active (histologically with polynucleotide cells) and inactive (histologically with mononuclear cells).

[1], [2], [3], [4]

Endoscopic signs of acute gastritis

Acute gastritis has a dual definition. In clinical medicine, this diagnosis is made for digestion disorders associated with food intake and manifested by pain or discomfort in the epigastric region, nausea, vomiting. With endoscopic and histological examination, the symptoms of gastritis do not correspond to these symptoms. The true acute gastritis is most often the result of exposure to chemical, toxic, bacterial or medicinal factors, and may also be the result of allergic reactions. In this case, as a rule, acute symptoms of digestive disorders are absent, and there are only violations of appetite.

[5], [6], [7], [8], [9]

Endoscopic signs of chronic gastritis

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

Endoscopic signs of chronic gastritis

1. Mucosal folds are usually easily spread by air and only at pronounced edema they have a slightly thickened appearance at the beginning of insufflation.
2. Color of the mucosa. Normally, the mucosa is pale or pale pink. With inflammation, the color is bright, different shades. If the areas of normal mucosa are mixed with areas of inflammation - a mosaic-like appearance.
3. On the mucosa often protruding above the surface of the formation of 0.1 to 0.5 cm in diameter. They can be single and multiple.
4. Vascular pattern. Normally not visible. Can be seen against the background of thinned mucosa.
5. Mucus overlays indicate inflammation. It can be frothy, clear, white, with an admixture of bile, sometimes it is difficult to wash off with water.

[10], [11], [12],

Endoscopic signs of superficial gastritis

It occurs often. It is 40% of all gastritis. Expressed glossy mucosa (a lot of mucus). Mucous is moderately edematous, hyperemic from moderately red to cherry color. Hyperemia can be draining and focal. With air insufflation, the folds are well straightened - a striped appearance. With a large increase, it can be seen that as a result of edema, the gastric fields flatten, the gastric fossa is compressed, the grooves become narrow, small, filled with an inflammatory secretion (exudate). More often there is a superficial gastritis in the body of the stomach and in the antrum. Total stomach damage is possible. Peristalsis active. Stomach well spreads the air.

Biopsy: flattening of the integument epithelium, the cells acquire a cubic form, the boundaries between them lose their clarity, and the cytoplasm - transparency. The nuclei in the cells are displaced to the surface, their shape and degree of transparency become uneven.

[13]

Endoscopic signs of atrophic gastritis

Stomach well spreads the air. Peristalsis is somewhat reduced, but can be traced in all departments. Localization: the anterior and posterior walls, the small curvature of the body of the stomach. The relief of the mucous is smoothed. The mucosa is thinned, through it the vessels of the submucosal layer are traced. There are focal and diffuse atrophic gastritis.

In focal atrophic gastritis, the mucous membrane has a small-spotted appearance: on the pink background of the retained mucosa, grayish-whitish patches of atrophy are visible (looks like sunken or retracted). Against the background of mucosal atrophy, there may be foci of hyperplasia.

With a diffuse (draining) atrophic gastritis, the mucosa is grayish-whitish in color or simply of a gray hue. It is dull, smooth, thin. The folds of the mucosa persist only on a large curvature, they are low and narrow, not crimped. The vessels of the submucosal layer are well visible, can be linear and tree-like, bulging in the form of bluish or whitish rollers.

Biopsy: the major and additional cells, the recesses of the gastric pits, which have a corkscrew appearance, decrease, sometimes significantly,.

The epithelium is flattened, sometimes it can be replaced by intestinal - intestinal metaplasia.

[14], [15], [16]

Endoscopic signs of hypertrophic (hyperplastic) gastritis

Hypertrophic folds of the stomach consider those folds that do not straighten out during air insufflation during endoscopic examination. Radiographically enlarged folds of the stomach are folds, whose width is more than 10 mm (with fluoroscopy of the stomach with barium suspension). Hypertrophic gastritis is a concept predominantly roentgenologic, so it's more correct to talk about hyperplastic gastritis. The large, rigid folds of the mucosa often closely adjoin each other. The furrows between the folds are deep, the creases are twisted. The relief of the mucous resembles "brain convolutions", "cobblestone pavement". The surface of the mucosa is uneven due to proliferative processes. Mucous inflammatory changes: edema, hyperemia, intralysion hemorrhage, mucus. With air insufflation, the stomach is straightened. Folds are changed in height and width, ugly configuration, increased, depart from each other. Between them are formed congestion of mucus, which with pronounced hyperemia of the mucous membrane can sometimes be mistaken for a ulcer crater.

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

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

[17], [18], [19], [20], [21]

Endoscopic signs of granular hyperplastic gastritis

For the first time described Frick. The mucous membrane is covered with insignificant elevations from 0.1 to 0.2 cm, velvety, rough, semi-oval. The folds are coarse, crimped. Localization is more often focal in the antrum, less often on the back wall.

[22], [23], [24], [25]

Endoscopic signs of warty hyperplastic gastritis

Sprouting on the mucosa 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"). More often in the antral department is closer to the gatekeeper and greater curvature.

[26], [27], [28], [29], [30]

Endoscopic signs of polypoid hyperplastic gastritis

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

With true polyps, the mucosal relief has not been altered, but with hyperplastic gastritis it is changed due to thickened convoluted folds. For all types of hyperplastic gastritis, a targeted biopsy should be used to exclude the malignant process.

[31], [32]

Endoscopic signs of Menetries disease

Menetries disease (1886) is a rare disease, one of the signs of which is the giant gross hypertrophy of the folds of the gastric mucosa. Changes can also be captured by the submucosal layer. Excessive growth of the mucosa is a manifestation of a metabolic disorder, more often a protein metabolism. In patients, weight loss, weakness, edema, hypoalbuminemia due to increased albumin release into the lumen of the stomach, iron deficiency anemia, dyspepsia are noted. At an endoscopic examination, sharply thickened, convoluted folds (up to 2 cm in thickness) can be seen. Folds frozen, in contrast to hypertrophic gastritis, are located along a large curvature with a transition to the anterior and posterior walls of the stomach. The folds do not straighten out even with increased air insufflation. The tops of folds can be multiple polypoid swelling, erosion, submucosal hemorrhage.

Biopsy: pronounced hyperplasia of the superficial epithelium, reconstruction of the glandular apparatus.

Differential diagnosis should be carried out with infiltrative stomach cancer. Control at least 2 times a year.

[33]

Endoscopic signs of rigorous antral gastritis

The gastric outlet outlet is affected in an isolated manner, which, due to hypertrophic changes, edema and spastic contractions of the musculature, deforms, becoming a narrow tubular canal with dense walls. At the heart of this defeat is a chronic inflammatory process that seizes all layers of the stomach wall, including serous. Characteristic persistent indigestion and achlorhydria are characteristic. When the endoscopic examination determines the narrowing of the antrum, its cavity has the form of a tube, air does not straighten out at all, the peristalsis is sharply weakened. Mucous is sharply edematous, swollen, with sites of pronounced hyperemia and plaque of mucus. With the progression of the disease - a violation of motor-evacuation (a sharp weakening of peristalsis), sclerosis develops in the submucosal and muscle layers - a persistent rigid deformity develops with a significant shortening of the antral part of the stomach.

[34], [35], [36], [37], [38], [39], [40]

Endoscopic signs of gastritis of hemorrhagic

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

• localized,
• generalized.

With a localized form, the bottom and body of the stomach are more often affected. With a small degree of anemia, hemorrhage in the form of petechiae. At medium and heavy degree mucous pale, the microrelief of the stomach can not be estimated - it seems to cry "bloody tears". Generalized hemorrhagic gastritis can be complicated by severe bleeding.

[41], [42], [43]

Endoscopic signs of plastic gastritis, true sclerosing gastritis

The wall sharply thickens and a connective tissue is formed in it.

[44], [45], [46], [47], [48]