Gastritis of the antral part of the stomach: erosive, chronic, superficial, atrophic, focal, catarrhal

Gastroenterologists diagnose antral gastritis when inflammation of the gastric mucosa is localized in the antrum pyloricum – the pyloric cave of its pyloric section, that is, in the narrowing cavity that passes into the pyloric canal leading to the pylorus (pyloric sphincter), through which chyme passes into the duodenum.

It is believed that hyperacid antral gastritis is more often detected in young and middle age, and antral gastritis with low acidity is more common among people over 60 years of age.

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Epidemiology

H. pylori-associated antral gastritis is usually not included in clinical statistics separately from other types of gastritis.

According to experts, more than half of the world's population is infected with Helicobacter, but more than 70% of infected people do not show any symptoms of gastric pathology.

Prevalence varies within and between countries, with higher prevalence noted among people of lower socioeconomic status and variable, increasing with age. Infection in early childhood is thought to result in pangastritis, while infection in later life may cause antral gastritis.

According to the World Gastroenterology Organisation, primary infection or recurrent reinfection with H. pylori in adults occurs at an annual rate of 0.3-0.7% of cases in developed countries and 6-14% in developing countries.

In almost 15% of infected patients, antral gastritis is not diagnosed, but H. pylori is detected in other parts of the stomach - against the background of partial atrophy of the mucosa, bile reflux or intestinal metaplasia (i.e. replacement of gastric epithelium with intestinal).

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Causes antral gastritis

In most cases, the causes of antral gastritis are associated with damage to the mucous membrane of the antrum of the stomach due to its colonization by gram-negative bacteria Helicobacter pylori. The functional feature of the antral part of the stomach is that additional secretory cells are concentrated here, which produce a protective mucin substance consisting of mucus, polysaccharides, proteins and hydrocarbonates.

To understand the pathogenesis of antral gastritis caused by H. pylori, it is necessary to characterize in general terms the mechanism of its destructive effect on the stomach. This microaerophilic bacterium, withstanding short-term exposure to an acidic environment (at pH values <4), grows only in a relatively narrow pH range - from 5.5 to 8, with optimal neutral conditions for reproduction. Therefore, the microorganism occupies the pyloric cavity of the stomach, since there, compared to the body of the organ, the environment is less acidic (pH 3.6-4.4), and in the submucosal layer - the most comfortable (pH 7).

Firstly, to avoid the acidic environment in the lumens of the stomach, this campylobacter burrows into the gastric mucosa with the help of flagella and, with the help of the adhesins it produces, sticks to the membranes of epithelial cells and even penetrates them. Secondly, the bacterium produces a urease enzyme that breaks down the urea secreted by the stomach into carbon dioxide and ammonia, and ammonia is toxic to the epithelial cells of the stomach.

Thirdly, the cells of the gastric epithelium are damaged by the protease synthesized by Helicobacter (an enzyme that breaks down proteins and phospholipids), as well as by the vacuolating cytotoxin A. Their combined aggressive action leads to damage to epithelial cells and their apoptosis.

Finally, the inflammatory reaction caused by bacteria changes the functioning of the entire gastroenteropancreatic endocrine system: secretion of the hormone gastrin by the G cells of the antrum increases, and gastrin stimulates the production of hydrochloric acid (HCl) by the parietal cells of the stomach.

In addition, antral gastritis can be a consequence of a number of autoimmune pathologies (such as Crohn's disease, Addison-Biermer disease), the result of the pathogenic effects of cytomegalovirus and fungal infections, enterobacteria, Mycobacterium tuberculosis, Treponema pallidum bacteria, as well as parasitic helminths.

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Risk factors

Gastroenterologists associate the main risk factors for inflammation of the antral mucosa with irregular meals, poor quality food (containing emulsifiers and preservatives), alcohol abuse and smoking. Stress also contributes to the development of gastritis, as the level of catecholamines in the blood increases, and these neurohormones (adrenaline and noradrenaline) increase the secretion of the gastric hormone gastrin, which enhances the production of HCl.

Risk factors include exposure to radiation therapy for cancer, consequences of gastric resection and endoscopic examination, as well as long-term use of non-steroidal anti-inflammatory drugs, steroids, and anti-cancer cytostatics (although some experts in these cases talk about gastropathy).

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Symptoms antral gastritis

Although colonization of the stomach with Helicobacter pylori causes certain histological changes in everyone, antral gastritis often has a latent form, and obvious clinical signs of this colonization - symptoms of antral gastritis - develop in a small proportion of patients.

Depending on how the disease progresses, acute antral gastritis or chronic antral gastritis is determined. And the stages of the disease - focal (early) and diffuse (late) - are recorded by doctors depending on the intensity of the atrophic and inflammatory process.

Cases where acute antral gastritis is diagnosed are few and mostly occur during an outbreak of inflammation of the mucous membrane, which can be provoked by improper nutrition, consumption of aggressive food ingredients, a sharp weakening of the immune system or severe stress.

The first signs of acute antral gastritis are nausea and vomiting, followed by a period of dyspepsia and loss of appetite. This can be quite severe when gastrointestinal bleeding occurs with melena (black stool) or bloody vomiting. In acute cases, the pain of antral gastritis can be quite intense and stabbing in nature.

Chronic antral gastritis is accompanied by atrophy of the mucous membrane and its inflammation. And depending on the degree of atrophy and its consequences for the functions of the gastric glands, gastroenterology distinguishes between: moderate, moderately expressed antral gastritis or expressed antral gastritis. These degrees are determined only during instrumental diagnostics of the disease.

The most common first signs are discomfort (feeling of heaviness) after eating.

Later, the following symptoms of antral gastritis are noted: decreased appetite; frequent heartburn; belching (with low acidity - rotten, with high - sour); unpleasant taste in the mouth (with reflux gastritis - bitter); whitish or grayish-yellow coating on the surface of the tongue; nausea; vomiting; bloating and flatulence; bowel disorders (diarrhea or constipation); melena (with erosive and hemorrhagic gastritis).

If pain occurs with antral gastritis, it is most often aching and bothers one and a half to two hours after eating or at night; with an empty stomach, the pain can be quite strong and spasmodic in nature. In the case of hypoacid antral gastritis, there is usually no pain, but against the background of loss of appetite and weight loss, increased fatigue and general weakness are noted.

Forms

In clinical gastroenterology, the types of antral gastritis are determined by the pathological changes that the mucous membrane of the antrum pyloricum undergoes. That is, in addition to the intensity of the inflammatory process and its impact on glandular structures, the features of the endoscopic signs of gastritis are taken into account.

• Superficial antral gastritis

Superficial or non-atrophic antral gastritis is a pathology with localization of damage in the upper layers of the mucosa (with desquamation of cells in the columnar epithelium), which, nevertheless, affects the secretion-forming functions of additional cells that produce a protective mucin substance.

• Catarrhal antral gastritis

This is an acute superficial gastritis (with swelling of the antrum mucosa and capillary hemorrhages), which is usually a consequence of exposure to dietary factors or a side effect of certain medications.

• Focal antral gastritis

This type of disease is often called superficial focal atrophic gastritis, since endoscopy clearly shows inflammatory foci on the mucosa in the form of sunken spots of varying colors.

• Diffuse superficial antral gastritis

In diffuse or diffuse antral gastritis, the entire significant part of the mucous membrane of this section of the stomach is damaged: it is thinner than the healthy inner lining, due to which the network of blood vessels located in the submucous layer is visible. At the same time, a significant decrease in mucous secretion is noted.

• Antral atrophic gastritis

This is a morphological diagnosis, which means that during an endoscopic examination of the stomach cavity, deeper defects of the mucous membrane were detected - right down to its plate, where the glands are concentrated. There is a reduction in the number of fully functioning secretory cells of the mucous membrane of the antrum, the entire pyloric section and the body of the stomach, which leads to their replacement with epithelial cells and thinning of the internal lining of the organ. Atrophy of significant areas is manifested by a decrease in the production of hydrochloric acid. Moreover, as atrophy progresses, the presence of Helicobacter pylori decreases. Antral subatrophic gastritis is considered the beginning of the stage of atrophic processes.

• Antral hyperplastic gastritis or antral gastritis with hyperplasia

In hypertrophic or hyperplastic gastritis of the antrum, inflammation of the mucosa leads to an increase in its folding (due to the proliferation of epithelial cells) with the formation of cystic and polypous neoplasia on the surface or between the layers.

• Granular antral gastritis

This is a type of focal hypertrophic gastritis, in which small granular growths appear on the mucous membrane against a background of edema; a decrease in the tone of the muscular layer of the stomach is noted, as well as some narrowing and shortening of the antrum pyloricum.

• Erosive antral gastritis

Erosive antral gastritis is characterized by the appearance of superficial areas with a mucous membrane completely or partially corroded by acid. Erosion may look like an ulcerated wound, and if it deepens to the basal layer of the mucosa, then in the process of subsequent regeneration, scar tissue is formed.

• Hemorrhagic antral gastritis

This type of gastritis, which can be called erosive-hemorrhagic, is a consequence of erosive gastritis, which, as the erosion deepens, reaches the blood vessels and damages the tissues of their walls and endothelium. Hemorrhagic antral gastritis is manifested by blood impurities in vomit and feces.

• Rigid antral gastritis

The distinctive features of rigid antral gastritis are considered to be achlorhydria (reduced secretory function of the stomach); disruption of the physiological arrangement of folds (they become transverse rather than longitudinal); change in the anatomical shape of the entire pyloric section of the stomach, including the pyloric cave and canal (leading to their persistent stenosis); hypertrophic change in the serous membrane of the stomach and spasticity of its muscle fibers (blocking gastric peristalsis).

• Antral reflux gastritis

It is distinguished by etiology, since this type of antral gastritis is caused by duodenogastric reflux - the reverse flow of the contents of the duodenum into the stomach cavity; it is classified as chemical-toxic gastritis.

• Antral gastritis with low acidity

Or hypoacid antral gastritis develops against the background of achlorhydria - a decrease in the secretion of hydrochloric acid by the parietal cells of the stomach. This occurs either with a decrease in the number of parietal cells due to atrophy of the gastric mucosa, or as a result of suppression of the functions of secretory cells after the use of drugs of the proton pump inhibitor group. In addition, this type of gastritis can occur after vagotomy performed for gastric ulcer (when the acidity of the stomach is reduced by blocking stimulation of the parietal cells, cutting certain fibers of the vagus nerve).

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Complications and consequences

In order to really assess the most probable consequences and complications of antral gastritis, serious medical studies were conducted. According to their results, pyloroduodenitis, diffuse chronic gastritis (pangastritis) with damage to the mucous membrane of all sections, and gastric ulcer were in first place among the frequently diagnosed consequences of chronic antral gastritis. Moreover, a perforated gastric ulcer can become a serious complication of erosive antral gastritis.

Then comes duodenal ulcer, that is, ulcerative disease of the duodenum, as a complication of antral rigid and reflux gastritis.

According to clinical data, in the presence of H. pylori, 1-2% of patients are at risk of developing gastric cancer - as a consequence of antral gastritis. This includes cancer of the antral and pyloric section, gastric adenocarcinoma, lymphoid tumors, non-Hodgkin's lymphoma of the stomach.

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Diagnostics antral gastritis

The necessary tests on the basis of which antral gastritis is diagnosed include:

• general and biochemical blood analysis;
• immunological blood test for antibodies (IgG) against H. pylori;
• breathing text on H. pylori;
• determination of gastric juice acidity (intragastric pH-metry);
• stool analysis (coprogram).

Instrumental diagnostics include radiography of the stomach; endogastroscopy or fibrogastroduodenoscopy (with the possibility of obtaining a biopsy - a tissue sample of the affected area of the stomach for histological examination); electrogastrography (study of gastric motility).

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Differential diagnosis

Differential diagnostics – using endoscopic ultrasonography, computed tomography and magnetic resonance imaging – makes it possible to identify or exclude gastric ulcer or duodenal ulcer, irritable stomach syndrome, and biopsy – to determine the benign or malignant nature of the pathology.

Treatment antral gastritis

If Helicobacter pylori infection is detected, treatment of antral gastritis, like any chronic gastritis of this etiology, is carried out with antibiotics. Usually, the most effective ones are used: Azithromycin (Azitral, Azitsid, Sumamed) - for three days, 1 g per day, and Clarithromycin (Claricin, Klabakt, Fromilid) - twice a day, 500 mg (for two weeks). Of course, these drugs have side effects in the form of the same nausea and vomiting, but it is impossible to get rid of this bacterium without them.

Medicines prescribed by gastroenterologists should also:

• regulate the production of hydrochloric acid (Omeprazole, Ventrisol, Nolpaza);
• protect the gastric mucosa (for which antacids are used, for example, Gastal, Almagel, etc.);
• relieve pain (No-shpa, Besalol, etc.);
• promote the regeneration of damaged tissues (Methyluracil) and the healing of erosions (vitamins B12, E and C).

Thus, the drug of the proton pump inhibitor group Omeprazole is prescribed at 20 mg once (before breakfast, with plenty of water), the duration of use is a maximum of a month. The drug can cause abdominal pain, dyspepsia, insomnia, anxiety and depression.

Side effects of Ventrisol (De-Nol) and all bismuth gastroprotective drugs include skin allergies, nausea, and bowel disorders. The drug is taken 30 minutes before each meal - one tablet three times a day, and before bedtime

A more detailed description of the drugs that are intended for the treatment of antral gastritis can be found in the publication - Tablets for gastritis

And about what kind of physiotherapy treatment is used for antral gastritis is described in detail in the article - Physiotherapy for chronic gastritis

Folk remedies

What remedies for antral gastritis are used in folk treatment? It is recommended:

• drink olive oil - one tablespoon a day for two to three weeks.
• drink honey water once a day (a teaspoon of May honey per 200 ml of warm water).
• For a week, drink an infusion of ginger root with honey twice a day (per glass of boiling water - a teaspoon of crushed fresh root and a teaspoon of honey, leave for 10 minutes, drink slowly).
• Before meals, take a decoction of flaxseed (a tablespoon per glass of water, boil for 10 minutes).

For increased acidity, it is recommended to drink raw potato juice - 100 ml (or 3-4 tablespoons) three times a day (half an hour before meals). Potato juice, which is an alkaline product, can help neutralize stomach acid and prevent bloating, cramps, excess gas, etc.

And herbal treatment is carried out:

• infusion of plantain, speedwell or fireweed (half a glass twice a day);
• infusion of chamomile flowers or calendula officinalis (1-2 teaspoons of dried flowers per glass of boiling water);
• a decoction of dried strawberry leaves or sparkling magenta;
• a decoction of licorice root or elecampane;
• tea with dried or fresh basil (4-5 leaves per cup);

Read also – Treatment of gastritis with high acidity

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Diet for antral gastritis

For successful treatment, it is very important that patients follow a diet for antral gastritis.

In case of exacerbations of the disease and increased acidity of gastric juice, diet No. 1 is prescribed with a strict ban on fried, fatty, spicy, raw vegetables, sour fruits and berries. Until the condition improves, legumes and mushrooms, fresh bread and pastries, confectionery, chocolate and coffee are also excluded.

Want to know what you can eat with erosive antral gastritis? Read the article - Products for stomach ulcers, gastritis and stomach pain

For menu options for antral gastritis compiled according to all the rules of therapeutic nutrition, see – Diet for gastritis, and also – Diet for atrophic gastritis

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Prevention

What can be done to prevent the development of antral gastritis? Doctors advise:

• reduce consumption of red meat, hot peppers, fatty and sweet foods;
• eat at regular intervals, the last meal should be two hours before bedtime;
• eat small portions, slowly, chew food well;
• do not drink water during meals, as this can slow down the digestive process;
• Drink green tea regularly and enough water throughout the day.

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Forecast

An accurate prognosis of the development of gastroenterological diseases is hardly possible, and - taking into account the causes, type, degree of atrophy of the gastric mucosa, the body's response to treatment - the doctor can assume how antral gastritis will behave in each specific case.

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