Subatrophic gastritis: chronic, antral, fundus, diffuse, focal, erosive

Subatrophic gastritis is a disease in which certain parts of the gastric mucosa and glands producing hydrochloric acid and pepsin are atrophied. The latter is an enzyme involved in one of the stages in the breakdown of food proteins into amino acids. Pepsin enters the stomach in an inactive form, but under the influence of hydrochloric acid it becomes active and participates in the process of digestion. With atrophy of the mucosa this process does not occur, moreover, on non-functioning areas of the stomach, connective and epithelial tissues are formed. As a result, the acidity decreases, the walls of the stomach thin out and its function - processing food can not be performed properly.

[1],

Epidemiology

The epidemiology of chronic gastritis is very extensive, according to statistics, they suffer a third of people on the planet, of which 18-20% are sick on subatrophic gastritis. Moreover, 5% of cases are people under 30 years old, 30% - from 31 to 50 years old and 50-70% - after 50 years. Absolute majority of diseases (80-90%) was provoked by the pathogen - the Helicobacter pylori bacterium, the others - autoimmune or other causes.

[2], [3], [4]

Causes of the subatrophic gastritis

The causes of subbatrophic gastritis can be different, from malnutrition, bad habits, pathologies, age-related changes to genetic or infectious conditionality, autoimmune. But the most frequent cause of atrophy is the bacterium Helicobacter pylori. Getting into an acidic environment, it begins to multiply actively, which leads to inflammation of the mucosa.

[5]

Risk factors

The risk factors for the development of subatrophic gastritis include:

• chronic forms of other types of gastritis;
• hereditary factor, especially stomach cancer in relatives;
• violation of the diet;
• physical overload;
• bad habits (smoking and alcohol);
• prolonged stressful conditions;
• long-term use of medicines;
• age.

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

Pathogenesis

The pathogenesis of subatrophic gastritis is a chain of complex transformations and chemical reactions of the body. In a simplified form, this is a failure in the regeneration of the cells of the inner mucous layer of the stomach, as a result of which the secretion process is disrupted. In the absence of pathologies, cells are updated every six days. In the case of subatrophic gastritis, hydrochloric acid and pectin are not produced, which leads to the fact that the intragastric medium becomes weakly acidic, gradually transforming into an Achilles - its complete absence. From damaged immature cells spikes are formed - the result of pathological regeneration, unable to perform its function.

[10], [11]

Symptoms of the subatrophic gastritis

Symptoms of subatrophic gastritis are caused by a decrease in the functional activity of the stomach and are characterized by the following manifestations:

• dyspepsia (heaviness in the stomach, bad breath, abundant salivation, decreased appetite, nausea, eructation);
• excess bacterial growth (rumbling of the abdomen, its swelling, diarrhea);
• anemia, due to lack of absorption of iron, vitamin B12, folic acid;
• painful sensations, without specific localization, intensifying after eating;
• intolerance to dairy products;
• "Polished" tongue, with exacerbation of a coated white coating.

As studies show, the first signs of subatrophic gastritis are often absent. No severe pain, as with gastritis with high acidity, heartburn. At later stages of pathological changes of the stomach, there are signs characteristic of other types of gastritis: belching, heaviness in the epigastric region, heavy odor from the mouth, flatulence.

Stages

The concept of "stage" of subatrophic gastritis is the principle of determining the suitability of the secretory glands to perform their functions. To assess the extent of their damage (the area of localization of damaged cells of the superficial epithelium and the depth of penetration of inflammation into the gastric mucosa), a visual analogue scale is used. If less than 50% of the mucosa in the field of view of the eyepiece of the microscope is affected by dystrophic and disregenerative changes, then this stage is considered weak or moderate (the first and second stages of inflammatory activity), with lesions greater than 50% expressed (the third stage). At large areas of cell structure disorders, there is a strong stage, capable of provoking the appearance of cancer.

[12], [13], [14], [15], [16], [17]

Forms

The type of subatrophic gastritis is determined by the localization and nature of the lesions detected during endoscopy and examination of tissues under the microscope, the clinic of the disease. Subatrophic gastritis can have a chronic form, which is characterized by a prolonged nature of the disease with a gradual atrophy of the cells of the epithelium. In this case, dystrophic processes predominate over inflammatory processes and this stage of the disease is called remission. With exacerbation of chronic gastritis, acute or active subatrophic gastritis occurs. It can be triggered by aggressive external factors: toxins, strong acids or alkalis. It manifests itself in pain in the stomach, nausea, vomiting, diarrhea, sometimes loss of consciousness, coma. When examining such a patient, the edema of the walls of the stomach, the fullness of its vessels, the penetration of leukocytes beyond the walls of the vessels, the destruction of the epithelium, and sometimes erosion are revealed.

[18]

Chronic subatrophic gastritis

Chronic subatrophic gastritis with recurrences and progressions that occur periodically, is characterized by low acidity, mucosal dystrophic changes, decreased evacuation, motor and absorption functions of the stomach. Prolonged destructive processes in it without treatment entail complications of other organs, the functioning of which is associated with the stomach: esophagus, duodenum, pancreas, liver. There is a hematopoietic, nervous system. Diagnosis of chronic subatrophic gastritis gives the following picture:

• thinning of the walls of the stomach;
• flattening of the epithelium;
• atrophy of glands, leading to low secretory activity;
• presence of lymphocytic follicles in the mucosa;
• penetration of leukocytes beyond the vessels.

Characteristic symptoms of chronic atrophic gastritis are a feeling of overflow of the stomach after taking even a small portion of food, weakness, unpleasant eructation, flatulence, instability of the stool - then constipation, diarrhea, poor appetite, rumbling in the stomach, sometimes weight loss.

[19], [20], [21], [22],

Antral subatrophic gastritis

Antral subatrophic gastritis is localized in the lower part of the stomach adjacent to the duodenum. The effects of inflammation - scarring of the antrum, muscle hypertrophy of its walls, proliferation of connective tissues at the base of the mucosa and deeper layers of the organ wall. This leads to deformation and disturbances of the gastric motility. The ailment makes itself felt with aching blunt pains in the solar plexus, eructation, general weakness, poor appetite, weight loss. When carrying out endoscopy, tumors and ulcers can be detected.

[23], [24], [25], [26], [27]

Deep subatrophic gastritis

Deep subatrophic gastritis is characterized by a deep penetration of inflammation into the walls of the stomach, down to the muscle layer. During this process, atrophy of the secretory glands does not yet occur in extensive areas of the stomach, but separate foci can occur in combination with the degeneration of the glandular epithelium into a flat one. Since this type of gastritis belongs to its chronic form, it also has symptoms characteristic of it.

[28], [29], [30], [31], [32]

Focal subatrophic gastritis

Focal subatrophic gastritis occurs in separate foci of the stomach. Its acute manifestation often occurs against the background of increased acidity produced by the secretory glands in intact areas. His symptoms do not differ from chronic gastritis, except that intolerance to dairy products, fatty foods increases.

[33], [34], [35], [36], [37], [38]

Diffuse subatrophic gastritis

Diffuse subatrophic gastritis is a form of inflammation of the gastric mucosa, which has not yet caused serious dystrophic changes. This is most likely a transitional stage between superficial and deep lesions of the secretory glands. Its peculiarity is the uniform spread of inflammation along the entire internal surface of the mucosa. Endoscopic studies establish the initial process of cell damage, deepening of the gastric pits, the formation of rollers on the walls of the stomach. Symptomatics in the initial stage of the disease is not very pronounced, but with the development of the disease there is a severity and episodic pains in the stomach, a decrease in appetite, fatigue, increased sweating.

[39], [40]

Erosive subatrophic gastritis

Erosive subatrophic gastritis is a form of gastritis, during which the walls of the stomach in one or several places are affected by small ulcers that eventually turn into erosion and are precursors of ulcers. Such a gastritis can be both acute and chronic. In acute form, the ailment is manifested by pain in the stomach, which is worse after ingestion, vomiting, and vomiting can be blood. The chronic course is accompanied by usual symptoms for gastritis.

[41], [42], [43]

Distal subatrophic gastritis

Distal subatrophic gastritis is a kind of inflammation of the stomach, affecting its most distant, distal areas. According to studies, this gastritis is more likely to affect residents of large cities, in particular men. The explanation for this is the fact that people in megacities are more likely to carry emotional overloads, eat irrationally, smoke a lot, and often abuse alcohol. Distal subatric gastritis is characterized by pain in the epigastric region, belching with an unpleasant rotten or acidic odor, bloating, loss of appetite, and often weight. It can occur in both chronic and acute forms, it can be erosive.

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

Subatrophic gastritis in children

The manifestations of subatrophic gastritis in a child are no different from the symptoms of an adult. At first - the absence of pain, a feeling of overfilling and heaviness of the stomach, bloating, unpleasant belching, intolerance to dairy products, fatigue, loss of vision, brittle nails and hair. Flowing it into a chronic form leads to a thinning of the walls of the stomach, the death of the secretory glands.

Complications and consequences

Subatrophic gastritis can have serious consequences and complications. From this disease, the organs suffer, which because of their anatomical intimacy with the stomach, feel the negative effect of the ailment. This pancreas, which can respond with pancreatitis, duodenum - duodenitis, liver - cholecystitis, intestine - colitis. Due to poor absorption of food, the body lacks the necessary vitamins and trace elements, which can lead to anemia. The nervous system suffers. But the biggest threat is the risk of tumors, especially malignant tumors. Reduced acidity, characteristic of subatrophic gastritis - it is the environment that promotes the appearance of neoplasms.

[48], [49]

Diagnostics of the subatrophic gastritis

Diagnosis of subatrophic gastritis is based on:

• anamnesis of complaints, their features, duration and nature of symptoms;
• information on the history of life: the presence of hereditary factors, specific diet, harmful habits, whether there was a chemical effect;
• physical examination of the skin condition of a person, its mucous membrane, palpation of the abdomen and stomach;
• laboratory and instrumental research;

[50],

Analyzes

There are various tests to determine the diagnosis. First of all, this is a general blood test showing:

• increase in leukocytes;
• the density of blood coming from vomiting and diarrhea;
• pepsinogen, gastrin - markers of subatrophic gastritis, the amount of which is directly proportional to the presence of healthy cells of the secretory glands;
• increasing the level of gastrin;
• antibodies to stomach cells that produce hydrochloric acid, the internal factor of Castle (a substance that helps to assimilate vitamin B12).

Stool analysis will confirm the diagnosis if unprocessed fiber, starch, muscle fibers are found in it. A general urine test will determine the concomitant damage to the kidneys and bladder.

There are also several laboratory methods for detecting the most common pathogen of subatrophic gastritis: Helicobacter pylori bacteria:

• respiratory test;
• Immuno-enzymatic analysis of blood and feces.

[51], [52], [53], [54]

Instrumental diagnostics

Instrumental diagnosis in the case of gastritis has on its armament a lot of different tools and techniques that allow to accurately determine the diagnosis. Consider these:

• fibroesophagogastroduodenoscopy (FEGDS) - the entry through the mouth into the interior of the optical instruments by which the surface of the stomach is examined and the mucosal condition and the extent of the lesions are determined, simultaneously a material is taken from several areas of the stomach for biopsy - the most reliable method for determining subatrophic gastritis;
• Radiography - the reception of contrast fluid makes the stomach visible for X-rays and shows a reduction in its size, depth of folds, and motor skills;
• ultrasound examination - determines the damage to the organs of the gastrointestinal tract;
• intragastric pH-metry - establishes a reduced secretion;
• spiral computed tomography (CT) - on X-ray images gives an accurate image of the stomach at different depths.

Differential diagnosis

Differential diagnosis of subatrophic gastritis is carried out with ulcers, cancer, functional disorders of the stomach. So, the ulcer gives intensive nocturnal pains and during palpation, which is not peculiar to gastritis. In addition, X-rays and endoscopy reveal an ulcer. Cancer gives poor blood counts, a strong general weakness, a sharp weight loss, the presence of blood in the stool and is also determined by instrumental diagnostics. Functional disorders of the stomach are associated with imbalance in the nervous system and do not entail structural changes in the mucosa, although they disrupt its motor function. In this case, the secretion varies from low to high and vice versa.

[55], [56], [57], [58], [59], [60]

Treatment of the subatrophic gastritis

Treatment of subatrophic gastritis depends on the clinical manifestations, the phase of the disease, the features of the gastric mucosa, the presence of complications.

Drug treatment is divided into several stages. The first - etiotropic therapy, is to eliminate the causes of the disease. If the causative agent of subatrophic gastritis is the Helicobacter bacterium, then the following preparations are used:

• aimed at its destruction;
• proton pump inhibitors;
• healing damaged tissue.

If the cause of the disease is autoimmune, i.e. The body produces antibodies that damage healthy cells, then in the case of a lack of vitamin B12, glucocorticoid treatment is prescribed.

The next stage of treatment of gastritis is pathogenetic therapy, which affects the mechanisms of its development. It consists of:

• replacement therapy (replenishment of the body with substances that he lacks);

• use of stimulants for the production of hydrochloric acid;
• gastro-protectors, restoring mucous membranes;
• astringent and enveloping preparations;
• prokinetics, improving gastric motility;
• anesthetics in case of need.

Diet therapy plays an important role in the treatment of subatrophic gastritis. During an exacerbation strict diet (table №1) is applied, in the further - less strict diet №2.

Medications

At the stage of etiotropic therapy, antibiotics are prescribed. Due to the stability of the bacteria, combinations of two groups of drugs are used for treatment. Such drugs include clarithromycin (analogues of binocular, clacid, clarexide), omeprazole (omez, omephesis, permease), amoxicillin (amoxiclav, amoxicar, amoxyl). Combine them with an antibacterial drug - metronidazole.

Clarithromycin is a tablet with a dosage of 250 and 500 mg. It is taken 2 times a day for 500 mg. Treatment with two drugs (together with proton pump inhibitors) is carried out 10 days, with the connection of the third (antibacterial) - 14 days. Contraindications are hypersensitivity to the drug and age to 12 years. There may be adverse reactions in the form of nausea, vomiting, diarrhea, weakness, dizziness, tachycardia, allergies.

Proton pump inhibitors include pantoprazole, rabeprozole, lansoprazole, ranitidine, omeprazole.

Pantoprazole is a white crystalline powder that dissolves well in water. It is used either orally or intravenously. The daily dose of 40 mg. The duration of the combined treatment is 7-14 days. Contraindicated in patients with hepatitis, cirrhosis, with hypersensitivity. Pregnant and lactating - only as prescribed by the doctor. Adverse events are possible in the form of nausea, vomiting, diarrhea, allergies, dry mouth, eructations, headaches, swelling.

To heal lesions of the stomach mucosa, bismuth tricalium dicitrate is used, a preparation that forms a protective layer at the sites of cell lesions. On the basis of this active substance, a de-nol medicine is created, which is a gastroprotective agent.

De-nol - creamy-white tablets, covered with a shell. It is taken one half an hour before meals 4 times a day or two twice a day. The course lasts 4-8 weeks. Pregnancy, breast-feeding, kidney failure - contraindications. Side effects can arise from the gastrointestinal tract (nausea, vomiting). In case of an overdose, allergic reactions are possible.

Pathogenic therapy includes a complex of drugs used in the second stage of treatment and designed to support the effect of etiotropic. Substitution therapy involves the introduction of enzymes, hydrochloric acid preparations, vitamin B12 with their deficiency.

Some of them: acid-pepsin, mezim, creon, pancreotin, pancreosim.

Acidin-pepsin - a pill that stimulates the production of hydrochloric acid. It is taken during or immediately after a meal of 2 pieces 3-4 times a day. Contraindications are hyperacid gastritis, ulcers, erosion, gastric bleeding, tumors. There are no studies on the effect on pregnant women. Side effects are associated with the possibility of an overdose of the drug, which can cause allergic reactions, nausea, vomiting, constipation. Therefore, simultaneous use with analogs is unacceptable.

Enveloping medications absorb or delay the absorption of irritating substances, astringents - the protein is folded on the damaged areas, forming a protective film. These include preparations of bismuth and aluminum: almogel, vikalin, vicair.

Regulate the motility of the stomach, strengthening peristalsis and strengthening sphincters, prokinetics. Popular among them are domperidone, motilium, cisapride, cerucal.

Domperidone - has various forms of release: tablets, capsules, suspensions, solutions, suppositories. It is taken before meals with 10 mg 3-4 times. Suppositories are 2-4 times in 60 mg. Taking the drug can cause dry mouth, nausea, vomiting, allergic reactions, stomach cramps. Contraindicated in pregnant women, nursing women, children with body weight below 20 kg, patients with bleeding and perforation of the stomach and intestines.

Vitamins

Subatrophic gastritis due to poor absorption of food often leads to hypovitaminosis - a deficiency of vitamins A, C, P, B6, B12. In these cases, they are prescribed together with E and folic acid.

Physiotherapeutic treatment

Physiotherapeutic treatment is aimed at reducing pain syndrome, improving gastric motility, stimulating the regeneration of epithelial cells. It is contraindicated in the period of exacerbations of subatrophic gastritis, in the presence of polyps and other neoplasms. In the state of remission ozocerite and paraffin compresses are applied to the stomach area, inductothermy (high-frequency magnetic field effect), UHF-irradiation, galvanization, electrophoresis with calcium and novocaine, diadynamic currents.

Alternative treatment

Treatment of gastritis is more effective in combination with alternative treatment. Together with medicinal treatment, the medicinal properties of herbs, mineral sodium chloride waters of high mineralization, apyproducts, various fruits and their juices are used. If with increased acidity it is recommended to take an empty stomach on an empty stomach dissolved in warm water, then with subatrophic gastritis before eating, you must eat a teaspoon, washed down with water. The juice of raw potatoes helps very well, for which it must be rubbed on a grater and squeezed through gauze. You need to drink it 100 ml before meals three times a day. A good effect on the increase of the secretory activity of the stomach is provided by the juice of white cabbage, it should also be taken in half a glass for 20-30 minutes. Before eating.

[61], [62]

Herbal Treatment

Plantain is found in the first positions of treatment of subatrophic gastritis with herbs. Its dry extract is used in the production of plantagluticide. The medicinal properties of plantain consist in anti-inflammatory, antispasmodic, anti-edema, acidifying action. A few leaves of fresh grass should be crushed, pour boiling water, hold for 10 minutes on a small fire. In a day, strain and drink 100ml for 20 minutes before eating. You can take a spoon before eating and pure raw juice of plantain.

Effective enveloping agent is a flax seed. In addition, it contains more polyunsaturated fatty acids omega3, omega6 than in fish oil. It is best to prepare a jelly from it. For this, a tablespoon of seeds is poured with two glasses of boiling water, wrapped in a warm thing and left for 8-10 hours. Before taking, you can improve the taste by adding honey, lemon, cinnamon.

Anti-inflammatory effect has flowers of elderberry, chamomile, linden, fennel, therefore used to treat gastritis. Combining these herbs in the collection and taking 2 tablespoons per half liter of boiling water, you can prepare a decoction, which after several hours of insisting is ready for use.

Successfully used for subatrophic gastritis is the cranberry berry. From her prepare the fruit: for 4 cups of cranberries take 6 glasses of water and half a kilogram of sugar. After boiling, allow to cool.

Fresh or dry parsley roots are also used in the treatment of subatrophic gastritis. Prepare the broth this way: three teaspoons of raw material pour a glass of boiling water and infuse for 10 hours. Drink a tablespoon 3 times a day for 30 minutes before eating.

Homeopathy

In the pharmaceutical market, there are many homeopathic medicines used to treat subatrophic gastritis. Gastricumel is a universal remedy for various types of gastritis. A wide range of activities are provided by its components:

• meadow throat;
• chilibuha;
• charcoal;
• metallic silver;
• arsenious anhydrite;
• antimony trisulphide.

Produced in tablets, contraindications and side effects are not identified. Do not recommend to children under two years old. The tablet is absorbed under the tongue for a quarter of an hour before meals or an hour after meals 3 times a day.

Plantaglucid - based on the extract of dry plantain. Has anti-inflammatory, analgesic properties, increases the acidity of the stomach. It is sold in the form of granules, a floor or a teaspoon of which must be diluted in a quarter of a glass of water and drink 2-3 times a day for 30-40 minutes before meals. Contraindicated with increased acidity of the stomach.

Sea buckthorn oil is known for many healing properties, including healing, analgesic, regenerating, thanks to its composition: provitamin A, vitamins of group B, C, E, K, etc., pectins, organic acids, tannins, flavonoids, many macro- and microelements, plant antibiotics, etc. Drink before eating a teaspoon 2-3 times a day. Contraindicated with individual intolerance, with inflammation of the gallbladder, liver, pancreatitis, cholelithiasis. Side effects are possible in the form of a feeling of bitterness in the mouth, nausea, diarrhea, itching, rashes on the skin.

Spirituous tincture of propolis is also successfully used for treatment of gastritis, ulcers. Only with hyperacid gastritis is used tincture on water, and with subatrophic gastritis - alcohol. Take an hour before eating 10-15 drops. There may be an adverse reaction in case of allergies to bee products.

Alcoholic tincture of bitter wormwood stimulates the production of all juices, including gastric juice, and also has a bactericidal, anti-inflammatory, immunostimulating agent. Take 15 drops for 20-30 minutes before eating.

Side effects can be with increased sensitivity, with an overdose - headaches, nausea, rash, cramps.

Operative treatment

Surgical treatment with subatrophic gastritis is not required, unless complications arise in the form of a malignant tumor. In this case, the whole stomach or part of it is removed.

Diet with subatrophic gastritis

Diet therapy is one of the important factors of successful treatment and restoration of the stomach. At the stage of exacerbation, it is necessary to adhere to a strict diet based on the principles of keeping the food temperature sparing, milling it, and the absence of chemical effects on the mucous membrane. Then gradually move on to products that stimulate the production of hydrochloric acid, while preserving the crushing of food, excluding hot, cold, spicy, fatty foods. Portions should be small, in order to preserve a full-fledged diet, you must distribute food for at least six meals. These requirements correspond to diet number 2. In its diet, it is necessary to limit coarse plant fiber, refractory animal fats, raw milk, fatty meat, flour products. Give preference to cereals, vegetable soups, non-fermented meat broths, not raw fruit. During the remission, you can drink freshly squeezed fruit juices, and breakfast with a baked pumpkin with apples with honey and lemon juice will be a real balm for the stomach mucosa.

[63], [64], [65], [66]

Prevention

The best prevention of gastritis is adherence to the diet: exclusion of snacks on the go, dry food, overeating, abuse of mayonnaise, smoked products, alcoholic beverages. It is also necessary to follow the rules of hygiene, tk. Helikobakter pylori, the most frequent culprit of gastritis - this is nothing like an intestinal infection that has a fecal-oral route of transmission. Therefore, it is more often to wash hands, disinfect drinking water - a favorable environment for their dwelling. When detecting an infection, you should not delay treatment.

[67], [68]

Forecast

The unfavorable prediction of subatrophic gastritis is that epithelial cells that have undergone rebirth never transform into healthy glandular cells. Also, with a deficiency of vitamin B12, malignant anemia and the degeneration of damaged cells into malignant cells can occur. Favorable is the fact that timely treatment leads to preventing the progression of stomach dyspepsia.