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

Subatrophic gastritis is a disease in which individual sections of the gastric mucosa and glands that produce hydrochloric acid and pepsin atrophy. The latter is an enzyme that participates in one of the stages of breaking down 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 digestion process. With atrophy of the mucosa, this process does not occur; moreover, connective and epithelial tissues form on the non-functioning sections of the stomach. As a result, acidity decreases, the walls of the stomach become thinner, and its function – to process food – cannot be performed properly.

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Epidemiology

The epidemiology of chronic gastritis is very extensive, according to statistics, a third of people on the planet suffer from it, of which 18-20% are ill with subatrophic gastritis. Moreover, 5% of those who fall ill are people under 30, 30% - from 31 to 50 years old, and 50-70% - after 50 years. The absolute majority of diseases (80-90%) are provoked by the pathogen - the bacterium Helicobacter pylori, the rest have autoimmune or other causes.

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Causes subatrophic gastritis

The causes of subbath gastritis can be different, from poor nutrition, bad habits, pathologies, age-related changes to genetic or infectious causes, autoimmune. But the most common cause of atrophy is the Helicobacter pylori bacterium. Getting into an acidic environment, it begins to actively multiply, which leads to the occurrence of inflammation of the mucous membrane.

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Risk factors

Risk factors for the development of subatrophic gastritis include:

• chronic forms of other types of gastritis;
• hereditary factor, especially stomach cancer in relatives;
• violations of the meal regime;
• physical overload;
• bad habits (smoking and alcohol);
• prolonged stress conditions;
• long-term use of medications;
• age.

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Pathogenesis

The pathogenesis of subatrophic gastritis is a chain of complex transformations and chemical reactions of the body. In simplified form, it is a failure in the regeneration of 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 renewed every six days. In the case of subatrophic gastritis, hydrochloric acid and pectin are not produced, which leads to the fact that the intragastric environment becomes slightly acidic, gradually transforming into achylia - its complete absence. Adhesions are formed from damaged immature cells - the result of pathological regeneration, unable to perform their function.

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Symptoms 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, excessive salivation, decreased appetite, nausea, belching);
• bacterial overgrowth (rumbling, bloating, diarrhea);
• anemia due to insufficient absorption of iron, vitamin B12, folic acid;
• painful sensations, without a specific location, intensifying after eating;
• intolerance to dairy products;
• "polished" tongue, coated with a white coating during exacerbations.

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

Stages

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

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Forms

The type of subatrophic gastritis is determined by the location and nature of the damage revealed during endoscopy and examination of tissues under a microscope, and the clinical picture of the disease. Subatrophic gastritis may have a chronic form, which is characterized by a long-term nature of the disease with gradual atrophy of epithelial cells. In this case, dystrophic processes prevail over inflammatory ones, and this stage of the disease is called remission. With an exacerbation of chronic gastritis, acute or active subatrophic gastritis occurs. It can be provoked by aggressive external factors: toxins, strong acids or alkalis. It manifests itself as pain in the stomach, nausea, vomiting, diarrhea, sometimes loss of consciousness, coma. When examining such a patient, edema of the stomach walls, plethora of its vessels, penetration of leukocytes beyond the walls of the vessels, destruction of the epithelium, and sometimes erosion are revealed.

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Chronic subatrophic gastritis

Chronic subatrophic gastritis with periodic relapses and progression is characterized by low acidity, dystrophic changes in the mucosa, decreased evacuation-motor and absorption functions of the stomach. Prolonged destructive processes in it without treatment entail complications of other organs whose functioning is associated with the stomach: the esophagus, duodenum, pancreas, liver. The hematopoietic and nervous systems suffer. Diagnosis of chronic subatrophic gastritis gives the following picture:

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

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

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Antral subatrophic gastritis

Antral subatrophic gastritis is localized in the lower part of the stomach adjacent to the duodenum. The consequences of inflammation are scarring of the antral section, muscular hypertrophy of its walls, proliferation of connective tissues in the base of the mucous membrane and deeper layers of the organ wall. This leads to deformation and disturbances of the motility of the stomach. The disease makes itself known by aching dull pains in the solar plexus, belching, general weakness, poor appetite, weight loss. Tumors and ulcers can be detected during endoscopy.

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Deep subatrophic gastritis

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

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Focal subatrophic gastritis

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

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Diffuse subatrophic gastritis

Diffuse subatrophic gastritis is a form of inflammation of the gastric mucosa that has not yet caused serious dystrophic changes. This is most likely a transitional stage between superficial and deep damage to the secretory glands. Its peculiarity is the uniform spread of inflammation over the entire inner surface of the mucosa. Endoscopic studies indicate the initial process of cell damage, deepening of the gastric pits, and the formation of ridges on the walls of the stomach. Symptoms in the initial stage of the disease are not very pronounced, but as the disease develops, heaviness and episodic pain in the stomach, loss of appetite, fatigue, and increased sweating appear.

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Erosive subatrophic gastritis

Erosive subatrophic gastritis is a form of gastritis, during which the walls of the stomach in one or more places are affected by small ulcers, which over time turn into erosion and are precursors to ulcers. Such gastritis can be both acute and chronic. In the acute form, the disease manifests itself as pain in the stomach, which intensifies after eating, vomiting, and there may be blood in the vomit. The chronic course is accompanied by symptoms common to gastritis.

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Distal subatrophic gastritis

Distal subatrophic gastritis is a type of gastric inflammation that affects its most distant, distal areas. According to research, this type of gastritis is more common in residents of large cities, especially men. This is explained by the fact that in megalopolises people experience more emotional stress, eat unhealthily, smoke a lot, and often abuse alcohol. Distal subatrophic gastritis is characterized by pain in the epigastric region, belching with an unpleasant rotten or sour smell, bloating, loss of appetite, and often weight loss. It can occur in both chronic and acute forms, and can be erosive.

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Subatrophic gastritis in a child

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

Complications and consequences

Subatrophic gastritis can have serious consequences and complications. This disease affects organs that, due to their anatomical proximity to the stomach, feel the negative impact of the disease. This is the pancreas, which can respond with pancreatitis, the duodenum - with duodenitis, the liver - with cholecystitis, the intestines - with colitis. Due to poor absorption of food, the body does not receive the necessary vitamins and microelements, which can lead to anemia. The nervous system suffers. But the greatest threat is the risk of tumors, especially malignant ones. Low acidity, characteristic of subatrophic gastritis, is exactly the environment that contributes to the appearance of neoplasms.

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Diagnostics subatrophic gastritis

Diagnosis of subatrophic gastritis is based on:

• history of complaints, their characteristics, duration and nature of symptoms;
• information about life history: presence of hereditary factors, specific diet, bad habits, whether there was chemical exposure;
• physical examination of the condition of the human skin, mucous membranes, palpation of the abdomen and stomach;
• laboratory and instrumental studies;

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Tests

There are various tests that can help determine the diagnosis. First of all, there is a general blood test that shows:

• increase in leukocytes;
• thickening of the blood resulting 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;
• increased gastrin levels;
• antibodies to stomach cells that produce hydrochloric acid, and to Castle's intrinsic factor (a substance that helps absorb vitamin B12).

A stool test will confirm the diagnosis if it contains undigested fiber, starch, and muscle fibers. A general urine test will determine any associated damage to the kidneys and bladder.

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

• breath test;
• enzyme immunoassay of blood and feces.

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Instrumental diagnostics

Instrumental diagnostics in case of gastritis has at its disposal many different tools and techniques that allow to accurately determine the diagnosis. Let's consider them:

• fibroesophagogastroduodenoscopy (FEGDS) – insertion of optical instruments through the mouth, with the help of which the surface of the stomach is examined and the condition of the mucous membrane and the extent of damage are determined, at the same time material is taken from several areas of the stomach for biopsy – the most reliable method for determining subatrophic gastritis;
• radiography – taking a contrast fluid makes the stomach visible to x-rays and shows a decrease in its size, depth of folds, and motility;
• ultrasound examination – determines damage to the gastrointestinal tract;
• intragastric pH-metry – establishes decreased secretion;
• spiral computed tomography (SCT) – on X-ray images provides an accurate image of the stomach at different depths.

Differential diagnosis

Differential diagnostics of subatrophic gastritis is carried out with ulcer, cancer, functional disorders of the stomach. Thus, the ulcer gives intense pain at night and during palpation, which is not typical for gastritis. In addition, X-ray and endoscopy reveal an ulcer. Cancer gives poor blood counts, severe general weakness, sudden 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 of the nervous system and do not entail structural changes in the mucosa, although they disrupt its motility. In this case, secretion fluctuates from low to high and vice versa.

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Treatment subatrophic gastritis

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

Drug treatment is divided into several stages. The first is etiotropic therapy, which consists of eliminating the causes of the disease. If the causative agent of subatrophic gastritis is the Helicobacter bacterium, then the following drugs are used:

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

If the cause of the disease is autoimmune, i.e. the body produces antibodies that damage healthy cells, then in the case of vitamin B12 deficiency, treatment with glucocorticoids is prescribed.

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

• substitution therapy (replenishing the body with substances that it lacks);

• use of hydrochloric acid production stimulants;
• gastroprotectors that restore the mucous membrane;
• astringent and enveloping preparations;
• prokinetics that improve gastric motility;
• painkillers when needed.

Diet therapy plays a major role in the treatment of subatrophic gastritis. During an exacerbation, a strict diet is used (table No. 1), later - a less strict diet No. 2.

Medicines

At the stage of etiotropic therapy, antibiotics are prescribed. Due to the resistance of bacteria to treatment, combinations of two groups of drugs are used. Such drugs include clarithromycin (analogues of binoclari, klacid, clarexidi), omeprazole (omez, omefez, promez), amoxicillin (amoxiclav, amoksikar, amoksil). They are combined with the antibacterial drug metronidazole.

Clarithromycin is a tablet with a dosage of 250 and 500 mg. It is taken 2 times a day, 500 mg. Treatment with two drugs (along with proton pump inhibitors) is carried out for 10 days, with the addition of a third (antibacterial) - 14 days. Contraindications include hypersensitivity to the drug and age under 12 years. Side effects may occur in the form of nausea, vomiting, diarrhea, weakness, dizziness, tachycardia, allergies.

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

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

To heal damage to the gastric mucosa, bismuth tripotassium dicitrate is used - a drug that forms a protective layer in places where cells are damaged. The drug de-nol, which is a gastroprotector, was created on the basis of this active substance.

De-nol is a creamy white film-coated tablet. Take one tablet half an hour before meals 4 times a day or two twice a day. The course duration is 4-8 weeks. Pregnancy, breastfeeding, renal failure are contraindications to the drug. Side effects may occur from the gastrointestinal tract (nausea, vomiting). In case of overdose, allergic reactions are possible.

Pathogenic therapy includes a set of drugs used at the second stage of treatment and designed to reinforce the effect of etiotropic therapy. Replacement therapy involves the introduction of enzymes, hydrochloric acid preparations, vitamin B12 in case of their deficiency.

Some of them are: acidin-pepsin, mezim, creon, pancreatin, pancreozyme.

Acidin-pepsin - tablets that stimulate the production of hydrochloric acid. Taken during or immediately after meals, 2 tablets 3-4 times a day. Contraindications include hyperacid gastritis, ulcers, erosions, 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 irritants, astringent medications coagulate protein in damaged areas, forming a protective film. These include bismuth and aluminum preparations: almogel, vikalin, vikair.

Regulate gastric motility, enhancing 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 at 10 mg 3-4 times. Suppositories are put 2-4 times at 60 mg. Taking the drug can cause dry mouth, nausea, vomiting, allergic reactions, stomach cramps. Contraindicated in pregnant women, lactating women, children weighing less than 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 lack of vitamins A, C, P, B6, B12. In these cases, they are prescribed together with E and folic acid.

Physiotherapy treatment

Physiotherapeutic treatment is aimed at reducing pain, improving gastric motility, and stimulating epithelial cell regeneration. It is contraindicated during periods of exacerbation of subatrophic gastritis, in the presence of polyps and other neoplasms. In a state of remission, ozokerite and paraffin compresses are applied to the stomach area, inductothermy (exposure to a high-frequency magnetic field), UHF irradiation, galvanization, electrophoresis with calcium and novocaine, and diadynamic currents are used.

Folk remedies

Treatment of gastritis is more effective in combination with folk remedies. Along with drug treatment, they use the medicinal properties of herbs, mineral chloride-sodium waters of high mineralization, bee products, various fruits and their juices. If with increased acidity it is recommended to take honey dissolved in warm water on an empty stomach, then with subatrophic gastritis you need to eat a teaspoon before eating, washed down with water. Raw potato juice helps very well, for which it should be grated and squeezed through cheesecloth. You need to drink 100 ml before meals three times a day. White cabbage juice also has a good effect on increasing the secretory activity of the stomach, it should also be taken half a glass 20-30 minutes before meals.

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Herbal treatment

Plantain is at the forefront of herbal treatment of subatrophic gastritis. Its dry extract is used in the production of the drug plantaglucid. The medicinal properties of plantain include anti-inflammatory, antispasmodic, anti-edematous, and acidity-increasing effects. Several leaves of fresh grass should be crushed, poured with boiling water, and kept on low heat for 10 minutes. Strain after 24 hours and drink 100 ml 20 minutes before meals. You can also take a spoonful before meals and pure raw plantain juice.

Flax seed is an effective enveloping agent. In addition, it contains more polyunsaturated fatty acids omega3, omega6 than fish oil. It is best to make jelly from it. To do this, pour a tablespoon of seeds with two glasses of boiling water, wrap in a warm thing and leave for 8-10 hours. Before taking, you can improve the taste by adding honey, lemon, cinnamon.

Elder flowers, chamomile, linden, fennel fruits have anti-inflammatory properties, so they are used to treat gastritis. By combining these herbs into a mixture and taking 2 tablespoons per half a liter of boiling water, you can prepare a decoction, which after several hours of infusion is ready for use.

Cranberries are successfully used for subatrophic gastritis. Fruit drinks are prepared from them: for 4 glasses of cranberries take 6 glasses of water and half a kilo of sugar. After boiling, let it cool.

Fresh or dried parsley roots are also used to treat subatrophic gastritis. The decoction should be prepared as follows: pour three teaspoons of raw material with a glass of boiling water and leave for 10 hours. Drink a tablespoon 3 times a day 30 minutes before meals.

Homeopathy

There are many homeopathic preparations on the pharmaceutical market that are used to treat subatrophic gastritis. Gastricumel is a universal remedy for various types of gastritis. Its components provide a wide range of action:

• meadow pasqueflower;
• chilibuha;
• charcoal;
• metallic silver;
• arsenic anhydrite;
• antimony trisulfide.

Available in tablets, no contraindications or side effects have been identified. Not recommended for children under two years of age. The tablet is dissolved under the tongue a quarter of an hour before meals or an hour after meals 3 times a day.

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

Sea buckthorn oil is known for its many medicinal properties, including healing, pain-relieving, regenerating, due 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 meals, a teaspoon 2-3 times a day. Contraindicated in case of individual intolerance, 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, skin rashes.

Propolis alcohol tincture is also successfully used to treat gastritis and ulcers. Only for hyperacid gastritis, water tincture is used, and for subatrophic gastritis, alcohol tincture is used. It is necessary to take 10-15 drops an hour before meals. There may be a side effect in case of allergy to bee products.

Alcohol tincture of wormwood stimulates the production of all juices, including gastric juice, and also has a bactericidal, anti-inflammatory, immunostimulating effect. Take 15 drops 20-30 minutes before meals.

Side effects may occur with increased sensitivity, and in case of overdose - headaches, nausea, rash, convulsions.

Surgical treatment

Surgical treatment for subatrophic gastritis is not required unless complications such as a malignant tumor arise. In this case, the entire stomach or part of it is removed.

Diet for subatrophic gastritis

Diet therapy is one of the important factors for successful treatment and recovery of the stomach. At the stage of exacerbation, it is necessary to adhere to a strict diet based on the principles of maintaining a gentle temperature of food, grinding it, and the absence of chemical effects on the mucous membrane. Then gradually switch to foods that stimulate the production of hydrochloric acid, while maintaining the grinding of food, excluding hot, cold, spicy, fatty foods. Portions should be small, to maintain adequate nutrition, you need to distribute food into at least six meals. Diet No. 2 meets these requirements. In your diet, you need to limit coarse vegetable fiber, refractory animal fats, raw milk, fatty meat, and flour products. Give preference to porridge, vegetable soups, non-rich meat broths, and non-raw fruits. During the period of remission, you can drink freshly squeezed fruit juices, and a breakfast of baked pumpkin with apples with the addition of honey and lemon juice will be a real balm for the gastric mucosa.

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Prevention

The best prevention of gastritis is to follow a diet: avoid snacking on the go, dry food, overeating, abuse of mayonnaise, smoked foods, and alcoholic beverages. It is also necessary to follow hygiene rules, since Helicobacter pylori, the most common culprit of gastritis, is nothing more than an intestinal infection that has a feco-oral transmission route. Therefore, it is worth washing your hands more often, disinfecting drinking water - a favorable environment for their habitation. If an infection is detected, do not delay treatment.

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Forecast

The unfavorable prognosis of subatrophic gastritis is that the epithelial cells that have undergone degeneration never transform into healthy glandular cells. Also, with a deficiency of vitamin B12, pernicious anemia and degeneration of damaged cells into malignant ones may occur. The favorable fact is that timely treatment leads to the prevention of the progression of gastric dyspepsia.