Endoscopic signs of erosions of the stomach

Erosive-ulcerative lesions of the stomach affect people at an active age. Over the years, there has been an increase in the incidence rate in our country. The age range is expanding. Women on average suffer 4 times less often than men. Women of young age, unlike men, are sick less often than women of advanced age.

[1], [2], [3], [4], [5], [6], [7], [8], [9]

Stomach erosion

Erosion is a small superficial defect in the mucous membrane of white or yellow with even margins. It grabs its own plate of mucous membrane, not penetrating to the muscular plate. The form is linear or rounded, the delimitation from the surrounding mucosa is fuzzy. For the first time described Findler in 1939. Erosions appear as a result of hemorrhages in the neck of the glands with the development of hypoxia in this area and complete rejection of the surface epithelium. More often occur against a background of superficial or hyperplastic gastritis. Can bleed, in this case, the term "erosion" is used only in the visible mucosa, not covered by a clot of blood. Erosions can be the cause of profuse bleeding.

Often, the term "aphthous erosion" is used to refer to erosion due to an afto-like base (aphtha is a yellow or white patch with a red rim) on which they are located - fibrinous exudate.

Classification of erosions of the stomach

1. Hemorrhagic erosion.
2. Incomplete erosion (flat).
3. Full erosion:
   • mature type,
   • immature type.

Hemorrhagic and incomplete erosion is a consequence of acute inflammatory process in the mucous membrane of the stomach, complete - chronic.

Hemorrhagic erosions are observed in hemorrhagic erosive gastritis. The latter can be diffuse and focal. Focal hemorrhagic erosive gastritis is more common in the arch and antrum. In endoscopic examination, hemorrhagic erosions look like small-dot defects of the mucous membrane, resembling a pin or a needle, with a diameter of up to 0.1 cm, they can be superficial and deep, the color of erosion from bright red to cherry. Erosion, as a rule, is surrounded by a rim of hyperemia, often more than the erosion itself - up to 0.2 cm. Erosions can be covered with blood or hemorrhagic plaque. Bleeding, as a rule, the edges of erosion. The mucous membrane around it is edematous, it can be covered with bloody mucus. The stomach is well spread by air, the peristalsis is preserved in all departments.

Biopsy: marked degree of microcirculation disturbance, hemorrhage in the neck region of the glands with rejection of the superficial epithelium and exit of blood to the surface of the mucous membrane.

[10], [11], [12], [13]

Incomplete erosions of the stomach

In endoscopic examination, incomplete erosions look like flat defects of the mucous membrane of various sizes and shapes - round or oval, with a diameter of 0.2 to 0.4 cm. The bottom can be clean or covered with fibrin plaque, the edges are smoothed. Mucous around is edematous, hyperemic in the form of a small narrow rim. There can be single and multiple. Localized more often by the small curvature of the cardiac and body parts of the stomach. They usually epithelize within 1-2 weeks, leaving no trace on the mucosa. Most often appear against a background of chronic atrophic gastritis, combined with a stomach ulcer, a hernia of the esophagus of the diaphragm, reflux esophagitis.

Biopsy: in the bottom and in the edges a small area of necrotic tissue, deeper a small area of leukocyte infiltration.

Complete erosions of the stomach

In endoscopic examination, polypoid formations of a conical shape on the mucosa with central impressions and ulceration or a defect of round or oval shape are determined. The defect is covered with fibrin often dark brown or black (hydrochloric acid hematin). Erosions are located on the tops of folds. With air insufflation, the folds are completely straightened out, and erosions remain. Dimensions from 0.1 to 1.0 cm (usually 0.4 to 0.6 cm). The mucous membrane in the erosion zone can be moderately edematous, hyperemic or almost unchanged. In the formation of these erosions, a leading role belongs to changes in the vascular and connective tissue of the mucosa and the submucosal layer, which leads to pronounced swelling and impregnation of the mucosa in the erosion zone by fibrin. As a result, erosion seems to bulge into the lumen of the stomach on the edema-inflammatory base. They can be single, but more often multiple. Multiple erosions can be located at the tops of the folds in the form of "suckers of the octopus."

[14], [15], [16], [17], [18], [19],

Chronic erosions of the stomach

Mature type. Polypoid formations have clear contours, regular rounded shape, resemble a volcanic crater. They exist for years. Currently, such chronic erosion is commonly called papules.

Immature type. Polypoid formations have indistinct contours: they look as though slightly "corrugated" or "eaten". They heal within a few days.

Biopsy: mature erosions from immature differ in histological pattern.

Immature type: pseudo-hyperplasia due to edema of the epithelium.

Mature type: fibrotic changes in tissues, stasis of erythrocytes in the vessels in the neck region of the glands leads to pronounced edema and impregnation with fibrin of the mucosa in the erosion zone, as a result of which erosion swells into the lumen on the edema-inflammatory base. When complete erosion heals, it is difficult to conduct differential diagnosis with a polyp of the stomach - you need to take a biopsy.

Localization. Hemorrhagic erosions can be localized in any part of the stomach, incomplete are observed more often in the bottom, full - in the distal parts of the body of the stomach and antrum.

Epithelialized incomplete and hemorrhagic erosions, with rare exception, quickly (usually within 5-14 days), leaving no significant (macroscopic) traces. Part of the total erosion is also fully epithelialized (sometimes for a long time - up to 2-3 years or more), after which the mucous membrane swelling disappears at the site of erosion. However, most erosions of this type become recurrent. In these cases, they periodically exacerbate and heal, but the swelling of the mucosa at the site of erosion remains constantly due to the developed fibrosis of the tissues and marked productive inflammation. In these areas, histological examination clearly reveals a predisposition to hyperplasia of the integumentary epithelium. Occasionally, hyperplasia of the glandular apparatus of the gastric mucosa is also determined. When the erosions of this form are healed, it is impossible to distinguish them from a true polyposis with an endoscopic study without studying the histological material. With the tendency towards hyperplasia, the chain of successive transformations is not excluded: erosion - glandular polyp-cancer. In this regard, dynamic monitoring of these patients is required in connection with the danger of developing malignant neoplasms in them.

[20], [21]