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

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

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

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

Epidemiology

Associated with H. Pylori antral gastritis is usually not taken into account by clinical statistics separately from other types of gastritis.

Experts estimate that more than half of the world's population is infected with Helicobacter pylori, but more than 70% of infected people have no symptoms of gastric pathology.

Differences in prevalence exist within and between countries, and a higher prevalence is noted among people with lower socioeconomic status and varies, increasing with age. Infection in early childhood is believed to lead to pangastritis, while infection at a later age can cause an antral gastritis.

According to World Gastroenterology Organization, primary infection of adults or re-reinfection of H. Pylori occurs at an annual frequency of 0.3-0.7% of cases in developed countries and 6-14% in developing countries.

Almost 15% of infected patients have antral gastritis, but H. Pylori is found in other parts of the stomach - against a background of partial mucosal atrophy, bile reflux or intestinal metaplasia (ie, replacement of the gastric epithelium with intestinal).

[5], [6], [7], [8], [9], [10], [11]

Causes of the antral gastritis

In most cases, the causes of antral gastritis are associated with damage to the gastric antrum mucosa due to its colonization by Gram-negative bacteria Helicobacter pylori. The functional peculiarity of the antral part of the stomach consists in the fact that additional secretory cells are concentrated here, which produce a protective mucin substance consisting of mucus, polysaccharides, proteins and hydrogen carbonates.

To understand the pathogenesis of the development of antral gastritis, provoked by H. Pylori, it is necessary to outline in general terms the mechanism of its destructive effect on the stomach. This microaerophilic bacterium, surviving a short exposure to acidic medium (at pH <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, in comparison with the body of the organ, the medium is less acidic (pH 3,6-4,4), and in the submucosa it is the most comfortable (pH 7).

First, in order to avoid acidic environment in the lumens of the stomach, this campylobacter with the flagella buries into the mucous membrane of the stomach and with the help of the produced adhesins it adheres to the membranes of the epithelial cells and even penetrates them. Secondly, the bacterium produces a urease enzyme that cleaves the urea secreted by the stomach into carbon dioxide and ammonia, and for ammonia epithelial cells ammonia is toxic.

Third, gastric epithelial cells are damaged by Helicobacteria protease synthesized (an enzyme that breaks down proteins and phospholipids), as well as vacuolizing cytotoxin A. Their combined aggressive action leads to epithelial cell damage and apoptosis.

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

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

[12]

Risk factors

The main risk factors for inflammation of the mucosa of the antral part of the stomach are associated gastroenterologists with irregular nutrition, poor food quality (containing emulsifiers and preservatives), alcohol and smoking abuse. Promotes the development of gastritis and stress, in which the level of catecholamines in the blood increases, and these neurohormones (adrenaline and norepinephrine) increase the secretion of the gastric hormone gastrin, enhancing the production of HCl.

The risk factors include the impact of radiation therapy for cancer, the effects of resection of the stomach and endoscopic examination, as well as long-term use of nonsteroidal anti-inflammatory drugs, steroids, anti-cancer cytotoxic agents (although some experts in these cases talk about gastropathies).

[13], [14], [15], [16]

Symptoms of the antral gastritis

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

Depending on how the disease proceeds, acute antral gastritis or chronic antral gastritis is determined. A stage of the disease - focal (early) and diffuse (late) - are fixed by physicians, depending on the intensity of the atrophic and inflammatory process.

Cases when acute antral gastritis is diagnosed are few and mostly occur during an outbreak of mucosal inflammation, which can be caused by malnutrition, the use of aggressive food ingredients, a sharp weakening of immunity 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 severe enough when there is gastrointestinal bleeding with melena (black feces) or bloody vomiting. In acute cases, pain with antral gastritis can be quite intense and has a piercing character.

Chronic antral gastritis is accompanied by atrophy of the mucosa and its inflammation. And depending on the severity of atrophy and its consequences for the functions of the gastric glands in gastroenterology distinguish: moderate, moderately pronounced antral gastritis or pronounced antral gastritis. These degrees are determined only in the course of instrumental diagnosis of the disease.

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

Further symptoms of antral gastritis are noted, such as: decreased appetite; frequent heartburn; eructation (with reduced acidity - rotten, with increased - acid); an unpleasant aftertaste in the mouth (with reflux gastritis - bitter); A whitish or grayish-yellow coating on the surface of the tongue; nausea; vomiting; bloating and flatulence; disorders of stool (diarrhea or constipation); Melena (with erosive and hemorrhagic gastritis).

If there is pain with antral gastritis, it is often aching and bothers a half to two hours after ingestion or at night; with an empty stomach the pain can be strong enough and have a spasmodic character. In the case of hypoacid antral gastritis, pain usually does not occur, but with increased appetite and weight loss, fatigue and general weakness are noted.

Forms

In clinical gastroenterology, the types of antral gastritis are determined by those pathological changes that the mucous antrum pyloricum undergoes. That is, in addition to the intensity of the inflammatory process and its effect on the 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 lesions in the upper layers of the mucosa (with desquamation of cells of the cylindrical epithelium), which nevertheless affect the secretion function of the additional cells producing the protective mucin substance.

• Catarrhal antral gastritis

This is an acute superficial gastritis (with edema of the mucosa antrum and capillary hemorrhages), which is usually a consequence of the influence of nutritional factors or a side effect of some medications.

• Focal antral gastritis

This type of disease is more often called superficial focal atrophic gastritis, since endoscopy on the mucous clearly shows inflammatory foci in the form of sunken spots that have different colors.

• Diffuse superficial antral gastritis

With diffuse or diffuse anthral gastritis, the entire significant part of the mucosa of this part of the stomach is damaged: it is thinner than a healthy inner shell, because of which the network of blood vessels located in the submucosa layer is viewed. At the same time there is a significant decrease in mucous secretions.

• Antral atrophic gastritis

This is a morphological diagnosis, which means that with endoscopic examination of the stomach cavity, deeper defects of the mucous membrane are revealed - up to its plate where the glands are concentrated. There is a reduction in the number of fully functioning secretory cells of the mucous antrum, the entire pyloric section and the body of the stomach, which leads to their replacement by epithelial cells and thinning of the inner membrane of the organ. Atrophy of significant areas is manifested by a decrease in the production of hydrochloric acid. And with the progression of atrophy, 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

With hypertrophic or hyperplastic gastritis 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 neoplasias on the surface or between layers.

• Granular antral gastritis

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

• Erosive antral gastritis

For erosive antral gastritis, the appearance of surface areas with completely or partially acid-eroded mucosal membrane is characteristic. Erosion can have the appearance of an ulcerated wound, and if it deepens to the basal layer of the mucosa, then during the subsequent regeneration, scar tissue is formed.

• Hemorrhagic antral gastritis

This kind 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 impurities of blood in the vomit and feces.

• Anhydral gastritis

Distinctive features of rigid antral gastritis are considered to be achlorhydria (reduction of the secretory function of the stomach); violation of the physiological location of folds (they do not become longitudinal, but transverse); change in the anatomical shape of the entire pyloric part of the stomach, including the pylorus cavern and canal (leading to their persistent stenosis); hypertrophic changes in the serous membrane of the stomach and spasticity of its muscle fibers (blocking the gastric peristalsis).

• Antral reflux-gastritis

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

• Antral gastritis with low acidity

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

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

Complications and consequences

In order to really assess the most likely consequences and complications of antral gastritis, serious medical research was conducted. According to their results, in the first place among the often diagnosed consequences of chronic antral gastritis were pyloroduodenitis, diffuse chronic gastritis (pangastritis) with mucous membrane damage of all parts, as well as gastric ulcer. And a serious complication of erosive antral gastritis can be a perforated stomach ulcer.

Then follows the duodenal ulcer, that is, peptic ulcer of the duodenum, as a complication of antral rigidity and reflux gastritis.

According to clinical data, in the presence of H. Pylori, the risk of developing gastric cancer - as the effects of antral gastritis - is exposed to 1-2% of patients. This is cancer of the antrum and pyloric department, adenocarcinoma of the stomach, lymphoid tumors, non-Hodgkin's lymphoma of the stomach.

[21], [22]

Diagnostics of the antral gastritis

The necessary tests, which are used to diagnose antral gastritis, include:

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

Instrumental diagnosis consists of radiography of the stomach; endogastroscopy or fibrogastroduodenoscopy (with the possibility of obtaining a biopsy specimen of the tissue of the affected area of the stomach for histological examination); electrogastrography (study of gastric motility).

[23], [24], [25], [26], [27], [28]

Differential diagnosis

Differential diagnosis - using endoscopic ultrasonography, computer and magnetic resonance imaging - makes it possible to identify or exclude peptic ulcer or duodenal ulcer, irritable stomach syndrome, and biopsy - to determine the benign or malignant nature of the pathology.

Treatment of the antral gastritis

When Helicobacter infection is detected, treatment with antral gastritis, like any chronic gastritis of this etiology, is performed with antibiotics. Usually the most effective ones are used: Azithromycin (Azitral, Azicidum, Sumamed) - for 1 day per day, and Clarithromycin (Claricin, Klabakt, Fromilid) twice daily for 500 mg (for two weeks). Of course, these drugs have side effects in the form of the same nausea and vomiting, but you can not get rid of this bacteria without them.

Gastroenterologists prescribed medicines should also:

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

So, the preparation of the group of proton pump inhibitors Omeprazole is prescribed 20 mg once (before breakfast, with plenty of drinking water), the duration of application is a maximum of a month. The drug can cause abdominal pain, dyspepsia, insomnia, anxiety and depression.

Side effects of Ventrisola (De-Nol) and all bis-matt gastroprotective drugs include skin allergies, nausea, and stool disorders. The medicine is taken 30 minutes before each meal - one tablet three times a day, and before bedtime

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

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

Alternative treatment

What remedies for antral gastritis use alternative treatment? Recommended:

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

With increased acidity, it is advised to drink juice from raw potatoes - 100 ml (or 3-4 tablespoons) three times a day (half an hour before meals). Potato juice, which is an alkaline product, can help in neutralizing stomach acid and prevent bloating, spasms, excess gases, etc.

And herbal treatment is carried out:

• infusion of herb plantain, veronica or kipreya (twice a day for half a cup);
• infusions of chamomile flowers or calendula officinalis (1-2 teaspoons of dried flowers a glass of boiling water);
• decoction of dried leaves of strawberries or majestic shining;
• decoction of licorice root naked or elecampane high;
• tea with dried or fresh basil (4-5 leaves per cup);

Read also - Treatment of gastritis with high acidity

[29], [30],

Diet with antral gastritis

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

With exacerbations of the disease and an increased level of acidity of gastric juice, diet No. 1 is prescribed with strict prohibition of roast, fatty, spicy, raw vegetables, sour fruits and berries. Prior to the improvement, beans and mushrooms, fresh bread and pastries, confectionery, chocolate and coffee are also excluded.

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

Compiled by all the rules of therapeutic diet menu options for antral gastritis see - Diet with gastritis, as well as - Diet with atrophic gastritis

[31], [32], [33], [34], [35]

Prevention

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

• reduce the consumption of red meat, bitter pepper, fatty and sweet food;
• take food at regular intervals, the last meal should be two hours before bedtime;
• eat small portions, slowly, well chew food;
• Do not drink water while eating, as this can slow the digestive process;
• regularly drink green tea and plenty of water throughout the day.

[36], [37], [38]

Forecast

An accurate prognosis of the development of gastroenterological diseases is hardly possible, and - given the causes, variety, degree of atrophy of the gastric mucosa, the body's response to treatment - the doctor can assume how antral gastritis behaves in each case.

[39], [40], [41]