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Causes, symptoms, treatment of atrophic gastritis

The content of the article:

Atrophic gastritis is the most insidious type of chronic gastritis is likely to cause precancerous conditions of the stomach. Often develops in men of middle and old age. In the opening stages of inflammation are asymptomatic. With the depletion of compensatory mechanisms does not always have a bright clinical picture.


What is atrophic gastritis?

The lack of striking symptoms in the first stage of the pathogenesis is not a good sign. On the contrary, people who are not experiencing obvious discomfort, does not give value problem. In vain. Will try to simplistically explain the insidiousness of this disease.

The key word in the name of the disease – atrophy. This means that the cells of the stomach wall entering into the composition of the secretory glands, in the course of the disease undergo atrophic degeneration, that is, lose their ability to function normally, do not produce the components of gastric juice. It is proved that in the first place glands transformirovalsya more education, producing slime instead of gastric juice. Atrophic gastritis usually occurs on the background of lowered acidity of a stomach.

However, the main danger of atrophic gastritis is not associated with changes in gastric acidity, since the pH level is correctable. A friend in danger. Atrophic gastritis is widely recognized by the medical community of the status of the provoker of gastric cancer in humans.

So, in order. All cells of the body, including the cells of the walls of the stomach are in every moment of cooperation with the organism. This means that regeneration, the emergence, morphological and functional differentiation, functional load, the natural death of cells and their subsequent updating are influenced by hormonal, immune, enzymatic and other yet unknown regulating factors. So far nobody has been able to reliably and dramatically change the properties of the Mature cells of the body. Normal all cells of the body have strict specialization is an axiom of modern biological science.

The pathogenesis of atrophic gastritis

Simplify the problem, describe the pathogenesis as a two-step process. Agree that at the first stage of pathogenesisthe leading role played by acid-fast bacteria, and the second – autoimmune processes in the body.

Many forms of gastritis the glands inner walls of the stomach are attacked by the bacteria Helicobacter pylori, which damages them and locally change the pH environment of the stomach wall. Bacteria are normal inhabitants of the acidic environment of the stomach. They only pave the way, open the gates for the development of atrophic gastritis by any other type of inflammation.

In the second stage of atrophic gastritis in the pathogenesis involves complex autoimmune processes that affect the immature forms of the cells of the glands, inhibit their subsequent specialization. The mechanism of the origin and occurrence of autoimmune reactions is of interest for scientists, but in this text, their disclosure does not matter.

The suppression specialization of cells – the key words in the pathogenesis of this form of inflammation. This means that the cells of the glands of the stomach wall under the action of autoimmune reactions atrophy, cease to perform complex work on the development of the components of gastric juice.

Is violated physiological process of regeneration of the glandular cells of the stomach. Regeneration means that the normal place exhausted their resource of life glandular cells occupy new cells, with similar properties. In a healthy organism, a complete renewal of the cells of the mucous membranes of the stomach occurs every six days.

As a result of violations of regeneration of glandular cells instead of hydrochloric acid begin to develop a more simple product – mucus. This mucus has protective properties, but little is involved in digestion. Therefore, the stomach wall, abundantly covered with mucus, under normal endoscopic examinations have the form of healthy tissue. Environment of the stomach from the acidic to slightly transformered up to ahilii.

In the future, under the influence of the cascade of autoimmune reactions to damaged cells start to develop in large numbers similar to themselves immature cells that are unable to develop and ultimately lost the ability to acquire secretory specialization. In this case it is a pathological regeneration. Conventionally, these immature cells can be called a currently fashionable term – stem cells.

Stem cells are available from any healthy person, but in a normally functioning body they invariably become strictly specified evolutionary memory properties, and are converted into Mature cells: stomach, intestines, heart, lungs, other organs and tissues, and perform only specific for each type of cell functions.

If scientists learn guaranteed to manage stem cells – it will mean a revolution, and will allowhumanity embark on the path individually adjustable a lifetime. You can grow any organ or tissue, and thereby change the metabolism, hormones and so on. While the work to control stem cells is at an early stage of scientific study and practical application of this technique is a guaranteed risk. But back to the topic of atrophic gastritis.

The body has multi-layered protection from damaging influences, therefore, even in conditions of atrophic gastritis do not always develop cancer. More than right here to speak about pre-cancerous condition.

It is believed that the atrophy of the cells of the gastric wall can't be completely cured. However, the correct drug exposure, adherence to diet, exclusion from the diet of certain foods significantly reduce the risk of cancer processes. Regarding diagnosis, prevention of atrophic gastritis and possible risk of cancer processes should consult with your doctor.

On fatal coincidence of circumstances, there is a strong external and/or internal effects provoked by the explosive growing exponentially, the growth of new (stem) cells of the stomach wall.

These cells do not bear the functional load, good for the body, on the contrary – they destroy it. The only function of imperfect cells that do not have cooperative ties with the body is permanent, not adjustable the body's reproduction of their own kind of pathological (cancer) cells and a negative impact on the body by products of metabolism.

It should be recalled that the above-described pathogenesis is a simplified idea about the true pathogenesis of atrophic gastritis. In the text there is no mention of serious morphological damage of the gastric glands, changes in hormone, vitamin and other types of exchanges, the influence of autoimmune processes on the development of pathogenesis and the influence of degenerative processes in the pathogenesis. There is no mention about more or less the effect of some strains of acid-fast bacilli and duodenogastric reflux in chronic gastritis. In the schematic, summarized this view about the transformation of atrophic gastritis to precancerous condition.


Symptoms of atrophic gastritis

The absolute most serious researchers indicates the absence of any significant symptoms of atrophic gastritis at the first stage of pathogenesis. Many seenthe absence of atrophic gastritis vivid pain syndrome, characteristic of hyperacid gastritis. No pain at all stages of atrophic gastritis.

To often-mentioned symptoms at the stage of exhaustion of compensatory mechanisms of the body include features that are common to all types of gastritis. On clinical examination, patients complain of a feeling of heaviness in the solar plexus after eating, regardless of its volume.

Also complain of the following signs of gastrointestinal pathology:

To symptoms not directly associated with disorders of the gastrointestinal tract, include:

  • reduction of body weight;

  • hypovitaminosis (a clear decline in levels of cyanocobalamin (vitamin b12), manifested in the form of anemia, ulcerations in the mucosa of the mouth, tingling tongue, headaches, yellowness of the skin);

  • violation hormonal metabolism (gipokortitsizm, decreased libido)

However, the main symptoms of atrophic gastritis detected in laboratory, functional and instrumental studies.

I should say that ultrasound, radiography, CT of the abdomen without contrast agents, MRI does not provide exhaustive information about the disease. The greatest diagnostic value is endoscopic, gastroscopy and its variants, for example, chromovitrectomy. This method of study of the stomach wall after pre-painting the surface.

With the help of the gastroscope see the thinning and flattening of the walls. Well observed the vessels of the gastric walls (OK they are not visible). Research of biopsy material of the walls reveals the degeneration and atrophy of the gastric glands. Valuable is the method of intragastric pH. Almost always detected the change in the pH environment of the stomach in the direction of neutral reaction, until ahilii. In the list of required methods for diagnosis of atrophic gastritis is the study of the microflora of the stomach. Many experts believe that the routine identification of bacteria Helicobacter pylori informative diagnostic method.

Topic: prevention of gastritis

The most convenient, promising, non-invasive (gentle) method of blood examination on the statethe functional activity of the stomach – gastropanel.

Gastropanel is a method of blood examination, which is based on identifying:

  • Antibodies to Helicobacter pylori;
  • Pepsinogen I protein responsible for the production of HCL;
  • 17 gastrin – the hormone that regulates the secretion of hydrochloric acid, the regeneration and strengthens the walls.

It is believed that the gastropanel should be used in combination with histological studies of cells of the stomach wall. Comparison of their results provides valuable diagnostic information.


The types of atrophic gastritis

In-depth laboratory, instrumental and other studies are valuable in determining the types of atrophic gastritis, depending on the localization of the pathogenesis and nature of the damage. Studies are valuable for identifying and differentiating various pathological masses in the stomach, stages and forms of inflammation.

Acute atrophic gastritis

In this case we should speak about the acute stage of chronic atrophic inflammation of the stomach wall. Some sources call this state of active gastritis. The symptoms resemble the symptoms of acute superficial inflammation of the stomach.

Laboratory and instrumental methods establish the following characteristic signs of acute atrophic gastritis:

  • swelling walls of the body;
  • plethora of vessels of the walls;
  • infiltration of white blood cells outside of blood vessels;
  • destruction of the surface epithelium, rarely erosions in the mucosa.

In some cases atrophy of the cells of the glandular tissue is influenced by external emergency factors, strong acids, alkalis, chemical poisons, and so forth. Diagnostics and therapy of acute toxic atrophy of the glandular tissue of the stomach is conducted not by gastroenterologists, doctors specializing in toxicology, addiction medicine, and surgery.

Symptoms of acute atrophic gastritis varied: severe pain, vomiting, diarrhea, a fever, disorders of consciousness, fainting, coma. Other specific symptoms characteristic of each particular pathological process. Effect on mucous membranes strong pathogens often ends with the death of the patient due to General intoxication of the body, the heart stops or breathing.

Chronic atrophic gastritis

Is an independent disease, and nottransformation of acute gastritis. Sometimes this state is called inactive gastritis or gastritis in remission. Characterized by long flowing, progressive atrophy of the cells of the glandular tissue, with predominance of dystrophic processes over inflammatory. Pathogenesis leads to a change in the secretory, motor and suction functions. In the chronic form of atrophic gastritis in the pathogenesis involved is anatomically related to the stomach organs: duodenum, esophagus, and organs associated with the stomach functionally: the liver, pancreas, endocrine glands. Because of General intoxication in the pathogenesis involved in the process of hematopoiesis and nervous system.

Pathogenesis usually develops on the background of low acidity of gastric juice. Clinical symptoms are consistent with gastritis with low acidity.

The diagnosis of acute and chronic gastritis is based on the data of differential diagnosis. The survey is conducted using an instrumental, functional and laboratory methods. Especially valuable are the endoscopy and its variations, pH-metry and histological methods of study biopsy, laboratory blood – gastropanel.

During diagnostic studies of chronic atrophic gastritis manifested by the following features:

  • normal or thinned wall of the body;
  • flattened mucosa;
  • wide gastric dimples;
  • the flattening of the epithelium;
  • low secretory activity of the glands;
  • moderate infiltration of leucocytes outside the vessels;
  • degeneration (vacuolization) cells glands.

Patchy atrophic gastritis

Characterized by the appearance of foci of pathologically changed tissue of the stomach wall. Acute focal gastritis in some cases is on the backdrop of increased acidity of gastric juice. Probably, the areas not involved in the pathogenesis of glandular tissue compensates for the function of the damaged foci with increased secretion of hydrochloric acid. The rest of the symptoms do not differ from the usual symptoms of gastritis.

Subclinical course of focal atrophic gastritis is manifested by intolerance of separate products it usually dishes based on milk, fat, meat, eggs. After eating heartburn, nausea, sometimes vomiting. The differential diagnosis is based onlaboratory and instrumental studies.

Moderate atrophic gastritis

The degree of involvement of the glandular tissue in degenerative and atrophic processes sometimes in clinical practice there are a modest form of inflammation. The designation is conditional and implies a light, a partial form of pathological cell transformation of gastric walls.

Moderate atrophic gastritis only detected at histological examination of the glandular cells. In doing so, a determination of the number of damaged cells per unit area of the gastric mucosa, as well as assess the depth of microstructural changes and degeneration of the glandular tissue, which is the criterion for determining this disease.

The clinical symptoms correspond to ordinary dyspeptic disorders. The pain characteristic of acute forms of gastritis are not always fully manifested in this disease. Often patients complain of discomfort in the epigastrium that occurs after a meal. Pain possible only when drinking is heavy (acute, salty, smoked, marinated or fatty) food.

Superficial atrophic gastritis

In accordance with the work classification is the precursor to atrophic inflammation of the stomach. This is the early stage chronic inflammation. Damage is minimal, the clinical symptoms are not expressed. Differential diagnosis is only possible with the help of endoscopy. A detailed study of a set:

  • the normal thickness of the stomach wall;
  • moderate degeneration of the surface epithelium;
  • slight hypersecretion of the cells.

Antral atrophic gastritis

Antral Department is located in the lower part of the stomach closest to the exit of the body and adjacent to the duodenum. The disease is characterized by scarring of the antrum. Visually, the division looks like a tube with thickened walls. Seal and strain is called rigidity. This form of gastritis is characterized by moderate to severe clinical signs of dyspepsia – dull pain in the solar plexus as well:

  • nausea in the morning;
  • belching after eating;
  • decreased appetite;
  • reduction of body weight;
  • General weakness.

When measuring the pH of a normal rare set, its value is often reduced in the slightly acidic side. Instrumental examination of the mucous membranes identify the deformation expressed macroscopic changes on the inner walls of the body, reducing motility of the walls due to their rigidity. Macroscopic changes oftendiagnosed as a nodule on the mucosa. In the antrum of the stomach is often diagnosed ulcerative processes.

Diffuse atrophic gastritis

Means the absence of major degenerative changes. This form of inflammation – an intermediate, transitional stage between the surface and degenerative damage to the walls. The main symptom of diffuse gastritis is the presence of local foci of degeneration of the glands of the stomach walls, as well as immature cells with signs of violation of the secretory activity.

Other signs of diffuse atrophic gastritis:

  • rollers on the walls of the stomach;
  • advanced gastric pits;
  • microstructural damage to the cells of the glands.
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Treatment of atrophic gastritis

Due to the diversity of microstructural manifestations of atrophic gastritis and mean of clinical symptoms there is no single approach to the treatment of this disease. It is recognized that the formed atrophic process are not correctable. That is, the degenerated cells cannot be transformed back to ferrous.

Meanwhile, proposed and there are effective schemes of medical treatment of atrophic gastritis in different forms and at different stages, preventing further development of pathogenesis.

All medical schemes are based on the in-depth study of the body. This is very important, as different data requires different therapeutic approaches. In this article we will not hold the concretization of medical techniques. Let it do the attending physician, based on specific conditions, condition of the patient involved in the pathogenesis of various links of the chain.

Meanwhile, the traditional scheme of treatment of atrophic gastritis includes:

  1. Eradicate Helicobacter pylori if acid-fast bacteria have a significant impact on pathogenesis. Methods of eradication of Helicobacter pylori are constantly improving.

    The problem of eradication:

    • suppression of bacterial growth andprevention of the formation of their resistance to antibiotics;
    • the use of proton pump inhibitors with the aim of improving well-being;
    • reduction of duration of treatment;
    • the reduction in the number of drugs, which significantly reduces the number of side effects from treatment;

    Usually used three - and four-component schemes of eradication:

    • As a means of suppressing the activity of bacteria, use of antibiotics (tetratziklinovogo, penicillin), as well as antibacterial drug metronidazole (Trihopol). The dosage and frequency indicated by the doctor.
    • As proton pump inhibitors use the drugs Omeprazole, Lansoprazole, Esomeprazole, Rabeprazole, Pantoprazole, Ranitidine, bismuth citrate and other.

  2. To influence the development of autoimmune processes in atrophic gastritis has not yet learned fully. The use of hormonal drugs and other immunomodulators in most cases not justified.

  3. Pathogenetic therapy of atrophic gastritis involves a complex use of drugs of different groups, among them:

    • aid gastric digestion – preparations of hydrochloric acid and gastric enzymes.

    • in States of deficiency of vitamin B12 use the appropriate vitamins in the form of parenteral injection.

    • means affecting the production of hydrochloric acid in the form of mineral waters (Essentuki 4,17, etc.). Although they are not drugs, but in some cases show high therapeutic activity.

    • a means of reducing inflammation – the juice of plantain or granular pharmaceutical preparation from plantain (Plantasia).

    • In recent years more widely applied in the treatment of gastrointestinal inflammation Riboxin. This drug has properties that are useful in the treatment of atrophic gastritis.
    • to protect the mucosa used drugs of bismuth or aluminum (Bismuth nitrate basic, Vikalin, Vikair, or Rother, Kaolin) .
    • means of regulating motor function of the stomach. Among the drugs in this pharmacological group most often used Domperidone and Cisapride.

All the above drugs are prescribed during the active phase of inflammation of the stomach with symptoms of atrophy. During remission the main principle of treatment is the restoration of themissing for full digestion of nutrients.

On topic: the list of effective products and tools for gastritis


Diet for atrophic gastritis

Diet is an integral part of the treatment of all types of gastritis. Treatment of atrophic gastritis (AG) is associated with some difficulties in the organization of supply. Depending on the tasks of therapy, the recommended four types of diets developed by a physician dietitian M. I. Pevzner.

  1. Baseline in atrophic gastritis is a diet № 2. It involves good nutrition of the patient and the stimulation of functional glands. Recommended dishes must uvarivaetsja, easy to fry, to stew, to bake. Do not apply cold foods with a rough texture. The diet allows eating a variety of meat and fish. Allowed dairy, flour products, eggs, hard boiled and scrambled eggs. Widely used vegetables and fruits. Only allowed more than thirty kinds of different products, allowing to organize high-quality and diverse food.

  2. When expressed pain syndrome prescribe a different diet. It is designated No. 1A and is appointed in the first days of the disease. This version of the diet provides a minimum load on the digestion. The objective of the diet is to reduce the reflex excitability of the gastric mucosa. Excluded from the diet products, having a stimulating effect on the receptors of the stomach. Food is allowed only in the form of liquid or puree, steamed, boiled, mashed. The diet consists of nine main recommended dishes, mostly soups. Allowed dairy products, provided good endurance – whole milk, cream, cheese.

  3. Diet No. 1 is assigned after subsiding of the symptoms of inflammation. It is used to accelerate the recovery process of the inflamed mucous membrane of the stomach. This diet helps to normalize the secretory and motor functions of the stomach. Exclude from the menu of hot and chilled meals. Not recommended foods rich in fiber. The list diet consists of about eleven kinds of dishes.

  4. A diet number 4 appointed in severe enteric syndrome, when the individual intolerance of milk and other products. The objective of this diet to normalize the functioning of the stomach by reducing the inflammatoryphenomena in the mucosa of the stomach. The mode power fraction. After calming down inflammation always come back to full power. In atrophic gastritis it diet number two.

Read more about diet: what you can and can't eat for gastritis?


orshenin Elena Ivanovna, doctor-gastroenterologist