Atrophic gastritis – chronic gastritis of type A at which the amount of gastric glands decreases decreases acid-forming function. Atrophic gastritis is a precancer state. It is shown by weight and dull aches in a stomach, nausea, heartburn, the dispepsichesky phenomena, anemia. The most significant methods of diagnostics are: gastroscopy with a fence and histology of bioptat, various researches for definition of existence of a helikobakterny infection. Are less informative a gastrografiya, ultrasonography of abdominal organs. As 90% of atrophies of a stomach are connected with influence of helikobakteriya, specific treatment usually includes an infection eradikation. Also replacement and symptomatic therapy, sanatorium treatment and physical therapy is appointed.
Atrophic gastritis – the chronic progressing inflammation mucous a stomach as a result of which obkladochny glands of a stomach are completely lost happens a gradual atrophy to the subsequent metaplaziya of sites of mucous. The main sign which indicates high probability of cancer is not the type of reorganization of cages, but the area of process – at prevalence of a metaplaziya for 20% of the area mucous a stomach and more probability of development of cancer of nearly 100%. According to modern representations of gastroenterology, chronic atrophic gastritis in 13% of cases comes to an end with development of oncological pathology. In comparison with not atrophic process the probability of such complication at atrophic gastritis is five times higher. The main objective of gastroenterologists is development of new, simple and noninvasive methods of reliable diagnostics of an atrophy, and also early diagnosis of cancer of stomach today. It is noticed that timely diagnostics and a full eradikation of infectious process in five years lead to restoration mucous a stomach and to considerable reduction of the area of a metaplaziya.
Reasons of atrophic gastritis
The main reasons which can lead to development of an atrophy mucous it is long the current helikobakterny infection and autoimmune process at which own antibodies damage G-cells of a stomach (they are the main component of obkladochny glands).
H.pylori causes chronic damage of cages, weakening local protective properties mucous a stomach that as a result allows toxins and free radicals to get freely into fabrics and to damage kernels of cages. In the final of this process of a cage gain properties of several types of fabrics – so-called hybrid cages which have properties of precancer. This process is called an intestinal metaplaziya. In the beginning these sites of mucous take a form of a tonkokishechny epithelium, then tolstokishechny. Than further process of a metaplaziya, subjects a high probability of development of an adenocarcinoma of a stomach came. Today the helikobakterny infection is included in the list of biological carcinogens, without appropriate treatment it leads to stomach cancer sooner or later.
Mechanism of development of autoimmune process a bit different. At the same time in an organism because of violation of immunity antibodies which distinguish own tissues of a stomach as alien begin to be formed. Most often antibodies are developed to G-cages and a factor of Kasl who is responsible for B12 vitamin absorption. Because of it acidity of a stomach gradually decreases, cages are reconstructed and begin to produce slime instead of hydrochloric acid. In a stomach iron and vitamins cease to be soaked up, heavy pernitsiozny anemia develops. If autoimmune gastritis is accompanied by a helikobakterny infection, the precancer state will develop much quicker.
Development of an atrophy of a ferruterous epithelium can be promoted by various associated diseases and states: uncontrolled reception of medicines, alcoholism, stresses and the expressed physical overfatigue, various professional harm, hereditary features of work of a GIT, a serious background illness.
Symptoms of atrophic gastritis
Atrophic gastritis develops slowly, defeat at the same time begins with a stomach bottom, passing to his body, and then and to other mucous. At the beginning of a disease of special symptomatology can not be that complicates diagnostics and disturbs an early initiation of treatment. After development of a full clinical picture in the patient several simptomokompleks can come to light.
The Anemichesky syndrome develops because of violation of absorption of iron and vitamins (especially B12, folic acid) in stomach cavities. It is shown by the expressed weakness, fatigue, drowsiness, constant fatigue (sometimes even usual activity of the patient is broken). Integuments and mucous turn pale. The patient notes constant pains in language, burning, mucous language becomes varnish. Also the patient shows complaints to violations of sensitivity in extremities, usually symmetric. Dry hair and fragile nails are characteristic, short wind at insignificant loadings disturbs, the pricking heartaches.
The Dispepsichesky syndrome is shown by the expressed weight in an epigastriya, more rare the dull aching aches in the top half of a stomach. Pains are connected with stretching of walls of a stomach food masses because of digestion violations. Also the patient is disturbed heartburn (a pelting of sour contents in a gullet), vomiting (a food pelting from a stomach in a mouth), an eructation (an involuntary air outlet from a stomach). These symptoms are followed by nausea, sometimes vomiting after which pain in an epigastriya decreases. In emetic masses – a large number of the eaten food, slime, bile. Appetite is considerably reduced.
Violations of digestion extend to other departments of a GIT – the discomfort in a stomach appears, the chair becomes unstable – locks are replaced by ponosa. In the mornings in a mouth unpleasant smack, disturbs a constant smell from a mouth. Language is laid over by a grayish raid, on it prints of teeth are visible. The broken digestion and a loss of appetite can lead to loss of weight, and in the absence of treatment – to the expressed alimentary dystrophy. Polyhypovitaminosis which leads to considerable decrease in immunity, accession of various infections develops.
Diagnosis of atrophic gastritis
Today more and more attention is paid to early and noninvasive diagnosis of atrophic gastritis. For this purpose gastroenterologists developed the special panel of diagnostics. When carrying out usual gastroscopy to reveal the epithelium dysplasia centers and furthermore it is not possible to determine their area. Because of it often there are mistakes connected as with hyper diagnostics, and hypodiagnostics: the area of a giperplaziya can be estimated incorrectly, and inflammatory changes can be taken for an epithelium metaplaziya. In order that it is correct to estimate the area of the changed epithelium, to take a biopsy from all changed sites, during gastroscopy coloring mucous is made (most often methylene blue) – dye is well perceived by sites with an intestinal metaplaziya.
The special hematologic Biohit panel allows to define quickly and effectively degree of a metaplaziya of an epithelium, an atrophy mucous and obkladochny glands, to avoid diagnostics errors. In this panel the level of a serumal pepsinogen is investigated, the ratio of a pepsinogen 1 to a pepsinogen 2, a histamine 17 is defined. Decrease in these indicators speaks about the expressed atrophy of cages of a ferruterous epithelium, and the low level of a gastrin 17 speaks about death of G-cells of glands of a stomach.
At the same time, increase in level of a gastrin 17 and a pepsinogen 1 often is associated with a helikobakterny infection. Substantial increase of level of a gastrin 17 is most often connected with autoimmune gastritis at which the akhlorgidriya or a gipokhlorgidriya is observed, function of antralny department of a stomach is kept. If in antralny department there are also atrophy centers (a multifocal atrophy), then levels of all these indicators will be low. This panel has not less than 80% of reliability, is used at the initial stages of inspection and allows to decide on gastritis type, its localization and the reason, to reveal a precancer state and to define the correct tactics of treatment.
In comparison with the hematologic panel and an endoscopic research with a biopsy fence, other methods of diagnosis of atrophic gastritis are less informative. So, at a gastrografiya the smoothness of folds mucous is noted and delay of a vermicular movement of a stomach, its sizes are reduced. The same picture is found when performing ultrasonography of a stomach. The intragastric rn-metriya finds decrease in acidity of gastric juice. For specification of the diagnosis it is desirable to take daily measurement of acidity. At suspicion on a malignization it is necessary to carry out MSKT of abdominal organs for an exception of tumoral process. All necessary researches for detection of contamination of H.pylori are also surely conducted: PTsR-diagnostics a helikobakter, the respiratory test, identification in blood of antibodies to a helikobakter.
Treatment of atrophic gastritis
The main objective of the gastroenterologist is the prevention of a further intestinal metaplaziya, cancer transformation. At a timely initiation of treatment of atrophic gastritis in five years there occurs considerable improvement of a condition of an epithelium. The medical diet which at the initial stage includes chemically, thermally and mechanically sparing food is surely appointed. After normalization of a state the use of chemically active products is allowed: the divorced juice (lemon, cabbage, cranberry). Fresh fruit are excluded from a diet, it is possible to eat only bananas. Special requirements are imposed to food – it has to be warm (it is impossible to accept cold and hot products), meals have to be frequent and fractional. It is necessary to exclude alcoholic drinks and smoking.
At detection of a helikobakterny infection an indispensable condition of recovery is the eradikation of the infectious agent. Modern protocols of treatment provide appointment of two - or the three-component scheme including antikhelikobakterny antibiotics, inhibitors of a proton pomp, bismuth medicines. Only full treatment from helikobakteriya can lead to restoration mucous and to decrease in risk of a malignization.
Glucocorticoid hormones at atrophic gastritis are appointed only at development B12-foliyevodefitsitnoy of anemia. Also symptomatic treatment is appointed: replacement therapy by natural gastric juice, enzymes, missing vitamins, iron medicines. For stimulation of secretion of hydrochloric acid it is necessary to drink mineral waters with the high content of salts, broths of herbs (a plantain, a wormwood, fennel), sour juice, solutions of lemon and amber acids. Gastroprotektor (, ), the regeneration stimulators (sea-buckthorn oil) enveloping means on the basis of aluminum and bismuth, medicines for improvement of a vermicular movement are used. The physical therapy is actively applied: an electrophoresis with medicines, electro-and magnetotherapy, thermal procedures on area an epigastriya. Sanatorium treatment out of the period of an aggravation includes therapy by mineral waters in balneological resorts.
Forecast and prevention of atrophic gastritis
The forecast of a disease is worse at patients of age group 50 years are more senior – at this age metaplastic processes develop much quicker and more often lead to a malignization. The early initiation of treatment, and also degree of an eradikation of the infectious agent is of great importance for an absolute recovery. If at repeated inspection after a course of antikhelikobakterny therapy in gastric contents microorganisms are defined, then the course should be repeated.
Prevention of development of atrophic gastritis is early diagnostics and treatment of H.pylori, observance of a day regimen and balanced diet, hygiene of hands for prevention of infection.