Chronic atrophic gastritis
Chronic atrophic gastritis – the disease which is characterized by an atrophy of gastric glands, regeneration of an epithelium of a stomach in intestinal, moderately expressed inflammatory process. Manifestations depend on localization and an etiology of atrophic processes: generally it is weight in a stomach after food, bystry saturability, an eructation, nausea, unpleasant taste in a mouth, anemia. The gold standard of diagnostics - EGDS with a biopsy mucous, an intragastric rn-metriya, H.pylori identification; other methods are auxiliary. Treatment consists in introduction of glucocorticoid hormones, natural gastric juice, B12 vitamin, application of the antikhelikobakterny scheme of therapy.
Chronic atrophic gastritis
Chronic atrophic gastritis – the diagnosis morphological for which verification results of EGDS are obligatory. Clinical displays of this pathology not always correspond to the changes revealed when carrying out a biopsy. Chronic atrophic gastritis can develop as at late stages of helikobakterny gastritis (because of a long persistention of an infection there is a gradual death of a significant amount of gastric glands), and as a result of autoimmune violations in an organism (antibodies to epitelialny cells of a stomach cause their death, the akhlorgidriya gradually develops). H.pylori comes to light more than at 80% of the population of Russia, at the same time the chronic inflammation mucous a stomach is found approximately in 50%. Autoimmune gastritis is diagnosed for women three times more often than at men, however is rather rare disease. Researches in the field of gastroenterology confirm that incidence of chronic gastritis increases by 1,5% annually.
Reasons of chronic atrophic gastritis
The infection of H.pylori and autoimmune processes are the most significant reasons of chronic atrophic gastritis. The atrophy of an epithelium of a stomach develops at late stages of the chronic helikobakter-associated gastritis. Bacteria at first colonize mucous antralny department, causing the chronic inflammatory answer; further, in process of progressing of an infection, process extends at first to a stomach body, and then and to its other departments, initiating pan-gastritis. At this stage atrophic changes of mucous are already accurately visualized, chronic atrophic gastritis is formed. Usually at this stage of a helikobakteriya cease to come to light as gastric glands atrophy, there is a replacement of a gastric epithelium on intestinal to which H.pylori has no tropnost.
At autoimmune gastritis defeat of the main glands of a stomach is observed at the beginning of a disease. The diffusion atrophy of an epithelium of a stomach very quickly progresses that is connected with development autoantitet to mikrosomalny anti-genes of parietal cages, gastrinsvyazyvayushchy proteins, an internal factor. Antibodies are directly involved in destruction of epitelialny cells of a stomach. The reason of education autoantitet today it is not defined, but gastroenterologists do not exclude hereditary predisposition to chronic atrophic gastritis. It is known that for start of autoimmune process in a stomach epithelium the caption of antibodies has to reach a certain critical figure, individual for each person. Various endogenous and exogenous provocative factors can influence the speed of this process.
Carry to endogenous factors: genetic features, a duodeno-gastralny reflux, endointoxication, oxygen starvation, chronic infections, exchange and endocrine violations, a lack of vitamins (hypovitaminosis), visceral reflex reactions at pathology of other bodies. Exogenous factors include violations of food, addictions (alcohol, smoking), reception of some medicines, impact of ionizing radiation, infectious agents (bacteria, mushrooms, parasites).
Symptoms of chronic atrophic gastritis
Both local, and general manifestations are characteristic of chronic atrophic gastritis. Some symptoms depend on a disease etiology (the HP associated or autoimmune type) and localizations of inflammatory process.
At bacterial genesis of chronic atrophic gastritis with localization in antralny department patients show complaints to weight in a stomach in time or right after food. If chronic gastritis it is long proceeded as giperatsidny, dispepsichesky violations can disturb the patient: diarrhea or locks, the raised meteorizm, abdominal murmur. Autoimmune gastritis is characterized by a tetrad of signs: autoimmune process, existence in blood of antibodies to obkladochny cells of a stomach, B12-foliyevodefitsitnaya anemia, an akhlorgidriya. At any kind of chronic atrophic gastritis pains in an epigastriya in time or after food, nausea, an unpleasant smell and smack in a mouth, an eructation and vomiting, burning in subspoon area or heartburn disturb.
The general manifestations are expressed by weakness, irritability, tendency to arterial hypotonia, the pricking heartaches. Dumping syndrome is characteristic of chronic atrophic gastritis: after food there is a sharp weakness, pallor of skin, perspiration, drowsiness, a hiccups, an unstable chair.
At autoimmune gastritis of an antibody strike not only cells of a stomach, but also the internal factor of Kasl participating in B12 vitamin metabolism. As a result of it the pernitsiozny anemia which is shown burning in language, symmetric paresteziya in hands and legs, fatigue, drowsiness, a depression develops. Besides B12-scarce anemia, chronic autoimmune gastritis can be complicated by stomach ulcer of a stomach and DPK, an akhlorgidriya, stomach cancer.
Diagnosis of chronic atrophic gastritis
At suspicion of chronic gastritis the patient without fail needs consultation of the gastroenterologist and endoscopist. On primary reception a number of analyses and researches is appointed: the general blood test, the analysis a calla on the hidden blood, EGDS, an intragastric rn-metriya. After obtaining results repeated consultation of the gastroenterologist on which usually and the diagnosis of chronic atrophic gastritis is exposed is held.
The analysis a calla on the hidden blood can be positive in the presence of ulcerations in mucous a stomach. Researches for the purpose of H.pylori detection are without fail conducted: definition a helikobakter in Calais by IFA method, PTsR-diagnostics, definition of antibodies to a helikobakter in blood, the ureazny respiratory test. Ezofagogastroduodenoskopiya allows to reveal an atrophy of a mucous membrane of a stomach. For confirmation of visual changes the endoscopic biopsy with a morphological research of bioptat is carried out. To determine the level of secretion of gastric juice, the intragastric rn-metriya is carried out. Ultrasonography of abdominal organs is used only for differential diagnostics and detection of the accompanying pathology.
Treatment of chronic atrophic gastritis
Before an initiation of treatment it is recommended to refuse addictions (smoking, alcohol intake). The diet is not the main method of therapy of chronic atrophic gastritis. Drug treatment is planned depending on a disease etiology (helikobakterny or autoimmune gastritis).
At the chronic atrophic gastritis which is followed by heavy autoimmune violations purpose of short rates of glucocorticoid hormones in low doses is shown. After stabilization of process and regress of clinical manifestations treatment stops. If sekretorny function of a stomach was not restored, appoint natural gastric juice, pro-kinetics, pancreas enzymes. Correction of B12-scarce anemia is carried out.
Treatment of the helikobakter-associated chronic atrophic gastritis standard: inhibitors of a proton pomp in combination with antibacterial medicines (, amoxicillin, furasolidone, metronidazole, ), bismuth medicines. Use of medicines of bismuth instead of IPP is shown to patients with the lowered sekretorny function of a stomach. After 1,5-2 months of antikhelikobakterny therapy it is necessary to conduct a repeated research on H.pylori. If the eradikation of the activator did not occur, then its sensitivity to antibiotics is defined, and further treatment is carried out according to the received results. Symptomatic therapy includes the medicines interfering a duodeno-gastralny reflux (urodezoksikholevy acid), a meteorizm, the replacing fermental therapy.
Forecast and prevention of chronic atrophic gastritis
The forecast at chronic atrophic gastritis depends on many factors: degrees of an obsemeneniye of H.pylori and an atrophy mucous, etc. Helikobakternaya the infection is an initial link of pathological process which in the future can lead to stomach cancer. At the initial stages the atrophy mucous can be prevented or stopped, at this stage most of patients asks for medical care. Considerably H.pylori eradikation before an atrophy mucous a stomach, and also a timely initiation of treatment of pernitsiozny anemia allows to improve the forecast. At a stage of an intestinal metaplaziya risk of a malignization extremely high.
Prevention of chronic atrophic gastritis consists in timely identification and treatment of an infection of H.pylori, elimination of other risk factors of this disease.