Atrophy of the gastric mucosa

Atrophy of the gastric mucosa is a pathological process that develops as a result of inflammation. With atrophy, the functioning cells gradually die out and replace them with scar tissue and then thin them.

Foci of atrophy can be detected with any gastritis, but in the classification of diseases of the stomach, a special form is distinguished - atrophic gastritis, for which such changes are most characteristic. It is important that this disease is a precancerous pathology. Therefore, all patients need medical treatment and supervision.

Characteristics of the process of atrophy

The most frequent localization for atrophy of the gastric mucosa is the lower third of the body or the antral section. One of the main damaging factors is Helicobacterium, which lives closer to the pyloric zone.

At the initial stage, glandular( goblet) cells produce hydrochloric acid even with an excess. Perhaps this process is associated with the stimulating effect of the enzyme system of bacteria.

Then the synthesis of gastric juice is replaced by mucus, the acidity gradually decreases.

By this time, the protective role of the mucous membrane is lost. Any food chemicals can damage the cells lining the stomach from the inside. Toxic products and the remains of broken cells become alien to the body.

An autoimmune mechanism is connected to the destruction process. The damaged cells produce antibodies, which continue to fight against their own epithelium. An important role is played by the blocking of recovery processes.

In a healthy stomach, the epithelial layer is completely renewed every 6 days. Here, old, inoperable cells remain on the ground or they are replaced with connective tissue.

In histology, instead of clear outlines of the epithelium( look at the top edge), the destroyed cells are visible, there are no pear-shaped glands

In any case, the atrophied mucosa can not replace the gastric juice with mucus. There is a gradual thinning of the stomach wall. Practically the organ is excluded from digestion, the production of gastrin is increased. The food lump enters the small intestine unprepared, which leads to the failure of other successive stages.

This is not the end of the process. There comes the most dangerous period of atrophic changes: the epithelium begins to produce similar, but not true cells. Most often they can be attributed to the intestinal. They are not capable of producing a gastric secret. Such a process is called metaplasia and dysplasia( transformation), precedes cancer degeneration.

Atrophic sites on the mucosa can not be completely restored, but with the help of treatment there is still a chance to support the remaining functioning cells, to compensate for the lack of gastric juice and to prevent the violation of the general process of digestion.

Reasons for

The most common causes of the disease are: the effect of Helicobacter pylori and autoimmune factors. Researchers have suggested isolating external( exogenous) and internal( endogenous) damage factors that can cause atrophic changes in the mucosa. Outside are poisonous substances entering the stomach, and eating disorders.

Toxic to the stomach are:

• nicotine, a product of decomposition of tobacco products;
• dust particles of coal, cotton, metals;
• salts of arsenic, lead;
• alcohol-containing liquids;
• drugs from the Aspirin group, sulfonamides, corticosteroids.

Food can turn into exogenous damage factors if:

• a person takes food irregularly, periods of hunger alternate with overeating;
• mainly eat fast food, sharp and greasy dishes, "dry";
• cold or too hot food gets into the stomach( ice cream, tea);
• is not enough chewed food in the mouth with diseases of teeth, gums, poor prosthetics, lack of teeth in old age.

This "workaholic dream" saturates the body, but is not a healthy food.

Internal causes include:

• any disorders of the neuromuscular and endocrine regulation of the secretory cells, resulting in disruption of regeneration processes( stresses, chronic diseases of the nervous system, myxedema, diabetes, violationfunctions of the pituitary and adrenal glands);
• general human diseases that disrupt blood flow in the wall of the stomach and regional vessels( thrombosis, severe atherosclerosis), stagnation in the veins against the background of increased pressure in the portal system;
• cardiac and respiratory failure, accompanied by tissue hypoxia( lack of oxygen);
• deficiency in the body of vitamin B12 and iron;
• hereditary predisposition - is the genetically determined shortage of factors for the restoration of the cellular composition of the mucosa.

Signs of atrophy

Symptoms of atrophy of the gastric mucosa appear late when acidity reaches zero. Young men and middle-aged men are more often ill. The pain syndrome is absent or very weakly expressed, that's why they turn to the doctor in the advanced stage of the process.

Symptoms of atrophy do not differ from the general symptoms of gastric disorders. Patients note the appearance of a feeling of heaviness in the epigastrium immediately after eating, at times nausea, eructation, bloating, loud rumbling, bad breath and unstable stools.

Nausea and dyspeptic disorder - symptoms of pathology

For signs of impaired digestion indicates:

• weight loss;
• symptoms of avitaminosis( dry skin, hair loss, bleeding gums, sores in the mouth, headaches);
• hormonal problems expressed in men in impotence, in women in the disordered menstrual cycle, infertility;
• increased irritability, tearfulness, insomnia.

Diagnosis

Atrophy of the gastric mucosa can only be diagnosed visually. It was previously defined by the physician as a pathologist, a surgeon, and now the widespread use of fibrogastroscopic techniques allows not only to fix the picture in different parts of the stomach, but also to take the material for histological examination, to divide the process into species, the degree of functional disorders.

Histologically, lymphocyte infiltration of cells of the mucous layer, destruction of glandular epithelium, thinning of the wall, folding disorder are revealed. There may be cracks and erosion.

Depending on the size of the affected area,

• focal atrophy of is distinguished; mucosal areas alternate with normal tissue atrophy, this process is most favorable for treatment, because there are still cells capable of taking on compensatory function;
• diffuse is a heavy and widespread process, it seizes the entire antral section and rises to the cardia, almost all cells are affected, instead of the mucous layer, there is a continuous fibrosis.

By the number of lost and remaining healthy cells, the degrees of atrophic changes are distinguished:

• is mild-10% of cells do not function, but 90% work correctly;
• average - atrophy captures up to 20% of the area of ​​the gastric mucosa;
• severe - more than 20% of the epithelium is replaced with scar tissue, transformed cells appear.

Subatrophy shows a shortening of the epithelial layer of the

. Depending on the severity of the atrophic process, histological changes are assessed as:

• weakly expressed changes or subatrophy - the size of glandular cells decreases, their small shortening is determined, additional glandulocytes appear in the cells( formations where the secret is synthesized), some are replaced by mucous( mucoid);
• moderate atrophy - more than half of the glandular cells are replaced by mucus, sclerosis is visible, the residual part of the normal epithelium is surrounded by an infiltrate;
• pronounced disorders - very few normal glandular cells, extensive areas of sclerosis are prominent, infiltration of different kinds of inflammatory epithelium is observed, intestinal metaplasia is possible.

In the diagnosis of pathology it is not sufficient to establish that the gastric mucosa is atrophic, in order to try to suspend the process the physician needs to know the cause of the changes, the degree of impairment of the organ function.

For this purpose, the following tests are carried out for the patient: detection of antibodies to Helicobacteria and Kastla factor( parietal cell components) in the blood, determination of the ratio of pepsinogen I, pepsinogen II( protein components for the production of hydrochloric acid), the method is considered an atrophy marker,undamaged epithelial gland.

It is also necessary to study gastrin 17, a substance of the hormonal type responsible for endocrine regulation of the secretion of epithelial cells, their recovery and motility of the muscular tissue of the stomach and daily pH-metry to determine the nature of acid formation.

What kinds of gastritis develop on the basis of atrophy of the epithelium?

Depending on the degree of development, the localization of the inflammation in the stomach during mucosal atrophy, it is common to distinguish several varieties of gastritis.

Superficial

The easiest form of the disease. The acidity of the gastric juice is almost normal. There is an abundant secretion of mucus glands, so protection remains. When histology shows the phenomenon of dystrophy.

Focal

Acidity is maintained by healthy epithelial sites. On the mucous the alternation of sites of atrophy and sclerosis with a healthy tissue is seen. Symptoms often include intolerance to milk and eggs. This indicates the role of impaired immunity.

Diffuse

The surface of the stomach is covered with overgrowth of immature cells, pits and ridges, the structure of the glandular mucosa is disturbed.

Atrophied mucosa has a grayish color, the clusters of vessels are visible.

Erosive

In the atrophy zone, there is a disturbance of blood circulation, which gives a pattern of spotted hemorrhages, accumulation of blood vessels. The course is severe with gastric bleeding. More often observed in alcoholics, people who have had respiratory infection.

Antral

Named for the predominant localization of the lesion. It differs by cicatricial changes in the antral zone, narrowing of the pyloric section, a tendency to transition to the ulcerative process.

Treatment of

The problem of how to treat atrophy of the mucosa depends on the prevailing aggressive action, the revealed cause of the process, the residual ability to repair( repair).Given the absence of severe symptoms, patients are often treated as outpatients. The mandatory recommendations include: diet and diet.

It is not recommended to engage in heavy sports, it is necessary to reduce physical activity to moderate. It is required to stop smoking and drinking alcoholic beverages, including beer. It is forbidden to arbitrarily take any medications, including headaches and flu.

Requirements for the

diet The patient's diet provides for the selection of foods that do not damage and do not irritate the gastric mucosa. Therefore, categorically forbidden:

• fried, smoked, salted and pickled dishes;
• strong tea, coffee, carbonated water;
• ice cream, whole milk;
• confectionery, fresh pastries;
• spices, sauces, canned food;
• beans.

The patient is recommended to maintain food in frequent small portions. Use stewed, boiled, steam, baked dishes. In case of pain for a few days, it is advised to switch to semi-liquid mashed food( meatballs, low-fat broths, oatmeal on water, jelly).

If the pain does not play a serious role in the clinic, then the food should be varied, taking into account the above limitations. Allowed:

• sour-milk products( low-fat sour cream, kefir, cottage cheese);
• omelet from eggs;
• stewed vegetables;
• of cereals most shown rice, buckwheat, oatmeal;
• fruit juice is best diluted with water.

The patient should consult a doctor about mineral water, as the choice depends on the acidity of the gastric juice, and it can be different during the atrophy process.

Drug therapy

To restore the gastric mucosa, it is necessary to get rid of the harmful effects of Helicobacterium in its presence and block the possible autoimmune process. To combat bacterial infection, a course of eradication is used.

A combination of tetracycline and penicillin antibiotics with Metronidazole( Trichopolum) is prescribed. The course and dosage are chosen by the doctor individually.

Good results are accompanied by treatment with the drug De-Nol( base - bismuth citrate)

To confirm the effectiveness of control studies on Helicobacter pylori. In the initial stage of atrophy, when acidity can be increased, proton pump inhibitors are recommended. They suppress the mechanism of production of hydrochloric acid.

The group includes:

• Omeprazole,
• Esomeprazole,
• Rabeprazole,
• Ranitidine.

These medications are contraindicated when hypo- and anacidic conditions occur. Assigns with the purpose of replacing its own secretion of Acidin-pepsin, gastric juice. It stimulates the regeneration process of Solcoseryl, Aloe in injections. Support and improve the motor function of the stomach can Domperidone, prokinetics.

Preparations based on bismuth and aluminum( Vikalin, Kaolin, bismuth nitrate) provide protection of the mucous membrane from chemicals and bacteria from food products. If in the course of diagnosis the fact of an autoimmune mood of the body becomes apparent, the patient is given corticosteroid hormones to suppress an excessive immune reaction.

With a severe degree of atrophy to pathology, a violation of enzyme production by all organs involved in digestion is added. Therefore, enzymatic agents may be required: Panzinorm, Festal, Creon.

For the time being, the fibrogastroscopic method is the only way for the patient to confirm the diagnosis of atrophy

. The folk and phyto-drugs

. The folk method of treatment should be approached with caution in view of acidity. With a normal secreting function, you can take broths of chamomile, calendula.

With reduced - to stimulate acid formation show broth of wild rose, diluted juices of tomatoes, lemon, potatoes. In the pharmacy it is possible to purchase collections of herbs with plantain, thyme, wormwood, St. John's Wort. It is convenient to use Plantago Glucose phytopreparation. It consists of a granular plantain extract, before being diluted in warm water.

The most significant problem of modern medicine is the identification of patients and the prevention of cancer degeneration. It is difficult to organize fibrogastroscopic examinations of patients, if they are of little concern. Much more closely to preventive maintenance include members of a family in which the unique case of an atrophic gastritis is revealed and there are lethal outcomes from a cancer of a stomach.

Such patients should go through fibrogastroscopy once a year, follow a diet, stop smoking and taking alcohol. No one can be sure of the difficulties that these people will have to overcome in life, and how their stomach will suffer a genetic predisposition.