Gastritis of the antrum of the stomach

Antral gastritis is a member of the group of chronic inflammations of the stomach. Has features of localization and clinical course. Requires a special approach in the appointment of therapy. Numerous studies have shown that in 95% of cases the cause of antral gastritis is Helicobacter.

According to the International Classification this type of inflammation has several names:

• is non-atrophic,
• is hypersecretory,
• is superficial,
• is type B,
• is diffuse,
• is interstitial,
• is associated with Hp( Helicobacter pylori).

All names in one form or another reflect the features of the forms and clinical signs of the disease. Scientists tend to believe that antral gastritis should be considered the initial stage of all other varieties of the disease.

A little anatomy

From anatomy it is known that in the stomach are distinguished:

• the upper part( cardiac and bottom) connecting with the esophagus;
• average( body);
• lower, bordering the duodenum( pylorus or pyloric department).

Features of the structure of the stomach

In the lower part there are:

• antrum adjacent to the body( 1/3 of the total stomach mass);
• is a small pyloric canal of a pylorus with a sphincter.

The antrum department performs the following functions:

• crushing the food lump to pieces of 2 mm;
• stirring the gruel from the accepted meal;
• pushing towards the gatekeeper;
• partial neutralization of hydrochloric acid of gastric juice to prepare for digestion in the duodenum;
• production of glandular endocrine cells gastrin( hormone informant about the presence of food in the stomach), serotonin( stimulator of the muscular apparatus of the organ), somatostatin( suppresses the secretion of enzymes if necessary).

Why does inflammation develop in the stomach?

The main cause of antral gastritis is Helicobacter. There are 9 species of this microorganism. It differs from others in the possibility of living in an acidic environment, the ability to actively move in the gel-like mucus of the stomach.

Helicobacterium provides its own protection by producing enzymes:

• urease,
• alkaline phosphatase,
• glucophosphatase,
• protease,
• mucinase,
• phospholipase,
• superoxide dismutase.

In addition, it synthesizes a protein that suppresses the production of hydrochloric acid by the glands of the stomach. For some time a person becomes an asymptomatic carrier of the pathogen, a reservoir of infection. Infection is transmitted through water, dirty hands, insufficiently processed endoscopic instruments, with saliva when kissing.

Intruding into the wall of the Helicobacterial epithelium, it is fixed in it and turns into inaccessible to the mechanical and chemical factors of the gastric juice

. What factors contribute to gastritis?

In addition to Helicobacter pylori, possible causes of digestive disorders and subsequent inflammation in the stomach, may be:

• a power failure( alternation of a long period of fasting with overeating);
• low quality of consumed products( lack of vitamins, protein);
• passion for sharp and greasy dishes, fast food;
• alcohol intake;
• smoking;
• long-term treatment with drugs that irritate the stomach wall( anti-tuberculosis drugs, Aspirin group, steroid hormones, non-steroidal anti-inflammatory drugs);
• stressful situations, hard work;
• availability of food allergies;
• hereditary predisposition in the family.

Fast food is not considered a healthy food

More often signs of antral gastritis develop in people suffering:

• with endocrine system diseases;
• pathology of the respiratory and heart;
• with iron deficiency states;
• kidney disease.

Foci of chronic infection in the oral cavity( carious teeth), nasopharynx( chronic sinusitis, tonsillitis), in the genital organs reduce the human immunity and allow the Helicobacter to manifest its pathogenic properties.

The presence of dysfunction of the digestive system, manifested in gastroduodenal reflux( throwing of contents from the duodenum into the stomach), additionally affects the nearby parts of the stomach. Accordingly, the spread of infection beyond the sphincter of the pylorus to the initial part of the intestine causes bulbitt of the duodenum.

How does gastritis develop?

With antral gastritis, the inflammatory reaction develops according to the classical scheme and includes:

• infiltration of the mucous membrane with neutrophils, lymphocytes, macrophages, plasma cells;
• formation of lymphoid follicles;
• processes of degeneration of the epithelium, the appearance of focal zones of damage or diffuse( massive) changes of varying degrees.

Antral inflammation usually occurs against a background of increased secretion of gastric juice. It causes the growth of glandular cells and the activation of their function Helicobacter.

Prolonged course of the disease leads to a gradual depletion of the epithelium, mucosal atrophy, replacement of fibrous tissue or transformation of the epithelium into the intestinal variant. This causes a risk of stomach cancer.

Diagnosis and nuances of treatment are handled by a qualified specialist

Symptoms of

Anthral damage to the stomach causes symptoms that are characteristic of any chronic gastritis. It is impossible to make an accurate diagnosis without further investigation.

Patients are concerned:

• pain in the epigastric department on an empty stomach or immediately after a meal, the intensity is different( from a sense of heaviness, to fights);Heartburn,
• , independent of the quality of food;
• belching;
• unstable nausea, sometimes vomiting;
• bloating( flatulence);
• a constant aftertaste in the mouth;
• bad breath when breathing;
• stool disorder( alternation of constipation and diarrhea).

In the diffuse process,

• appears to have unmotivated weakness;
• poor appetite;
• weight loss.

The erosive form is characterized by manifestations of bleeding( blood in vomit masses and feces).Prolonged disease leads to anemia. More persistent symptoms occur when an antral gastritis passes into a peptic ulcer, involving in the inflammation of the pancreas.

Classification of

Acute form of antral inflammation of the stomach is extremely rare. Most likely, it proceeds asymptomatically, therefore it is detected by chance. The main changes are found in the chronic course of the disease.

The depth of the defeat is distinguished:

1. Superficial - violations are detected only in the outer layer of the mucosa, scarring is not formed, the glandular cells function normally, the symptoms of antral gastritis are expressed non-permanently, can be treated well. A variety of surface forms is catarrhal gastritis. It accompanies acute inflammation, which has developed as a reaction to medicines, gross disruption of nutrition, a single intake of alcohol. At the same time, all the mucous membrane is edematous, covered with pinpoint hemorrhages( erythematous subtype).
2. Erosive - inflammation rushes into deep layers, forms erosions, cracks, ulcers with the subsequent formation of scars. It is much harder to treat it. The main symptoms are brighter and heavier. In feces, signs of latent or obvious bleeding are detected, vomiting reveals blood veins.

The appearance of the fibrogastroscopic diagnostic method allowed us to distinguish different types of gastritis

. In prevalence, we can distinguish:

• focal lesion - on fibrogastroscopy, alternating inflammation and normal tissue are seen;
• diffuse - begins with the antral section and spreads to the entire stomach, the process of inflammation disrupts the digestion of food, the toxic substances that are formed act on the whole organism( temperature, weakness, nausea).

By the degree of infringement of the secreting properties it is possible to single out:

1. Atrophic gastritis - is caused by the gradual loss of the gastric mucosa ability to produce acid, mucus, protective hormones. The cells die, the stomach wall becomes thinner. Some researchers distinguish the subatrophic stage with moderate impairment of function.
2. Hyperplastic is a variant of atrophic changes. The folds of the mucosa become large, forming cysts and small polyps. They are formed due to intensive proliferation( proliferation) of cells of the epithelium of the antrum. Specific symptoms are not available.

Rare forms of

Some variants of the disease are quite rare, symptomatically do not differ from the previous ones. The diagnosis is made only on the basis of fibrogastroscopic signs.

1. Follicular gastritis - refers to the rare forms of antral inflammation, because it is associated with an immune response. On the lesion sites, lymphocytes accumulate and form bubbles. They clog the exits from the glands that produce bicarbonates( alkalizing substances to maintain the level of acidity).Therefore, the acidity of the juice remains high for a long time.
2. Granular - on the mucosa, small protuberances( not more than cm in diameter) are formed due to local outgrowths.
3. Hemorrhagic - is regarded as an adverse consequence of the erosive form. Clinical manifestations include vomiting with blood, black loose stools, which can be considered signs of bleeding.
4. In severe cases, it is possible to develop antral rigidity gastritis. The transformation of the stomach wall into massive sclerotized areas is characteristic. Scarring leads to a significant narrowing of the entire pyloric department. The variant has an unfavorable prognosis - up to 40% of cases is transformed into a malignant tumor.

How is the diagnosis carried out?

In order to resolve the issue of diagnosis and treatment, the doctor prescribes mandatory tests:

• in the general blood test, signs of anemia are possible;
• for urinepsin of urine sets the type of acidity of gastric juice;
• for the analysis of feces for latent blood can be suspected erosive damage in the early stages of the disease;
• to confirm the presence of helicobacteria, blood tests are performed on the immune composition of antibodies, enzyme-linked immunosorbent assays, a polymerase chain reaction test, a urease respiratory test are recommended;
• radiography of the stomach allows to detect folding disorders, narrowing of the pyloric part, ulcerative process;
• fibrogastroscopic method - determines the degree of inflammation and the variant of the course of the disease, makes it possible to take a biopsy and to reveal the helicobacteria microscopically.

Ureasal breath test reveals ammonia and carbon dioxide obtained in the treatment of urea Helicobacteria

Treatment of antral gastritis

Treatment of chronic gastritis in the antrum department is not without mandatory diet. Nutrition requires more frequent meals( 6 times a day), in small portions without overloading the stomach.

Even with mild symptoms it is recommended to exclude fried and smoked dishes, spicy seasonings, sweets. All products must be preliminarily passed through a meat grinder. Cook should be cooked or steamed.

In the acute phase of the disease are prohibited:

• any canned food;
• fatty foods;
• fresh pastry, black bread;
• fast food;
• candy and chocolate;
• alcohol and carbonated water;
• coffee and cocoa;
• whole milk;
• rich soups;
• salted fish;
• grapes.

It is restricted to accept:

• compote of dried fruits;
• products containing coarse fiber( vegetables, fresh fruit).

It is recommended to build a diet:

• from chicken broth with croutons from dried white bread;
• boiled fish;
• porridge;
• vegetable puree or casserole;
• steam cutlets;
• curd casserole;
• pasta;
• of non-acidic jelly.

If infection with Helicobacter pylori is established, the treatment of gastritis antrum requires an eradication course( the so-called destruction process of the pathogen).For this, combinations of antibacterial drugs are prescribed:

• Clarithromycin,
• Ampicillin,
• Tetracycline,
• Metronidazole.

The patient must complete the eradication course and conduct a follow-up examination. In case of exacerbation of the disease, it is better to prescribe drugs in injections in order not to injure the gastric mucosa in addition.

The means from the proton pump inhibitor group

are connected. For the removal of the pain syndrome recommend known sympatholytics( No-Shpu, Papaverin).To block the excess secretory function of the stomach apply enveloping medications( Almagel, Denol, Gefal).To remove reflux casting helps Cerucal, it improves intestinal motility.

To activate the healing processes are appointed:

• Riboxin,
• Solcoseryl,
• Gastrofarm,
• anabolic.

Physiotherapy procedures are only used if signs of bleeding and transformation into a tumor are completely excluded. Usually prescribed:

• electrophoresis with drugs on the epigastric region;
• UHF;
• course of diadynamic currents;
• phonophoresis for pain relief.

In case of chronic antral gastritis, it is recommended to resort to sanatorium treatment using natural sources( Kislovodsk, Essentuki) or in local sanatoriums using mud and paraffin applications.

Admission of folk remedies should be agreed with the attending physician. Usually recommend a decoction:

• from flax seeds;
• Chamomile Pharmacy;
• yarrow.

Nicotine and ethyl alcohol, in addition to directly affecting the gastric mucosa, disrupt the regulation of immunity and deprive the body of the opportunity to protect itself.

Prevention

To prolong the period of remission, it is necessary: ​​

• to stop smoking and drinking alcohol;
• to adjust the diet;
• adhere to recommended dietary restrictions;
• to conduct courses of preventive treatment with vitamins in spring and autumn;
• at least once a year to do fibrogastroscopy.

Antral gastritis is a chronic disease, but with timely treatment with it you can cope without serious consequences. Any manifestations of symptoms require examination and consultation of a doctor.