Antral part of the stomach and its pathology

The anatomical structure and functional purpose of the stomach is divided into 3 parts:

• upper - connects to the esophagus, called"Cardiac", contains a dome or a bottom, a towering formation;
• middle-body;
• lower - pyloric, located on the border with the duodenum, in turn, is divided into antrum and the canal's channel, which ends with a muscular sphincter.

The antral part accounts for up to 30% of the stomach volume. It is precisely to determine visually where the antrum is located, since the boundary is very conventional. According to the histological picture of the epithelial layer, it is more likely to establish the belonging of the tissue to a certain part of the organ.

The antral part of the stomach participates in the general functions of the organ, but it also has its own characteristics. Their violation causes various diseases. Therefore, it is worthwhile to dwell on the specifics of the work of the antrum.

Physiological "duties" of the antrum

All functions of the antral part of the stomach are related to the process of digestion. Here occurs:

• grinding of food particles up to 2 mm or less with simultaneous mixing, the result should be a homogeneous mass without the selection of pieces;
• pushing the formed lump toward the pylorus and duodenum;
• preparation for further digestion in the intestine means a decrease in acidity, which was provided by the body of the stomach, because in the small intestine there must be an alkaline reaction, the maximum concentration of alkaline mucus is produced in the area of ​​the pylorus;
• for the elimination of hydrochloric acid in mucosal cells there is a hormonal substance - gastrin, it is also called the "hormone-informer", since the action is associated with the transfer of momentum to higher centers about the appearance of food;
• production of serotonin allows to ensure reliable evacuation of the food lump by stimulating the muscular apparatus of the stomach;
• synthesis of somatostatin, which, if necessary, can suppress the secretion of enzymes.

What causes anthrum diseases?

All variants of pathology of the antral department are united by the single most common cause - the presence of a specific Helicobacter pylori pathogen or Helicobacter. The fact is that antrum is a favorite place of localization of this microorganism.

Infection occurs through the mouth. And, getting into the stomach, in the pyloric part the pathogen finds the most convenient conditions for life. It well tolerates the acidity of gastric juice. Independently neutralizes it with the help of enzymes that release ammonia. Actively multiplies.

Due to the presence of the antennae, the bacterium is able to move in the gelatinous mucus environment of

In addition to Helicobacter pylori, in the pathology of the antrum, risk factors are involved:

• alcohol abuse;
• smoking;
• long-term use of medications, irritant effects( from the Aspirin group, non-steroidal anti-inflammatory drugs, against headache, for tuberculosis therapy);
• adherence to the violation of the rules of nutrition( passion for spicy seasonings, fried and smoked dishes, very hot or cold foods, fast food, disproportionate long breaks in food);
• stress conditions in the family, at work, contributing to the emergence of neuroses;
• general vascular changes with severe atherosclerosis, arteritis, diathesis, disturbing nutrition of the stomach wall;
• infection with parasites( helminthiases, amebiasis, giardiasis);
• allergic reactions to food;
• exposure to viruses( HIV, cytomegalovirus);
• decreased immunity, caused by various causes;
• hereditary genetic predisposition.

The association of the incidence of gastric lesions with diseases of the endocrine organs, bronchi, lungs and heart, iron deficiency, diseases of the urinary system, as well as the presence of chronic foci of infection( tonsillitis, sinusitis, caries, adnexitis in women and others).

Chronic pathology is accompanied by the suppression of the body's defenses. In combination with Helicobacter pylori these factors cause different in prevalence and depth of stomach damage. Consider the most common diseases with the characteristics of symptoms and treatment.

Diagnostics is based on revealed morphological changes in tissues, endoscopic research

Antral gastritis

Morphology of the inflammatory reaction includes step-by-step processes:

• infiltration of the antrum mucosa with lymphocytes, neutrophils, macrophages, plasma cells;
• formation of follicles from lymphoid tissue( lymphoid hyperplasia);
• destruction of the epithelium in the form of separate foci( focal gastritis) or massive damage zones.

Antral gastritis is mainly a chronic disease. Unlike gastritis, the body of the stomach is rarely acute. It starts against a background of high acidity. The production of hydrochloric acid by the cells is stimulated by helicobacteria.

Gradually, the functions of the epithelium are depleted, the processes of atrophy begin. This means replacing epithelial cells with non-functioning fibroids. Another option is the transformation of the gastric epithelium into an intestinal epithelium, atypical in location. The process is dangerous by degenerating into a cancerous tumor.

Depending on the secretion of secretion:

• atrophic gastritis - accompanied by a gradual loss of the gastric mucosa, the ability to synthesize acid, hormonal substances, mucus, death of the epithelium, thinning of the stomach wall, is considered a precancerous disease;
• hyperplastic - is characterized by the formation of large folds, cysts, small polyps, activation of the process of cell proliferation.

Depth of lesion depends on the type of antral gastritis. The most favorable form of the flow is considered to be superficial, the changes concern only the superficial layer of the mucosa, it is not accompanied by the formation of scarring, expressed by disorders of the secretory function.

Superficial inflammation reaches the muscles, but does not concern them

Erosive gastritis - the inflammatory reaction goes deep into the wall of the stomach. As a result, surface erosions and cracks are formed first. The chronic course of erosion without treatment leads to the formation of ulcers. With a favorable outcome, a scar appears in the focus of inflammation.

Symptoms of antral gastritis in case of superficial injury can not disturb a person or arise after overeating, drinking alcohol. Other forms are characterized by a more persistent current. Most patients are concerned about:

• pain of varying intensity immediately after eating or on an empty stomach;Heartburn and eructation
• ;
• smack in the mouth;
• odor when breathing;
• bloating;
• stool disorder( diarrhea or constipation).

The appearance of blood in the stool and vomit indicates the erosive form of gastritis. The addition of anemia is accompanied by increased weakness, headaches, pallor. Persistent symptoms that respond poorly to treatment should cause anxiety due to the transformation of gastritis into a peptic ulcer, a tumor, the attachment of pancreatic inflammation, the bulbitis of the duodenal head.

Ulcers

Ulcerous lesions of the antrum are possible after the stage of inflammation, when the focal atrophy of the mucosa passes through the stage of erosion to a deep lesion of the submucosal and muscular layers.

The ulcers that are found in the antral part account for up to 10% of the total ulcerative lesion of the stomach.

To the mechanisms of the disease, in addition to inflammation, the following are added:

• low contractile function of the antrum;
• stagnation and fermentation of the food lump;
• enhanced enzyme production.

The presence of risk factors provokes the transition of inflammation to the ulcer. Typical symptoms:

• pain in the epigastric region, become more intense at night;
• permanent heartburn;
• nausea and vomiting;
• burps after eating;
• admixture of blood in the feces, vomit.

Benign neoplasms of antrum

Non-cancerous antrum formations include polyps and lymphofollicular hyperplasia. Polyps arise when the glandular cells of the epithelium proliferate. The share of the antral department accounts for 60% of all polyps of the stomach.

They are characterized by a single growth or the formation of an entire colony. In form differ in size( up to 30 mm).Revealed against the background of other diseases of the stomach. They represent a threat of cancerous degeneration. Practically do not give any symptoms. Pain provoked by eating disorders. They can be twisted or jammed, then blood stains in the stool.

By origin, anthral polyps of three kinds are distinguished:

• inflammatory - begin with lymphoid follicles( 70 to 90%);
• adenomas - grow from the glandular epithelium;
• specific - neoplasms in the Peits-Egersa-Turena syndrome, which represents a hereditary pathology involving hyperpigmentation of the skin and polyposis of the intestine, stomach, characterized by a glandular structure, pigment content( melanin), rarely - muscle fibers.

For the Peits-Jägers-Turen syndrome, also the appearance of spots on the face( xanth), in which the pigment melanin is located at the level of the basal layer of the epidermis and in the mucosa. Pigmentation appears in childhood, with adulthood can diminish or disappear.

Polyps can "sit on a leg" or be attached with a wide base to the wall

Lymphofollicular hyperplasia is accompanied by the growth or formation of a follicular tissue in the submucosal layer of the stomach. The disease has no age advantages. Among the reasons other than those described above, a special place is given to:

• herpes infection;
• autoimmune diseases;
• disorders in the endocrine sphere;
• contact with carcinogens.

It is important that, according to observations, this type of hyperplasia most often precedes the formation of polyps.

Cancer

Cancer( cancer in Latin or abbreviated c-r) of the antrum is responsible for up to 70% of malignant tumors of the stomach. Distinguish:

• adenocarcinoma - is formed from glandular cells, the most common tumor( 90%);
• solid cancer is a rare neoplasm, the structure is not related to glandular elements;
• cancer-skyrr is an even rarer form, formed from connective tissue.

Specificity of antral cancer location:

• infiltrative growth without formation of clear boundaries;
• aggressive course with rapid metastasis;
• frequent recurrences after resection of the stomach.

The stage of cancer development is determined by the depth of lesion and the presence of metastasis

The most common cause of cancer is chronic atrophic gastritis. It causes morphological changes of three types:

• glandular atrophy - disappearance of mucosal cells;
• dysplasia - the appearance in the stomach of the epithelium, characteristic of the intestine( intestinal metaplasia) with respectively impaired properties;
• neoplasia - transformation into malignant cells.

Symptoms of antrum cancer, in comparison with those described above, differ:

• with a constant sense of overflow or raspiraniya in the stomach zone;
• nausea and vomiting, which patients cause themselves to alleviate the condition;
• aversion to food;
• significant depletion;
• irritability of the patient;
• temperature increase.

Infiltration of the tumor of stomach tissues is accompanied by destruction of the vessels. Therefore, one of the signs is gastric bleeding( vomiting with blood, black liquid stools).

The role of diagnosis

Diagnosis is crucial in detecting diseases of the antrum of the stomach, since the symptomatology does not reflect the prevalence and severity of the lesion.

Fibrogastroduodenoscopy is an endoscopic method that allows you to visually inspect all the departments of the esophagus, stomach and the beginning of the duodenum, in addition they are used to select a site of the mucosa for the extraction of cytological examination, microscopy for the detection of Helicobacter pylori.

To detect the root cause of the lesion and prescribe a treatment, it is necessary to confirm the presence of Helicobacter pylori in the stomach. To do this, methods of enzyme immunoassay, polymerase chain reaction to typical antibodies and immunoglobulins, urease respiratory test and stool analysis are used.

Unservedly, some doctors have forgotten the X-ray diagnostic method. It allows for the folding, deficiency or surplus tissue, the modified contours to judge the ulcer niche or the presence of polyps, cancer.

A benign

can be diagnosed by X-ray. Daily urine analysis can determine the amount of uropepsin released and calculate the acidity of gastric juice. In the general analysis of blood there are no characteristic signs. For serious illness, anemia, eosinophilia, and leukocytosis can speak. Analyzes are conducted both during the diagnosis period and for monitoring the effectiveness of treatment.

Features of fibrogastroscopic pattern: erosion and gastropathy

Consideration of erosive lesion of antrum became possible only with the development of fibroadastroscopic type of diagnosis. This pathology complicates gastritis and serves as the beginning of an ulcer, tumor degeneration.

Erosion is a violation of the integrity of the mucous membrane without penetrating into the deep sections of the stomach wall. Distinguish the following varieties:

• acute erosion - limited by seals, cured for 10 days;
• chronic - look in the form of spots up to 10 mm in diameter, require long-term treatment;
• hemorrhagic erosions - give a picture of the consequences of needle nicks, the size of the focus remains within 10 mm in diameter, in color take shades from scarlet to cherry red( depending on the affected vessel, the vein gives dark spots), mucous, surrounding foci, edematic,it contains blood.

Erosion, in contrast to the ulcer, is superficially located

In the antrum, single erosion with all the described features can be detected, as well as a complete type of erosion - differs by the spreading along the crests of the folds of the stomach, the formation of a black plaque. Antrum's gastropathy is described by the doctor, if there are no signs of inflammation, all the mucous membrane is hyperemic, but the specific form of the disease is unclear.

Treatment of

Each of the diseases of the antral department requires the choice of an individual approach to therapy. An obligatory condition is the refusal from smoking and alcohol, the fulfillment of dietary prescriptions for the rest of your life. Food should be as gentle as possible, avoiding breaks, the use of roasting and spicy seasonings.

For the normalization of the acidity of gastric juice, apply anti-calcification drugs( Almagel, Denol, Gefal).Patients with chronic pathology need to get rid of Helicobacter pylori as a source of the disease. To do this, use a course of antibiotic eradication.

In the recovery stage for gastritis and ulcer, drugs that promote tissue healing are used. Among them:

• Solcoseryl,
• Riboxin,
• Gastroparm.

With peptic ulcer it is very important to make sure there are no signs of bleeding, as well as suspicion of tissue degeneration. With a successful current, physiotherapy techniques are used( electrophoresis and phonophoresis with drug solutions, diadynamic currents).

Surgical treatment is required in cases of:

• persistent pain syndrome;
• bleeding;
• lack of the effect of conservative therapy;
• revealing polyps of the stomach;
• is a cancerous tumor.

Both laparoscopic and cavitary operations are performed.

One of the low-traumatic methods of treatment is endoscopic laser coagulation - it allows to remove single polyps, to eliminate bleeding. A phased removal of a group of polyps is possible. Suspicion of malignancy requires an early excision of tissues along with ulcers, polyps, a segment of lymphofollicular hyperplasia or a tumor.

Cancer treatment includes chemotherapy and radiotherapy. In the period of remission with different pathologies of the antrum, doctors prescribe immunomodulators, vitamins, and allow the use of decoctions of herbs. All methods of treatment must necessarily be agreed with the doctor. Observation of the revealed pathology by the method of fibrogastroscopy and analysis of feces for occult blood appears to be the most informative methods of early detection of exacerbation.