Focal atrophic gastritis of the stomach: symptoms and treatment

Atrophic gastritis , or the more correct medical name atrophy of the gastric mucosa , is an irreversible process in which the death of cells in the gastric mucosa that produce gastric juice and hydrochloric acid occurs. Atrophy also includes the gradual replacement of stomach cells with connective tissue and cells similar in structure to the cells of the intestinal mucosa.

Atrophy of the gastric mucosa is a dangerous condition for health, since over time and especially in the presence of additional risk factors, it can lead to the development of stomach cancer.

Causes of atrophic gastritis

There are more than ten different causes, each of which can lead to atrophy of the gastric mucosa. Most often, this condition is the result of a long course of inflammation, against the background of chronic gastritis.

Chronic gastritis is a common disease (found in up to 30% of the population in various populations), which has a chronic and recurrent course, manifested by inflammation of the gastric mucosa and confirmed by morphological examination.

The causes of the development of chronic gastritis are:

• presence of Helicobacter pylori infection (H. pylory);
• inflammation caused by an autoimmune process, when your own immune system damages the cells of the gastric mucosa;
• long-term use of medications, such as non-steroidal anti-inflammatory drugs (NSAIDs);
• doudenogastric reflux, when the contents of the duodenum, including bile, are thrown into the stomach;
• prolonged contact with harmful substances during work;
• exposure to radiation;
• the presence of other chronic diseases, for example, celiac disease, Crohn's disease, sarcoidosis;
• food allergies;
• endocrine disorders;
• other infections (except H. pylori), fungi, parasites.

That is, in most cases, atrophy of the gastric mucosa is the result of the most common (80%) chronic gastritis caused by Helicobacter pylori infection, or autoimmune gastritis, which occurs in 1-2% of cases. This article discusses in detail the atrophy associated with these two causes.

Fully or partially limited products

The diet for atrophic gastritis excludes the use of:

• Foods that are difficult to digest in the stomach: fatty rough meat and fish, baked goods, raw fruits and vegetables, black bread, smoked meats, mayonnaise, mushrooms, fish/poultry skin, cartilage, fried pies, legumes, margarine, pancakes, fresh milk.
• Products that contribute to intestinal bloating and increased gas formation: legumes, raw vegetables, okroshka, millet soup.
• Some types of cereals (corn, millet, barley, pearl barley).
• Products that irritate the mucous membrane: garlic, salty/smoked foods, fresh onions, hot seasonings, turnips, radishes, radish, canned snack foods, rutabaga.
• Hot sauces, vinegar, ketchup, pepper and spices.
• Undiluted fruit/vegetable juices, strong black tea, coffee, sour fruits, kvass, alcoholic beverages.

Table of prohibited products

What happens to mucosal cells during atrophy?

The gastric mucosa consists of three layers. The top layer covering the entire inner surface of the stomach is formed from cells that produce mucus to protect against the aggressive effects of gastric juice. Beneath it is the most important layer, called the “lamina propria of the stomach.” It contains the glands of the stomach, which produce substances that form gastric juice - hydrochloric acid, pepsin, hormones (internal Castle factor). The third layer contains muscle cells, the main task of which is to ensure the mobility of the gastric mucosa to move food along.

Atrophy of the gastric mucosa affects the upper layer and the lamina propria of the stomach and is an almost irreversible process that can be slowed down if the causes of inflammation are eliminated.

The gastric mucosa is exposed to an aggressive environment, so its cells are completely renewed every three days. The inflammatory process, which develops as a result of the influence of external factors, for example, a bacterial infection or internal causes, for example, the reaction of the immune system, disrupts the process of renewal (regeneration) of cells of the gastric mucosa, including the cells of the gastric glands that produce gastric juice. As a result, the cells of the stomach glands die and are replaced by connective tissue cells, as well as cells similar in structure to intestinal cells.

This process can be diagnosed using histological examination of samples of the gastric mucosa. If only a decrease in the number of cells of the gastric glands is detected, then they speak only of atrophy of the gastric mucosa. If intestinal cells are found in the test sample, then a diagnosis of atrophy with intestinal metaplasia is established. Metaplasia is the appearance of cells that are atypical for a given organ.

Why is eradication necessary?

Eliminating Helicobacter helps:

• suppress further development, the addition of other bacteria, and the growth of antibiotic-resistant strains;
• reduce the duration of treatment for gastritis;
• reduce the negative effects of medications;
• bring the acidity of gastric juice closer to normal.

The most effective treatment regimens are those that combine tetracycline and penicillin antibiotics and Metronidazole (Trichopol). The modern product De-Nol, a drug based on bismuth citrate, is actively used. Doses are selected individually.

How to correctly diagnose gastric mucosal atrophy?

To diagnose atrophic gastritis, FGDS (gastroscopy) with the collection of at least 5 biopsies (small fragments of mucous membrane) from different parts of the stomach. The number of biopsy samples is determined by the structure of the stomach, since atrophy in different sections develops at different rates, and therefore it is necessary to take samples from all five sections.

The diagnosis is established by a morphologist after a histological examination. Based on this study, treatment is selected and the frequency of examinations is determined for the timely detection of the oncological process.

Also, to assess the severity of atrophy, determination of the activity of the secretory function of the stomach using a laboratory blood test is used - Gastropanel (link).

Diagnosis of Helicobacter pylori infection is carried out using biopsy specimens and a 13C-urease breath test .

For autoimmune gastritis, laboratory diagnostics are carried out using a blood test to determine antibodies to stomach cells and internal Castle factor.

Authorized Products

The diet for atrophic gastritis includes:

• Concentrated broths based on lean meat/fish/mushrooms and first courses based on them with the addition of finely chopped vegetables and permitted cereals.
• Lean red meat (beef, pork, lamb), rabbit meat and poultry (chicken, turkey) boiled, baked or stewed (bits, cutlets, zrazy, quenelles).
• Low-fat fish (hake, pink salmon, cod, pollock, pike) in pieces or in the form of cutlets, meatballs.
• Dried (yesterday's) wheat bread, dry cookies, uneaten flour products.
• Broth-based jellied dishes, sauces prepared with meat broths for main courses.
• Porridges cooked with water/meat broth.
• Dairy/fermented milk products (kefir, yogurt, curdled milk, sour cream, omelet with cheese, grated cheese, milk, cottage cheese and cream in dishes).
• Vegetable puree (zucchini, potato, beetroot, pumpkin, carrot, cauliflower), green peas, stewed vegetables with the addition of garden herbs and vegetable oils.
• Ripe pureed fruits, oranges, baked apples, tangerines, watermelon, peeled grapes.
• Desserts: marshmallows, marshmallows, jam, marmalade, preserves, honey.
• Diluted vegetable/fruit juices, tea with lemon, mineral water, coffee and cocoa.

Table of permitted products

Atrophic gastritis associated with Helicobacter pylori infection

After infection with the bacterium Helicobacter Pylory, inflammation and chronic non-atrophic gastritis develop in the gastric mucosa. At the beginning of the disease, the glands of the stomach produce a sufficient amount of gastric juice. If left untreated, inflammation becomes more active and spreads to all parts of the stomach, leading to mucosal atrophy) and partial replacement of stomach cells with intestinal cells (intestinal metaplasia).

Symptoms

At the onset of the disease, gastritis is asymptomatic. As atrophy progresses, symptoms appear associated with a decrease in the production of hydrochloric acid and other components of gastric juice:

• loss of appetite,
• belching of air or rotten belching;
• nausea;
• feeling of heaviness and fullness in the stomach;
• bad breath; salivation, unpleasant taste in the mouth;
• rumbling, bloating;
• intolerance to certain foods;
• unstable stool;
• dull, aching pain that intensifies after eating;
• weight loss.

Treatment

Eradication (destruction) of Helicobacter Pylory is the first stage of treatment for this variant of atrophic gastritis.

Reviews and results

Dietary nutrition for atrophic gastritis, according to patients, is of great importance. Therapeutic nutrition is physiologically complete and is prescribed for a long period, however, due to the variety of approved products, patients do not feel significant discomfort.

• “... I was diagnosed with “chronic atrophic gastritis” 10 years ago, when I was admitted to the hospital with a suspected ulcer. Since then, there have been exacerbations almost every year and dietary nutrition has practically supported me. I usually go on a diet for 2-3 months, and then gradually expand my diet to the menu I’m used to. I don’t feel any particular discomfort while on a diet. Sometimes, of course, I have a desire to eat something from the list of prohibited foods, but I try not to give in to such feelings, because I broke down several times and realized that then I have to start all over again.”
• “... Atrophic gastritis with low acidity. I have long been accustomed to and adapted to dietary nutrition (Table No. 2). The diet is not complicated, not financially burdensome, especially since you can prepare soups with delicious broths, and foods can be lightly fried and stewed. When there is an exacerbation, I no longer run to the hospital - I immediately go on a diet, drink herbs, and sometimes drugs to stimulate gastric juice. I cook dishes mainly in a double boiler, the cooking process in which is simple and saves a lot of time. Usually after 3-4 weeks the symptoms subside, but I still take precautions and go on a diet for at least 2 months.”

Autoimmune atrophic gastritis

With this type of chronic gastritis, stomach cells are damaged by antibodies produced by the body's own immune system. In this case, chronic inflammation develops, leading to atrophy of the gastric glands and a decrease in the production of hydrochloric acid and internal Castle factor, which ensures the absorption of vitamin B12. A significant decrease in the production of intrinsic factor of Castle can cause anemia B12-deficiency anemia (pernicious anemia) - a disease characterized by impaired hematopoiesis.

Symptoms

The symptoms of autoimmune atrophic gastritis are similar to the symptoms of atrophy caused by Helicobacter pylori infection.

Additionally, anemia develops; autoimmune gastritis can often be accompanied by other autoimmune diseases.

Treatment

There is no specific treatment for autoimmune gastritis; treatment with corticosteroids is used only in exceptional cases.