Chronic gastritis is ... Symptoms, stages, diagnosis and treatment of chronic gastritis

In the structure of diseases affecting the digestive system, the first place is occupied by chronic hepatitis C (chronic gastritis). This is an ailment that occurs both due to health problems and due to an improper lifestyle. The disease is considered serious enough, because it can lead to ulcers in the stomach, as well as the development of oncology.

What is chronic gastritis

This term in medicine denotes a long-term current disease, in which periods of exacerbation are replaced by periods of remission. In chronic gastritis, the gastric mucosa becomes inflamed . She is undergoing negative changes. Because of them, the functions of the stomach are disturbed (secretory, incretory, motor).

Polyetiological diseases include chronic gastritis. This means that inflammation of the gastric mucosa can occur as a result of exposure to various factors. The main causes of the development of the disease include:

• infection of the mucous membrane with a spiral gram-negative bacterium Helicobacter pylori (this etiological factor is detected in approximately 85% of people with chronic gastritis);
• autoimmune processes leading to the formation of autoantibodies to the parietal cells of the stomach (this reason for the development of chronic hepatitis is observed in 10% of cases);
• duodeno-gastric reflux, in which the contents of the duodenum enter the stomach and damage to the mucous membrane.

Also, experts identify a number of additional provoking factors. The likelihood of chronic gastritis of the stomach is quite high with improper and malnutrition, smoking and abuse of alcohol, diseases of the endocrine system, metabolic disorders, frequent stress, etc.

How does the disease develop?

The main and additional provoking factors can irritate the stomach for a long time. Due to this effect, the mucosal epithelium is damaged. The processes of regeneration are disrupted. The number of glandular cells in the stomach is gradually reduced. The mucous membrane atrophies in this internal organ. Intestinal metaplasia begins to occur. This is a pathological process in which cells of the gastric mucosa are replaced by intestinal cells.

Negative changes in chronic gastritis in adults begin in the antrum. With the progression of the disease, they spread to the fundus of the internal organ. Later, negative changes become diffuse.

At the initial stage of the development of chronic gastritis, hypersecretion in the stomach is observed. With the progression of atrophy of the mucous membrane, the production of hydrochloric acid decreases. As a result, the processes of digestion of food are disrupted.

Classification of chronic gastritis

There are different classifications of the disease. One of them, for example, was created in 1973. Its authors are JR Mackay and RG Srtickland. According to this classification, there are 3 types of chronic gastritis:

1. A - autoimmune. With this type of gastritis, antibodies to parietal cells are present in the body. The body of the stomach is mainly affected.
2. B is bacterial. The defeat of the mucous membrane is provoked by the bacterium Helicobacter pylori. The antrum of the stomach is inflamed mainly. Immune disorders with this type of gastritis are not observed.
3. C - chemical toxic. The disease develops due to the negative effects on the gastric mucosa of chemicals, certain drugs, and the contents of the duodenum 12.

In 1994, the Houston classification was developed. It is presented in the table below.

Degrees and stages of HCG

In 2005, a new classification of the disease appeared, created to assess the degree and stage of chronic hepatitis C. The degree is the general severity of inflammation, and the stage is the severity of atrophy. The classification is called OLGA - Operative Link for Gastritis Assessment.

To determine the degree and stage, material is collected from a patient with chronic gastritis. This study is performed using 5 biopsies (2 taken from the body of the stomach, and 3 obtained from the antrum). The defeat of the body is determined in points. Separately, the body of the stomach and antrum are evaluated:

• 0 points - no infiltration, no atrophy;
• 1 point - weak infiltration and atrophy;
• 2 points - moderate infiltration and atrophy;
• 3 points - severe infiltration and atrophy.

Next, use the table.

Manifestations of chronic gastritis: the clinical picture

The disease is characterized by general and local symptoms. The first group of signs includes:

• irritability;
• weakness;
• drowsiness;
• dysfunction of the cardiovascular system (pain in the heart, pathological changes in the frequency, rhythm and sequence of contraction and excitement of the heart, low blood pressure), etc.

The group of local symptoms of chronic gastritis in adults includes dyspepsia - a violation of the digestion of food. Patients, for example, complain of a feeling of heaviness and fullness in the epigastric region. This sensation appears or intensifies during or after a meal. Often worried about heartburn. Symptoms such as an unpleasant aftertaste in the mouth, belching, and nausea can also torment. These symptoms are mainly manifested in antral gastritis. In case of damage to the body of the stomach, patients complain of severity in the epigastric region. This symptom occurs during meals or after a period of time after eating.

In patients suffering from bacterial chronic gastritis with increased secretory function, frequent bloating, rumbling, unstable stool are observed. With an allergic form, diarrhea occurs. People complain of intolerance to certain foods, drugs, abdominal pain, weight loss, nausea and vomiting.

Basic diagnostic measures

Diagnosis is carried out in several stages. It all starts with a patient examination. The doctor collects complaints of the patient, assesses the anamnesis. On palpation of the abdomen, the patient can tell about the sensation of moderate pain in the epigastric region.

If chronic gastritis is suspected, adults are prescribed FGDS - fibroesophagogastroduodenoscopy, which is the most informative method for diagnosing this disease. During the study, the following signs of chronic hepatitis can be identified:

• total hyperemia and swelling of the mucous membrane (with a non-atrophic form);
• spotty hyperemia without edema (with superficial focal chronic gastritis);
• education from 1 to 5 mm in diameter, protruding above the mucous membrane (they are often found and are both single and multiple);
• thinning of the mucous membrane, its pale grayish color (with atrophic gastritis);
• against the background of a thinned mucous membrane, a vascular pattern is visible (normally it is not noticeable);
• imposition of mucus (they indicate the presence of inflammation), etc.

Endoscopic diagnosis is carried out with a biopsy, because morphological changes in the gastric mucosa are the defining signs of chronic gastritis. Biopsies obtained during the procedure are sent for histological examination.

If it is impossible to conduct endoscopic diagnosis, an X-ray examination of the stomach is prescribed. It allows specialists to evaluate the motor-evacuation function of the stomach in patients.

Other studies

A diagnosis of chronic gastritis may require endoscopic ultrasonography. This method includes endoscopic and ultrasound diagnostics. Its advantages are that it can provide the doctor much more information. With endoscopic ultrasonography, it is possible to assess the nature and depth of changes in the wall of the internal organ, to carry out targeted sampling of the material for histological examination.

Patients undergoing diagnosis of chronic gastritis are prescribed intragastric pH-metry, a procedure that is performed to evaluate the acid-neutralizing and acid-forming functions of the stomach. It is performed using a probe. The procedure has several contraindications. The introduction of the probe is prohibited in case of gastric bleeding and for 10 days after its completion, in severe forms of hypertension and coronary insufficiency, burns, diverticulums, esophageal strictures, severe maxillofacial injuries.

Ultrasound may be prescribed for suspected chronic gastritis. This study plays an important role in the differential diagnosis of chronic hepatitis C with diseases affecting the hepatobiliary system.

Treatment

Treatment of chronic gastritis of the stomach has specific goals. They are:

• in eliminating the bacteria Helicobacter pylori (if the mucous membrane is infected with this microorganism);
• relief of inflammatory changes in the stomach;
• preventing the progression of changes in the mucous membrane, because the larger the lesion and the more noticeable atrophy, the higher the risk of cancer;
• lengthening the period of remission and reducing the duration of the period of exacerbation.

Treatment after diagnosis includes general measures related to changes in nutrition and lifestyle, the use of drugs.

Therapeutic nutrition and lifestyle

Dieting is an important element in the complex treatment of chronic gastritis. In case of illness, you need to eat, taking into account several basic nuances:

• a positive role is played by the chemical, mechanical and thermal sparing of the stomach;
• it is important to eat regularly, without skipping breakfast, lunch, dinner, snacks (5-6 meals a day are shown);
• while eating, you should thoroughly chew food, eat slowly and not gently;
• some foods should be excluded from the diet (pastry, fried, fatty, smoked, spicy foods, canned goods, fast food products, pickles, pickled vegetables, etc.).

Medical nutrition for each person is selected individually, because gastritis is different. People suffering from a hypersecretory form of this disease are assigned diet No. 1. Drinks that provoke the production of gastric juice (carbonated water, strong tea, coffee) and dishes rich in extractive substances (rich broths, soups) are excluded from the diet. If gastritis with secretory insufficiency is detected, then diet No. 2 is prescribed. It is based on the rules of mechanical sparing of the stomach and stimulation of secretory activity. A diet for chronic gastritis should be supplemented by a rejection of bad habits (smoking, drinking alcohol), and taking non-steroidal anti-inflammatory drugs.

Drug treatment

Drug therapy is determined by the type of chronic gastritis, the stage, the individual characteristics of each patient (because, for example, one person may experience intolerance to a specific drug, and this medicine will suit another person).

Treatment must be prescribed by a doctor. The patient is prescribed several drugs. Consider, for example, the treatment of chronic Helicobacter pylori gastritis with high acidity. With this diagnosis, the following medications are used:

• anti-Helicobacter pills (for example, Metronidazole, Clarithromycin, Amoxicillin);
• antisecretory drugs (proton pump inhibitors - "Omeprazole", "Lansoprazole"; H ₂ blockers - "Ranitidine", "Famotidine", "Roxatidine"; anticholinergic drugs - "Gastrocepin", atropine sulfate);
• antacids ("Almagel", "Phosphalugel");
• gastrocytoprotectors ("Misoprostol", "Venter").

In the treatment of chronic gastritis of Helicobacter pylori type with increased acidity in adults, 2 or 3 anti-Helicobacter pills and 1 antisecretory drug are simultaneously prescribed. Such therapy lasts 1 or 2 weeks. If after treatment ulcerative dyspepsia persists, the patient is left with an antisecretory drug or an antacid (or gastrocytoprotector) is prescribed. With pronounced dyspepsia with acidism syndrome, the administration of an antisecretory drug and antacid or antisecretory drug and gastrocytoprotector is indicated.

Treatment of chronic atrophic gastritis with low acidity is carried out according to a different scheme. During therapy, a number of goals are achieved:

1. The inflammatory process in the stomach is stopped. To achieve this goal, Plantaglucid, Venter, plantain juice are used.
2. Violation of the motor function of the stomach is corrected with the help of prokinetics (for example, with the help of Cerucal, Motilium, etc.).
3. Acidity is normalized due to substitution therapy. Used natural gastric juice, the drug "Acidin-Pepsin" and others.
4. Intestinal digestion is corrected. Such drugs as Pancreatin, Festal are prescribed.
5. The reparative and regenerative processes of the gastric mucosa are stimulated. Sea buckthorn oil helps to achieve this.

After treatment of the disease, it is necessary to adhere to preventive measures, because the ailment can worsen. The components of prevention are maintaining a healthy lifestyle, following the recommended diet for chronic gastritis, giving up bad habits, timely visits to the doctor when symptoms of the disease return.