Gastritis is a pathological condition in which the gastric mucous membranes become inflamed, regenerative processes, contractile gastric movements are suppressed, and secretory ability also changes. Currently, several approaches to the classification of chronic gastritis have been introduced. In addition to the chronicle, the disease is also acute.
What is it about?
Chronic gastritis is called when hydrochloric acid is excreted in violation, the gastric mucous membranes are transformed, the patient suffers from pain and discomfort, and digestive tract disorders. The disease is inherently complex; as is known from statistics, approximately every second able-bodied person in developed countries is sick with it. The greater the age, the more likely the chronic form of gastritis is higher. For patients, not only food intake, but also nervous situations that provoke exacerbations become a problem. Often, such people tend to get annoyed, get tired quickly, and feel weak. One of the indirect signs of chronic gastritis is low blood pressure.
About division into groups
The basic classification of gastritis: chronic, acute. In the first case, we are talking about a long-term disease that is prone to relapse. Acute is called the first appeared gastritis. The most common cause is the use of low-quality food or alcohol poisoning. Acute gastritis proceeds rapidly, due to the influence of strong irritants, due to which the mucous membrane becomes inflamed.
Classification of chronic gastritis is somewhat difficult due to the characteristics of the pathological condition. This disease develops for a long time, is polyetiological in nature. The gastric mucosa becomes an area of localization of inflammatory foci, while the structure of the tissues changes, the functions of the organ are gradually inhibited. There are several forms of a chronic disease.
Chronic gastritis can appear under the influence of internal, external factors. Usually it is not possible to identify one specific triggering process, the only cause of the pathology. In a chronic form, the disease appears as a result of the combined effect of several phenomena. The classification of chronic gastritis, adopted in medical institutions of our country, is based on the theories of Ryss published in the official directory in 1996.
Classes and Types
The modern classification of chronic gastritis involves the allocation of groups based on the etiology of the case. Gastritis is endogenous, exogenous, that is, secondary, primary.
Assessing the morphology, each case can be classified as superficial, atrophic, moderate or brightly progressive, in which the gastric tissue is gradually rebuilt, resembling intestinal tissue. A form of gastritis is also possible , in which there are no atrophic processes, but the glandular cells are affected by pathological changes. The last group of gastritis, distinguished by classification according to morphological characteristics - hypertrophic.
Since etiology, pathogenesis, and features of the development of the condition are evaluated in the classification of gastritis, one of the accepted divisions of all cases into groups is based on the area of localization of pathological processes. This allows you to highlight pangastritis, that is, a common form, and limited. It is called fundamental, antral (depends on the location of the focus).
What else are there?
Assessing the pathogenesis of gastritis as part of the choice of treatment, the functional principle is also chosen by the classification principle. There are cases in which the secretory ability of the stomach is normal or higher than normal, as well as situations where there is moderate to moderate type of deficiency.
Evaluation of clinical manifestations allows you to highlight the chronicle in remission or exacerbation.
The current classification system for gastritis according to ICD-10 involves the allocation of specific individual groups: a rigid form and erosion, eosinophilic gastritis, polyps, Menetrie disease.
The nuances of the chronic course
Doctors, developing and studying the classification, clinic, diagnosis, treatment of chronic gastritis, found that the disease is explained by the nuances of human genetics: it is at this level that defects are laid, due to which the gastric mucosa cannot regenerate normally.
Chronic disease usually occurs in atrophic or superficial form. Such terms were introduced in 1948 by a scholar from Germany, Schindler, gradually gained distribution around the world. They are used in the international classification of ICD 10. The division into categories is associated with an assessment of the state of normal glandular structures, or an analysis of the degree to which they are lost. This factor is important for identifying the current characteristics of the patient’s condition, and for formulating a correct prognosis for the occasion.
Gastritis: etiology
Diagnosis, treatment, classification of chronic gastritis is impossible without assessing the etiology of a particular case. It is customary to talk about three main types - A, B, C, as well as mixed cases and additional ones. Under letter A, a disease provoked by autoimmune factors is encrypted. As a rule, this is fundus gastritis, in which foci of inflammation arise due to the development of antibodies to certain gastric cells. Letter B means antral gastritis, due to the development in the stomach of the colony Helicobacter pylori. Finally, type C is a chemical, provoked by the ingestion of bile into the gastric cavity during reflux.
Additional types in the current concepts of the classification of gastritis are medicinal, associated with the use of alcohol and some other factors.
Different areas of localization are distinguished: damage to the body of the organ, pangastritis, violation of the integrity of the antrum, fundus.
1990: an important step forward in the study and treatment of gastritis
The Sydney classification of chronic gastritis, adopted in 1990 as part of a congress of physicians involved in gastrointestinal tract problems, is one of the most widespread today. It became the basis for the development of the Houston system and the OLGA variant. The event held in 1990 brought together representatives of various countries and medical schools, thanks to which it was possible to develop an optimal universal approach.
Based on the etiology, it was decided to isolate autoimmune A, bacterial B, reactive C varieties of gastritis. Topographically, it was customary to classify all cases as widespread, antral or fundal. Based on the results of endoscopic examination, it is necessary to determine whether, in a particular case, there is swelling, erosive foci, erythema, secretion, fold hyperplasia or atrophic processes, hemorrhages, and vascular reactions.
What else to look for?
In the framework of the Sydney classification of chronic gastritis, the division into groups involves an assessment of the category. Gastritis can be atrophic or hemorrhagic, hyperplasive, as well as associated with erythema, erosion, exudate.
On histology, inflammatory processes, increased activity of individual structures, metaplasia, atrophic processes and Helicobacter pylori can be detected. This allows each case to be assigned to a specific group. Histological examination allows us to rank the case as accompanied by fibrosis, atrophic processes, eosinophilia, swelling, granulomas. Within the framework of such a study, the patient can be classified as suffering from superficial, atrophic gastritis or a form in which the glands are affected, but there is no atrophy.
In practice, using this system, as well as the OLGA classification of chronic gastritis, doctors first determine how active the secretory gastric ability is, if there is a bacterial infection. If Helicobacter pylori penetrates into the stomach tissue, it can survive for a long time there, without showing itself at first. Sooner or later, this leads to large-scale damage to organic tissues.
Forms and types: what if in more detail?
Select, based on membership in a group according to the classification system of gastritis, treatment relevant for a particular case. For different variants of the disease, therapy can differ quite significantly. This explains why it is so important to correctly determine the type and class of the disease, as well as the reasons that provoked it. For example, there is an atrophic-hyperplastic type of disease. Currently, when diagnosing it, doctors on the patient’s map indicate a multifocal form with atrophy and individual foci of hypoplasia. This species is characterized by the simultaneous presence of both hyperplasia and atrophic processes. Sources of hyperplasia are undifferentiated gastric cells at the bottom of the organ and the neck of the glands. Focal hyperplasia is believed to precede polyps. The risk of malignant neoplasms is increased if the presence of adenomatous polyps is established, and their frequency of occurrence is 4% or higher among all existing polyps in the patient’s stomach.
Another form of the disease is hypertrophic (also present in the current classification of gastritis). Treatment is chosen for her, given that this type of disease is characterized by an increase in the thickness of the gastric mucous membranes, as interstitial hyperplasia occurs. An alternative is the proliferative form, glandular. The most severe variant of this gastritis is Menetrie disease.
Forms and Types: Continuing Consideration
The classification of chronic gastritis developed on the basis of the Sydney Houston classification suggests the allocation of a lymphocytic form of the disease into a separate category. This is formed under the influence of an autoimmune factor, it is possible with a mixed common pathology. When assessing the patient's condition, a large number of intraepithelial lymphocytes in superficial epithelial structures can be detected. Three hundred lymphocytes or more are found per hundred cells, while it is impossible to detect them in a healthy person. Currently, it was not possible to establish the exact pathogenesis of the disease. Presumably, this is the response of the immune system to Helicobacter pylori, which cannot be detected on the gastric mucosa in the analyzes using methods and equipment available to modern scientists.
The granulomatous form of pathology is distinguished in the Sydney, Houston, Kyoto classifications of chronic gastritis. With this variant of the disease, numerous small granulomas are formed in the stomach area. As a rule, Wegner or Crohn's disease is diagnosed. Test results similar to this form of gastritis are possible with parasitic invasion and the presence of a foreign object in the stomach.
What else are there?
In the Houston classification of chronic gastritis and others mentioned above, an eosinophilic type of disease is distinguished. This appears if the patient already has an atrophic or superficial lesion of the gastric mucosa. A distinctive feature of the eosinophilic form is the foci or diffuse distribution of eosinophils. This form of the disease is more often observed in allergy sufferers. The reason in the predominant percentage of cases are parasites, allergens that enter the body with food.
An infectious form of the disease is possible. With it, it is possible to establish a focal lesion or diffuse distribution of pathological bacteria, viruses, fungi. As a rule, the cause is Candida, cytomegalovirus or gastrospirilli. Gastritis is due to the monocytic response of the body to invasion.
About forms: a different approach to classification
The most common type is simple gastritis. It is explained by poor nutrition, food poisoning, taking medications, allergic reactions to food. Digitalis or salicylates, antimicrobials and sulfonamides, bromides can cause gastritis. Perhaps such a consequence when using butadione. Allergic reactions to food are most often observed on nuts, strawberries, mushrooms.
An endogenous type of disease is also distinguished. This is preceded by an acute infectious process. It may occur against the background of metabolic problems, burns, or another reason that provoked the active breakdown of protein structures. Sometimes this form is observed with strong radiation exposure.
The catarrhal form is diagnosed when the epithelium is infiltrated with white blood cells. The process is superficial, in some areas dystrophy or necrobiotic processes are possible. There is hyperemia of an inflammatory nature.
Hemorrhagic form and some other
Erosive, it is also hemorrhagic, is a form of gastritis in which the patient often suffers from bleeding in the stomach. The gastric mucous membranes are transformed under the influence of foci of inflammation and erosion, the production of gastric juice is maintained normal and above average. Sometimes, blood secretions are explained by excessive permeability of the vascular wall of the stomach, as well as injuries that the mucosa receives.
Rigid - a clinical form of the disease, which is characterized by deep scars and inflammatory changes. The main area of localization is the antrum, which narrows and deforms as the condition progresses. Pathology expresses itself with dyspepsia, pain in the stomach, overly active production of gastric juice, in some patients with achlorhydria. An x-ray reveals that the pylorus is narrowing in the shape of a tube, which is somewhat similar to tumor processes and complicates an accurate diagnosis. To confirm gastritis, it is necessary to take tissues for histological examination, perform gastrofibroscopy and monitor the development of the patient's condition.
The polyposis form is accompanied by atrophic processes, mucous hypoplasia according to the dysregenerative type, achlorhydria. The disease is not characterized by a certain typical picture. When making a diagnosis, it is important to distinguish it from polyposis. To clarify the condition, a biopsy is necessary.
Gastritis and related diseases: difficulties in determining
One of the possible types of disease is a giant tumor. This class includes Menetrie disease and polyadenoma. A distinctive feature of hypertrophic gastritis is the appearance in the gastric mucosa of cysts, adenomas. Those can be single, numerous. Formations lead to the fact that the folds thicken, become rough, the protein is washed out with gastric juice. In severe forms of the disease, hypoproteinemia is diagnosed.
Gastritis is possible with normal secretion of juice or above normal antrum. Such forms usually indicate pain in the abdomen. Symptoms are similar to an ulcer, and clarifying the diagnosis is not always easy. For a specific definition of the disease, it is necessary to monitor the patient's condition for a while. In particular, with gastritis there are no seasonal exacerbations. At the peak of the acute phase, tests do not confirm the presence of gastric mucous ulcers.
The difficulty of the issue
All attempts to form a unified classification system for gastritis (as well as a number of other pathological conditions) encountered great difficulties. Known to scientists, methods and schemes for dividing pathology into groups and types are often not used in clinical practice. Many schemes are studied only by doctors as part of the educational process.
With respect to any classification, one cannot say exactly what the scientific value of this idea is. Science is developing, new values are accumulating, more effective approaches to diagnosis are being developed, the causes of the disease are being identified. A person delves deeper into the essence of the phenomenon, determines the laws, qualities inherent in him. Therefore, the previously developed classification ceases to satisfy the existing requirements, does not correspond to the ideas and information.
In fact, classification is a temporary scheme that simplifies the work of a doctor at a particular stage. It is necessary not only to know the systems currently used, but also to be prepared for awareness, acceptance of new ones. It is important for a modern doctor to quickly master the latest approaches to dividing cases into categories in order to choose treatment methods quickly and effectively.