Constant stomach pains, weakness, nausea, belching, stool disorders….the diagnosis is chronic gastritis. After the doctor pronounced the word “chronic”, it seems that this is a verdict. Do not rush to despair. Clinical active manifestations of gastritis with erosion, esophagitis, focal may differ from each other, and even in ICD 10 they have different codes. Anyway, the essence is the same: gastritis is an extremely unpleasant disease and it must be treated. About how to live with the disease chronic gastritis, as well as its classification and degrees, you will find in our new material gastritinfo.com.
- What is chronic gastritis
- Chronic gastritis Clinic
- Chronic gastritis erosion
- Chronic gastritis: remission
- Chronic reflux gastritis
- Chronic esophagitis gastritis
- Chronic gastritis with focal atrophy
- Classification of chronic gastritis
- Houston classification of chronic gastritis
- Working classification of chronic gastritis
- New classification of chronic gastritis
What is chronic gastritis
Chronic gastritis is an inflammation that has a long, recurrent character. The result of a long course of the inflammatory process is mucosal degeneration, pathological changes in its structure, atrophy of cellular elements. The glands in the submucosa cease to function and are replaced by interstitial tissue. If at the beginning of the disease the decrease in secretion and peristaltic activity of the stomach is not pronounced enough, then in the later stages of chronic gastritis these symptoms increase.
Chronic gastritis is classified in terms of:
- anatomical location of the inflammation zone (antral or fundal gastritis);
- origin(bacterial, autoimmune, endogenous, iatrogenic, reflux gastritis);
- histological picture (superficial, atrophic, hyperplastic);
- conditions of secretory function (hypacid – decreased secretion, hyperacid – increased secrecy, with normal secretory function).
Clinical classification of chronic gastritis: chronic gastritis type A – primary autoimmune gastritis of the stomach floor (fundal); gastritis type B – antral gastritis of bacterial origin; type C – reflux gastritis.
There are also specific chronic gastritis, such as radiation, allergic, lymphocytic, granulomatous. According to the stage of the chronic process, gastritis may be in remission or inflammation.
Chronic gastritis Clinic
The clinical picture of chronic gastritis is characterized by a number of local and general symptoms, and also depends on the type of chronic gastritis. Sometimes chronic gastritis does not affect the general condition of the patient. Appetite remains, there is no tendency to reduce body weight, there are no dyspeptic manifestations.
Basically, the typical symptoms of chronic gastritis are the following manifestations:
- periodic pain in the epigastrium 1.5-2 hours after eating, increasing when walking and standing (characteristic symptoms of helicobacter gastritis);
- feeling of heaviness and overflow in the stomach after eating;
- belching air, food taste or somethingthat rotten, heartburn;
- unpleasant “metallic” taste in the mouth, salivation;
- poor appetite, nausea;
- rumbling and bloating, flatulence;
- violation of the stool (tendency to constipation or a tendency to relax the stool).
With an objective examination of a patient with chronic gastritis, there are often no external signs of the disease, especially at an early stage of the disease.As the disease progresses, the inflammatory process spreads to other parts of the stomach and the disease becomes diffuse with atrophy of the gastric mucosa and secretory insufficiency.
When examining patients, weight loss, pallor of the skin, symptoms of hypovitaminosis (congestion in the corners of the mouth, bleeding gums, hypercreatosis, brittle nails, hair loss) are observed. The tongue is overlaid with a white or yellowish-white plaque with tooth prints on the lateral surface. Moderate diffuse soreness appears in the epigastric region. The abdomen is usually soft, sometimes swollen, rumbling is detected on palpation; the lower border of the stomach is determined by the sound of splashing and is located below the normal level.
Patients with chronic gastritis often have symptoms of damage to other organs of the gastrointestinal tract. This makes differential diagnosis difficult, since often these diseases are primary, and chronic gastritis is their consequence.
The final diagnosis should be based on a comprehensive assessment of the clinical picture, the results of laboratory and instrumental studies with the identification of the main types of chronic gastritis.
Of great importance in the diagnosis of chronic gastritis is the exclusion of other similar diseases. If these symptoms occur, contact medical centers for diagnosis and treatment! Do not let the development of the disease take its course, this can lead to a neglected disease and cause complications.
Chronic gastritis erosion
Chronic erosive gastritis is based on impaired secretory processes. They can be associated with both a violation of the nature of nutrition, and with internal failures of the body. In this case, there is a violation of microcirculatory processes, blood circulation in the stomach and increased release of aggressive components of gastric juice. Naturally, the ischemic mucous membrane is not able to resist them, which leads to its inflammation with further ulceration and the formation of erosions.
It is extremely difficult to suspect the erosive form of gastritis only by clinical signs and complaints of the patient. The exception is those cases when gastric bleeding occurs against the background of confirmed gastritis.
In such situations, the fact of erosion formation becomes obvious. All other symptoms are typical for any type of gastritis and can only indirectly indicate its erosive appearance by their strong severity and persistence.
Symptoms of chronic erosive gastritis include:
- pain in the projection of the stomach (epigastric area of the upper abdomen): with erosive gastritis, it may not be intense, but with a common process, even the introduction of strong analgesics may be required for its relief;
- heartburn: it is most characteristic of chronic erosive gastritis with impaired gastric motility and reflux of acidic gastric contents into the lower esophagus;
- dyspeptic disorders in the form of persistent heaviness in the stomach, sour and rotten belching, dryness and bitterness in the mouth, stool disorders;
- an increase or occurrence of pain after eating or on an empty stomach, when only gastric juice is present in the stomach cavity, irritating pain receptors at the bottom of erosions.
Any suspicion of erosive gastritis should be confirmed or refuted using additional research methods. For these purposes, a visual assessment of the gastric mucosa during fibrogastroduodenoscopy is used.
This method allows us to reliably assess the degree of structural changes caused by the inflammatory process, determine its prevalence and, if necessary, make a biopsy. At the same time, a fragment of the mucous membrane is taken along the edge of erosion for its examination under a microscope.
To assess the secretory activity of the stomach and acidity during endoscopic examination, appropriate studies and measurements are performed. In hyperacid erosive gastritis with high acidity, a test for helicobacter infection is carried out, which affects the volume of therapeutic measures.
Chronic gastritis: remission
Chronic gastritis in remission is similar in the condition of a patient with a superficial form of the disease, which is an early period of the disease. To diagnose this type of ailment, the gastroenterologist directs the patient to the gastroscopy procedure.
In the inactive stage of the disease, the patient has completely or partially no signs of the disease. The patient can stop strict measures aimed at treating the disease. But it is very important to understand that you will still have to carry out prevention and be constantly monitored by the attending physician. This is necessary to prevent exacerbation.Patients often wonder what it is – remission of chronic gastritis. Doctors call this long-term ailment the last stage of gastritis.
It is important to realize that only effective recommendations from specialists will help minimize the manifestation of the disease. A chronic disease can develop in the body for a long time. Doctors attribute Helicobacter pylori to the main causes of exacerbation of the disease. After the penetration of the bacterium into the mucosa, it actively multiplies.
Doctors advise when diagnosing this serious ailment to completely abandon alcohol, since its use, even in a minimal amount, leads to an increase in the level of acidity in the stomach. Also factors affecting the exacerbation are problems with teeth, oral cavity, smoking, frequent use of medications, polluted air.
At this time, the following is observed in the patient’s body:
- the gastric mucosa has a thickening, and with complete remission, the shell acquires a natural state;
- dystrophic changes have affected the integumentary-pit epithelial tissue, but this is practically not visible;
- the nuclei acquire a larger size and become hyperchromic;
- positive material is located above the cell nuclei in the cytoplasm;
- there is a layer of mucus on the surface of epithelial tissue;
- the amount of RNA is significantly increased.
After a long remission , the patient can recognize the process of exacerbation by the following symptoms:
- after eating, a feeling of heaviness sets in;
- there are periods of pain;
- belching and heartburn torment;
- loss of appetite.
These feelings are implicit, so the patient may not attach importance to them and only resort to taking medications to drown out the symptoms. An important point that experts note is that the periods of symptoms are not constant and are associated with the diet. This suggests that the inflammatory process of the mucosa has not reached its apogee.
For example, when eating fried, salty food, heaviness occurs, and heartburn appears after the patient has drunk kefir or eaten citrus fruits. Such nutrition increases acidity. It is possible to talk about the return of a chronic ailment only after a daily increase in the manifestation of symptoms.
Chronic reflux gastritis
Reflux gastritis, its full name is chronic chemical-toxicoinduced or bile reflux gastritis, or type C gastritis, is a type of chronic gastritis. Reflux gastritis is a consequence of a violation of the function of the pylorus of the stomach, in which reflux (casting) of the contents of the duodenum (duodenum) into the stomach occurs.
Symptoms of chronic reflux gastritis:
- weight loss;
- vomiting with bile;
- feeling of heaviness in the stomach during or after eating;
- nausea;
- unpleasant taste in the mouth;
- diarrhea or constipation;
- bloating.
Often there is a “jam” on the lips, dry skin, anemia and weakness in the body. Such a diagnosis unites a large group of patients with duodenogastric reflux (DHR), i.e. the throwing of the contents of the duodenum containing very aggressive bile into the stomach. DHR can be caused by taking nonsteroidal anti-inflammatory drugs (see medicinal diseases), the result of surgical intervention (gastric resection).
Duodenogastric reflux is caused by insufficiency of the closing function of the pylorus, chronic duodenitis and increased pressure in the duodenum (duodenum). Such a violation of motor skills is detected with the help of antroduodenal manometry.
DHR leads to damage to the gastric mucosa, mainly the antrum, by bile acids, their salts, pancreatic enzymes, lysolecitin and other components of the contents of the duodenum.
It is very important not to make a diagnosis based solely on symptoms. It is necessary to undergo a thorough examination. Biochemical and general blood analysis, fibrogastroduodenoscopy (FGDS), ultrasound examination of the liver, gallbladder and pancreas, biopsy, stomach and duodenal X-ray examination should be performed. It is possible to diagnose DHR by conducting a daily pH-metry of the stomach.
Treatment of reflux gastritis depends on the main causal factor and is primarily aimed at normalizing the motility of the gastrointestinal tract and the binding of bile acids.
Since bile acids and lysolecitin have a damaging effect only in the presence of hydrochloric acid, then, depending on the severity of clinical manifestations, proton pump inhibitors can be used.
To prevent the contents of the DPC from being thrown into the stomach, prokinetics are prescribed.
Ursodeoxycholic acid is used to neutralize bile acids that have a damaging effect on the gastric mucosa.
Chronic esophagitis gastritis
Esophagitis is a disease of the esophagus, accompanied by inflammation of its mucous membrane.The most common cause is gastro—esophageal reflux, which leads to damage to the esophageal mucosa due to the effects of acid-peptic factor. If esophagitis is caused by reflux, it is called reflux esophagitis.
Chronic esophagitis is an inflammation of the mucous membrane of the esophagus, lasting more than 6 months. The disease can develop with insufficiently cured acute esophagitis or as a primary chronic process. Chronic esophagitis can develop with prolonged intake of excessively coarse or spicy food, strong alcoholic beverages.
The most common variant of this disease is peptic esophagitis (reflux esophagitis). Chronic esophagitis is accompanied by pain behind the sternum and in the epigastric region, it is often combined with gastritis or duodenitis, which gives a diverse clinical picture.
- belching with air or with an admixture of gastric contents after eating and physical exertion;
- complaints of heartburn, especially in the evening and at night;
- nausea, vomiting, hiccups, salivation, difficulty breathing are also possible.;
- hiccups usually begin after belching and last for a long time.
During chronic esophagitis, there are periodic exacerbations and remissions. If treatment starts late and esophagitis steadily progresses, scarring of the esophagus may form.
Chronic gastritis with focal atrophy
The classification of gastritis is quite diverse, and its atrophic form is no exception. According to the clinical manifestation, the disease can occur in an acute or chronic form.
Chronic atrophic gastritis is considered to be a subatrophic form in which foci with impaired trophism of the mucosa alternate with areas of epithelial hyperplasia Chronic atrophic gastritis is considered to be a subatrophic form in which foci with impaired trophism of the mucosa alternate with areas of epithelial hyperplasia: the stomach tries to compensate for the secretion deficiency caused by atrophy of some cells, which causes increased production of hydrochloric acid in healthy areas of the mucosa.
There is an imbalance of the acid balance, this process leads to more serious problems. Often, chronic gastritis develops against the background of an untreated acute form of the disease.
Chronic gastritis with focal mucosal atrophy has signs characteristic of many other forms of the disease:
- decreased appetite is one of the most characteristic manifestations of the atrophic type of gastritis, accompanied by a decrease in the patient’s body weight;
- pain sensations are localized mainly in the epigastric region, but pain may be absent, which is also characteristic of the atrophic form of pathology;
- digestive disorders in the form of nausea / vomiting – a common symptom for gastritis of almost all types;
- rumbling in the stomach, frequent heartburn, belching are also obvious signs of gastrointestinal problems;
- flatulence in atrophic gastritis is a consequence of metabolic disorders;
- diarrhea is a consequence of secondary intestinal damage by helicobacterium;
- after eating occurs a feeling of heaviness in the stomach lasting up to an hour;
- the smell of rotting coming from the mouth is a sign of the seriousness of the problem;
- the skin, which turns pale, and the hair, and nails, which is a consequence of beriberi in gastritis, undergo changes;
- headaches, dizziness may occur, blood pressure jumps are possible;
- with the atrophic form of the disease, a whitish plaque is found on the tongue, which may also indicate the presence of pancreatitis, enteritis, cholecystitis.
If a combination of several of the above symptoms is noticed, it is a signal of the presence of serious gastrointestinal problems and a reason to immediately consult a gastroenterologist – only a specialist should determine the symptoms and treatment of pathology.
Classification of chronic gastritis
The classification of chronic gastritis consists of the following forms:
- bacteria-associated Helicobacter pylori;
- autoimmune;
- chemically mediated;
- idiopathic;
- eosinophilic;
- granulomatous.
According to the production of gastric juice, the following types of ailment are distinguished: with an increased level of hydrochloric acid; with low acidity.
At the time of the biopsy, the doctor may detect the development of chronic gastritis in the following forms: non—atrophic — there is a lesion of the gastric gland, but it does not atrophy; subatrophic — partial necrosis of the pancreas; mixed – suppuration in the mucosa, due to which the tissues of the organ become dead.
Chronic gastritis can turn into an ulcer, and patients with two complex gastrointestinal diagnoses form an oncological risk group.
The classification of chronic gastritis is divided into categories according to the nature of the disease:
- type A or autoimmune — formed during a collision of immune system cells with the gastrointestinal mucosa;
- type B — destruction by Helicobacter pylori bacteria;
- type C or reflux gastritis — bile enters the stomach from the duodenum, affecting gastric mucosa. This discharge causes irritation and progression of the disease.
Houston classification of chronic gastritis
In this case, scientists distinguish types of chronic gastritis, based on different categories and etiology of the disease. In this theory, gastritis has certain varieties that do not have a secretory function study and the stages of the disease are not taken into account.
According to the creators of the classification, chronic gastritis happens:
- non-atrophic anacid or hypoacid — the body is affected by the bacterium Helicobacter pylori;
- atrophic antral diffuse — develops from an autoimmune process;
- atrophic multifocal diffuse — progresses due to poor nutrition, damage to gastric juice secretion or from the bacterium Helicobacter pylori;
- chemical — provoked by bile or frequent use of medications;
- radiation — due to radiation damage;
- lymphocytic — due to immune disorders and Helicobacter pylori bacteria;
- erythematous — deep layers of the organ are not affected;
- exudative — progresses under the influence of chronic ailments;
- follicular — rarely diagnosed.
The working classification of chronic gastritis is actively used to diagnose chronic gastritisThe developers of this classification did not base their achievements on the clinical and functional properties of the disease, so in practice doctors do not use it.
Working classification of chronic gastritis
Practitioners use other types of gastric gastritis from Dr. M. S. Ryss. This classification is a working one and is actively used for the diagnosis of chronic gastritis.
There is a classification of the disease by the type of inflammation:
- superficial;
- atrophic – multifocal and with unclear etiology;
- other forms of the disease — reactive, radiation, lymphocytic, granulomatous, eosinophilic, giant hypertrophic and others.
The disease can form in the antrum of the stomach; the body of the stomach. Based on the endoscopic picture, clinicians distinguish: superficial; erosive; atrophic; with bleeding (hemorrhagic); mucosal hyperplasia.
By morphology, gastritis is determined by:
- stages of inflammation;
- activity of the inflammatory process;
- presence of atrophy of the gastric glands;
- the presence of a predisposition to the oncological process;
- the stage of development of the bacterium.
According to the functional characteristic, there are: secretion with normal indicators; increased level of secretion; secretory insufficiency. Clinical symptoms of gastritis also indicate certain stages of the disease: exacerbation; remission. Based on the knowledge of the types of gastritis, the following types of pathological processes can be distinguished: bleeding; malignancy.
New classification of chronic gastritis
According to the new classification developed by German scientists, there are such forms of this disease: autoimmune; helicobacter; mixed; chemical-toxic; lymphocytic; special types.
At the present stage of medicine, an accurate diagnosis can be made thanks to a complete examination, correct analysis indicators and a detailed description of the ailment. Most often in practice, doctors use the expanded classification of Lynx, and the other types of gastritis presented remain its complement.