Atrophic gastritis is one of the most complex forms of the disease. Patients who have been given this diagnosis are often confronted with discouraging information about its prognosis. The prognosis for life with atrophic gastritis is disappointing, it is frightening that there is a possibility of the transformation of the disease into stomach cancer. A timely diagnosis, regular visits to a gastroenterologist and a well-chosen treatment plan help determine a positive direction in which there will be no significant deterioration in the patient’s condition. Prognosis for life with atrophic gastritis – learn more gastritinfo.com.
Prognosis for life with atrophic gastritis
Atrophic gastritis is a complicated histological sluggish pathology that provokes chronic inflammation of the gastric mucosa. Accompanied by atrophy, followed by loss of glandular cells and their replacement by an epithelium similar to the intestinal membrane.
The disease progresses when the body is infected with the bacterium Helicobacter pylori and the development of autoimmune processes leading to self-destruction of cells. It can be complicated by the presence in the body of the Epstein-Barr strain (type IV herpes virus infection). With the diagnosis of atrophic gastritis, the prognosis for life can be made qualitatively only on the basis of laboratory and endoscopic studies.
What is known today about atrophic gastritis
The most common etiological factors causing atrophic gastritis are Helicobacter pylori (H. pylori) infection and autoimmune gastritis. Moreover, the occurrence of the vast majority of atrophic gastritis is associated with H. pylori.
H. pylori bacteria, persisting on the gastric epithelium, cause chronic Helicobacter pylori superficial gastritis. Long-existing superficial Helicobacter pylori gastritis without appropriate treatment is transformed into atrophic.
Atrophic gastritis clinically, as a rule, does not manifest itself for a long time, therefore the diagnosis of chronic gastritis is more morphological than clinical. The main method for diagnosing atrophic gastritis is endoscopic examination. With endoscopy, the esophagus, stomach, and duodenum are examined. With severe atrophy, the gastric mucosa has characteristic differences in comparison with that with, for example, superficial gastritis.
The final diagnosis allows you to establish a morphological analysis of biopsy specimens of the gastric mucosa taken during endoscopy. Morphologically, atrophy is determined by a decrease in the number of functioning specialized cells of the stomach. It has been proven that in H. pylori-associated gastritis, atrophy processes more often occur when infected with certain strains (Cag A + and Vac A +) of H. pylori. One of the morphological signs of atrophic gastritis is intestinal metaplasia, which has traditionally been considered as a precancerous change in the gastric mucosa.
Other research methods – radiography of the stomach, ultrasound examination of the abdominal cavity and computed tomography – are not informative in terms of diagnosing atrophic gastritis.
Risks of atrophic gastritis
The disease can affect all segments of the population, regardless of gender and age. According to the results of studies conducted by the World Health Organization, about a twelfth of the population suffers from it, in varying degrees of severity. To make a prognosis for the course of the disease, you need the opinion of a highly qualified gastroenterologist. Based on all the available data, the specialist draws conclusions about the current state of the patient, gives a conclusion about how the disease complicates the anamnesis, whether the disease will proceed safely or be accompanied by a complex of complications.
Data on a decrease in life expectancy, subject to the recommendations of specialists, maintaining the prescribed treatment, has not been recorded.
The prognosis worsens as you advance through the age group. Metaplastic processes occur much more rapidly and lead to malignancy in the vast majority of cases. People over the age of 50 suffer from complications much more often than younger people.
Options for the development of the disease and the prognosis of the further course
To count on a favorable prognosis for life, atrophic gastritis must be treated at a very early stage. The treatment process should be supervised by a qualified specialist. Constant monitoring of the condition, observation by a doctor, regular examinations are mandatory factors in making a prognosis for patients with a similar diagnosis. Theoretically, the natural course of the disease develops according to two scenarios.
- In the first variant, a long-term sluggish chronic gastritis causes a significant decrease in the tone of the stomach functions responsible for acid formation. This leads to the need to resort to replacement therapy in order to avoid disruption of the digestive function. With insufficient attention, the absence of therapeutic and preventive measures, the likelihood of a cancerous tumor fluctuates within 10%.
- The second option provokes a failure in the cellular renewal of the epithelium of the stomach, which appears against the background of a constant focus of inflammation of the mucous membrane. As a result, atrophied cells mutate and become targets for the harmful effects of carcinogens. As a result, the cellular epithelium of the mucous membrane is replaced by atypical for the stomach dysplastic or tumor. With an unfavorable further course of the disease, experts predict the development of a cancerous tumor of the stomach, the risk of progression is 5 times higher than with ordinary gastritis.
Planned activities for a favorable forecast
The prognosis for atrophic gastritis for human life plays a significant role. It allows you to draw up the right treatment plan that will help to avoid complications or minimize their consequences. Evaluation and prediction of the development of stages of atrophic gastritis is made depending on the degree of inflammatory changes and deformities. The greater the percentage of lost functionally active cells of the epithelium of the gastric mucosa, the higher the risk of developing pathologies. Risk groups for stomach cancer are formed according to the stages of development of atrophic processes.
A good effect is the early treatment of pernicious anemia, which is a consequence of atrophy of the epithelium of the gastric mucosa. For a favorable prognosis, during the course of the disease, it is important not only to follow the recommendations of doctors, but also to support the body with non-drug means.
Compliance with the correct sparing diet (usually table number 1, 2 is prescribed) helps to reduce the load on the digestive tract. It includes fractional meals, with portions not exceeding 60 gr. each, pureed food with neutral acidity, low-fat broths, foods with reduced gas formation.
A prerequisite is to avoid food that contains stabilizers and carcinogens (chips, smoked meats, some types of canned food). As a result of proper nutrition, the secretion of gastric juice is stimulated, and subsequently the gradual restoration of the cell epithelium of the gastric mucosa occurs.
Do not neglect traditional methods of treatment:
- Decoctions and infusions of mint, chamomile, calendula, plantain, stinging nettle help reduce inflammation in the stomach.
- Healing is promoted by the composition of aloe with honey.
- Strengthening agents from eleutherococcus and ginseng root, cabbage and potato juice stimulate the body, restore secretion.
A favorable prognosis for atrophic gastritis significantly increases the rejection of such bad habits as smoking, drinking alcohol. This increases the chances of a positive trend in the course of the disease. You should also avoid stressful situations, increased physical exertion, take hormonal and laxative drugs with caution.
How to avoid the transformation of atrophic gastritis into stomach cancer
The answer to this question consists of equal parts: early detection of precancerous changes, their adequate treatment and prevention (prevention) of the manifestation of the latter.
When observing patients with chronic gastritis, it is important to catch the moment when atrophy of the gastric mucosa occurs and begins to progress, and it is desirable to do this in a simple, informative and non-invasive way.
Timely detection of atrophy of the gastric mucosa is the first diagnostic step in identifying the risk of gastric cancer.
Numerous recent studies have shown that foci of complete and incomplete intestinal metaplasia of the gastric mucosa cannot be regarded as a reliable marker of an increased risk of developing gastric cancer. Studies show that it is much more important to assess not the type of metaplasia, but its volume. So, with a large amount of metaplasia, exceeding 20% of the surface of the gastric epithelium, real conditions are created for the development of dysplasia, followed by the formation of gastric adenocarcinoma. Therefore, the risk of developing gastric cancer increases with severe atrophy of the gastric epithelium, characterized by extensive foci of intestinal metaplasia.
How, in practice, to determine the area of such a lesion? It should be remembered that these changes occur at the cellular level and cannot be recognized with conventional endoscopy. An affordable and effective way to diagnose metaplastic changes in the gastric mucosa is the method of chromogastroscopy – intravital staining of the gastric mucosa with a dye (usually methylene blue), carried out during endoscopic examination.
This technique is based on the absorption of the dye by foci of intestinal metaplasia, which makes it possible to assess their size, perform targeted biopsy for histological analysis of the mucosal biopsy and identify possible dysplasia or metaplasia.
However, the morphological diagnosis of atrophic gastritis is associated with a number of difficulties. The complexity of diagnosing atrophy by the morphological method is due to the fact that in the early stages the process is never diffuse, therefore, the results of gastrobiopsy can contribute to overdiagnosis and underdiagnosis. With inflammation, the microscopic picture may change and the manifestations of atrophic gastritis may be inadequately assessed due to a false conclusion about the loss of glands. The subjectivity of the methodology is also high. All this makes us look for other reliable ways to test atrophic changes in the gastric mucosa.
A number of minimally invasive hematological tests (Biohit test panel) have been developed to avoid diagnostic errors, to give a cumulative assessment of the state of the gastric mucosa, the degree of its atrophy and the loss of normal glands and cells in the antrum and body of the stomach.
During an endoscopic examination, detection for the presence of H. pylori must be carried out. At the same time, urease or histological methods (from gastrobiopsy specimens) of the study should be recognized as the most appropriate.
Determination of the level of serum pepsinogen (S-PGІ) or the ratio of pepsinogen I to pepsinogen II (PGI / PGII) is a non-endoscopic method for diagnosing atrophic gastritis with damage to the body of the stomach. As the degree of atrophy of the gastric corpus mucosa (loss of normal acid-producing glands) increases, the levels of S-PGI and PGI/PGII gradually decrease. Determination of the level of gastrin in the blood serum, mainly gastritis-17 (SG-17), can be used as an indicator of the morphological state of the mucous membrane of the antrum of the stomach. That is, a decrease in SG-17 is a biochemical marker of atrophic gastritis with damage to the antrum of the stomach (loss of antral G-cells).
Decreased levels of SG-17 and S-PGI can be seen as a result of progressive atrophic gastritis with loss of normal glands and cells of the mucosa of the body and antrum. G-17 is almost completely synthesized and secreted by G-cells in the antrum of the stomach. These cells are components of normal antral glands; in the case of progression of atrophic gastritis, their number decreases against the background of damage to the antral glands and the appearance of intestinal metaplasia.
In H. pylori-associated gastritis, there is a tendency to increase the serological levels of G-17 and PGI. Low intragastric acidity contributes to an increase in the serological level of G-17, and vice versa.
Permanent long-term hypo- or achlorhydria leads to extremely high levels of G-17 in the blood. This is especially often observed with low acidity (atrophic gastritis with damage to the body of the stomach) in combination with the preserved mucous membrane of the antrum. This clinical picture is most characteristic of autoimmune atrophic gastritis. If there are concomitant signs of mucosal atrophy in the antrum (multifocal atrophic gastritis), then SG-17 levels do not increase and the test panel shows low S-PGI and SG-17 levels.
The overall accuracy of the test panel in the diagnosis of atrophic gastritis is about 80% (when compared with the results of endoscopy and biopsy). This test panel is a minimally invasive alternative to the initial screening of patients with suspected gastric atrophy and dysplasia. It allows you to reliably identify patients with various forms of gastritis, determine the localization and etiology of the pathological process, assess the likelihood of developing gastric cancer and build further tactics for managing the patient.
Considering the connection between the occurrence of atrophy of the gastric epithelium and intestinal metaplasia with H. pylori infection, the choice of a method of treatment and prevention of further progression of the process becomes obvious. The method of choice is antihelicobacter therapy.
In 2002, Japanese researchers convincingly proved the possibility of regression of metaplastic changes in the gastric mucosa after the successful destruction of H. pylori bacteria. With the help of chromoscopy, they were able to establish that within five years after successful anti-Helicobacter therapy, the size of foci of intestinal metaplasia decreased by almost 2 times compared to the original ones. Subsequent studies have confirmed the feasibility of this therapeutic approach.
Currently, there is no doubt about the need for anti-Helicobacter therapy in patients with atrophic gastritis. Preliminary data from several multicentre monitoring studies of H. pylori-associated gastric precancer and cancer suggest reversal of gastric mucosal inflammation and associated atrophy, intestinal metaplasia, and genetic instability. In this regard, ideally, patients with H. pylori-positive chronic atrophic gastritis should undergo eradication therapy, and in the absence of an effect, a study to identify markers of genetic instability and careful monitoring.
This recommendation is reflected in the international guidelines for the diagnosis and treatment of diseases associated with H. pylori – Maastricht Consensus 3 (2005). For the destruction of H. pylori bacteria, as in the Maastricht Consensus 2 (2000), three- and four-component regimens of antibacterial drugs are recommended in combination with proton pump inhibitors (PPIs) in standard doses: PPI + clarithromycin + amoxicillin and PPI + tetracycline + metronidazole ( furazolidone) + colloidal bismuth.
At the same time, it should be remembered that the complete restoration of the mucosal structure in severe atrophy to normal takes a long time, and in some cases, apparently, this is not possible. In cases where pretumor processes do not undergo regression or progress, it is necessary to apply more radical methods of treatment, using the arsenal of modern endoscopic operations, up to resection of the gastric mucosa.
The main goal of primary prevention of atrophic gastritis is the timely and effective treatment of superficial Helicobacter pylori gastritis. To do this, use the standard schemes of anti-Helicobacter therapy, in accordance with the recommendations of the Maastricht Consensus 2 (2000) and 3 (2005). An important point is the subsequent monitoring of the success of this therapy. Control should be carried out using non-invasive methods (respiratory urease or stool test). In case of unsuccessful eradication, repeat courses of treatment.
In addition, it has been proven that a healthy diet can reduce the risk of cancer (progression of wasting), as confirmed in studies conducted in several countries. It is recommended to avoid the use of canned, pickled and smoked foods, stop smoking and drinking strong alcoholic beverages (especially in combination with fatty, fried, smoked and salty foods), avoid overeating.
It is necessary to control body weight, perform active physical activity, consume more fresh vegetables (including onions and garlic), fruits and natural juices, vitamins A, C, b-carotene, greens, whole grains, dairy products. In some developed countries of Europe and the USA, the introduction of a healthy lifestyle has led to a decrease in the incidence of stomach cancer by several times,
Monitoring – continuous observation with periodic re-examination – is absolutely necessary for patients with atrophic gastritis. So, now the need for special attention to atrophic gastritis is obvious. The complex application of modern research methods – endoscopic, morphological, hematological (test panel) and others – contributes to its accurate diagnosis.
The use of effective methods of treatment and prevention of atrophic gastritis, the elimination of conditions that contribute to its development, today represent a real opportunity to improve the prognosis of this disease, eliminate the risk of developing stomach cancer.
Atrophic gastritis of the stomach