Etiology and mechanisms of development
The development of chronic inflammation in the stomach is caused by exposure to various damaging factors. The primary role in the development of this pathology is played by an infectious agent — the bacterium Helicobacter pylori. However, there are also non-microbial triggers capable of initiating and sustaining the inflammatory process.
Non-microbial factors include:
- Dietary and toxic: alcohol abuse.
- Drug-induced: mucosal damage associated with the use of non-steroidal anti-inflammatory drugs (NSAIDs) and other aggressive medications.
- Chemical: exposure to bile entering the stomach during duodenogastric reflux.
- Immune: body malfunctions leading to the production of autoantibodies against its own cells.
The morphological picture of the disease undergoes significant changes over time. The dynamics have a clear staging. In the initial stages, superficial lesions occur, characterized by pronounced tissue infiltration by lymphocytes and plasma cells. With further progression of the process, inflammation affects the glandular apparatus of the stomach. A regular outcome is the formation of gastritis with atrophy, which is visually manifested by a noticeable decrease in mucosal folding.
General clinical picture
The insidiousness of chronic gastritis lies in the fact that the disease often has a completely asymptomatic (latent) course. When symptoms are present, the pain syndrome is usually localized in the epigastric region. The pain is vague and, as a rule, quite mild.
Dyspeptic syndrome comes to the forefront in patients, which is usually divided into two types:
- Gastric dyspepsia: manifested by decreased appetite, a distressing sensation of fullness immediately after eating, nausea, episodes of vomiting, and frequent belching.
- Intestinal dyspepsia: includes pronounced abdominal bloating (flatulence), rumbling, and irregular bowel movements.
Clinical features depending on secretion
To establish an accurate clinical diagnosis, it is extremely important to differentiate symptoms based on the current level of acid production.
1. Variant with preserved or increased secretion Such patients most often complain of persistent heartburn and sour belching. The pain syndrome manifests as dull, aching pains in the epigastrium, which usually occur on an empty stomach or at the very peak of digestive processes. A tendency toward constipation is noted from the intestinal tract.
2. Variant with secretory insufficiency In this case, the leading complaints become dull pain, nausea, and a sensation of fullness in the abdomen. A specific sign is an unpleasant taste in the mouth and foul-tasting belching, which is a direct consequence of stagnation and fermentation of undigested food. Stools more often tend toward diarrhea.
Due to a critical impairment in nutrient absorption, malabsorption syndrome and hypovitaminosis develop. They manifest as systemic signs: dry skin, cracks ("angular cheilitis") at the corners of the mouth, and pathological nail changes. Dumping syndrome is also possible — the appearance of severe weakness, tachycardia, dizziness, and sweating occurring immediately after eating.
Diagnostic workup and management tactics
The definitive diagnosis is based exclusively on instrumental data. EGD with biopsy is recognized as the "gold standard" — this method allows visual assessment of the mucosa and histological confirmation of the diagnosis.
A mandatory step is the detection of Helicobacter pylori, which is critically important for prescribing eradication therapy and achieving a complete cure. Assessment of gastric secretory function is carried out using fractional probing with stimulants such as pentagastrin or histamine. Contrast-enhanced X-ray examination is inappropriate, as changes typical of gastritis are not visualized on images.
Treatment of mild chronic gastritis:
- Regimen and diet therapy: the basis of treatment is easily digestible food and strict exclusion of triggers (alcohol, individually intolerant foods, NSAIDs). Specific treatment is often not even required.
- Etiotropic therapy: upon detection of the bacterium Helicobacter pylori, mandatory eradication therapy is prescribed.
- Replacement support: strictly according to indications, vitamin B12 is used, as well as gastric juice preparations or hydrochloric acid solutions, which are taken strictly with food.
Briefly: answers to topical questions
What specific drugs are included in Helicobacter pylori eradication therapy regimens?
Eradication therapy regimens for Helicobacter pylori infection include proton pump inhibitors, antibacterial agents, and bismuth preparations. Treatment components include the following drugs:
- Omeprazole — a proton pump inhibitor.
- Amoxicillin — a broad-spectrum penicillin antibiotic.
- Clarithromycin — a macrolide antibiotic.
- Metronidazole — an antibacterial agent.
- Bismuth preparations — used in standardized treatment regimens.
What stages and severity grades are distinguished in the histological assessment of gastritis according to the OLGA system?
In the histological assessment of chronic gastritis according to the OLGA system, the following are distinguished:
- Stages 0, I, II, III, and IV. Stage is an integral assessment of mucosal atrophy in all parts of the stomach. Stage 0 corresponds to the minimal risk of carcinogenesis, Stage IV to the maximum risk; in patients with stages III–IV, the risk of developing intestinal-type gastric cancer is increased by 6 times.
- Grade of chronic gastritis — assessment of the severity of inflammatory infiltration.
Specific gradations of grades are not detailed in the sources.
According to what criteria is chronic gastritis classified into types A, B, and C?
Chronic gastritis is classified into types A, B, and C based on etiology, localization of the lesion, and features of the pathological process.
| Type | Synonym | Etiology | Localization and features |
|---|---|---|---|
| Type A | Autoimmune | Autoantibodies to parietal cells | Lesion of the gastric body, pronounced decrease in secretory function |
| Type B | Bacterial / infectious | Helicobacter pylori | Usually the antrum |
| Type C | Chemical / reflux gastritis | Exposure to bile or NSAIDs | Reactive epithelial changes without pronounced inflammation |
Class and exam questions
Why is barium X-ray not prescribed for chronic gastritis?
Contrast-enhanced X-ray examination in this pathology is inappropriate, as characteristic structural changes of the mucosa are not visualized on images.
On what basis is the definitive diagnosis established?
Verification of the diagnosis is entirely based on the results of endoscopic examination (EGD) and subsequent histological evaluation of the obtained biopsy specimen.
Why is it necessary to detect Helicobacter pylori?
Detection of this infectious factor is critically important, as its presence requires the prescription of mandatory eradication therapy, without which a cure is impossible.
What else to study on this topic
- Pathogenesis of dumping syndrome in secretory insufficiency
- Methodology for fractional gastric probing with stimulants
- Mechanisms of malabsorption syndrome and vitamin B12 hypovitaminosis
- Regimens for Helicobacter pylori eradication therapy
- Impact of duodenogastric reflux on the development of mucosal atrophy
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