Antral gastritis is a chronic inflammatory disease of the stomach that affects the mucous membrane in the outlet (antrum). It refers to chronic gastritis type B – bacterially caused. It is manifested by pain in the epigastrium (hungry or a couple of hours after eating), nausea, belching acid, dyspeptic phenomena with preserved appetite. The main diagnostic method is fibrogastroduodenoscopy, a study for the presence of helicobacteria. Anti-helicobacter antibiotics, antacids, regenerating and painkillers are necessarily included in the treatment.
ICD 10
K29 Gastritis and duodenitis
Meaning
Antral gastritis is a chronic inflammation of the gastric mucosa localized in the pyloric department. This part of the stomach performs the function of alkalizing the food chyme before passing into the intestine. Inflammation in the antrum causes blocking of bicarbonate production, the acidity of gastric juice increases, and acidic contents enter the duodenum, provoking the formation of ulcers. Antral gastritis is usually considered as an early stage of chronic gastritis, with this form of inflammation, helicobacteria are detected in very large numbers. When the infection spreads to other departments, the number of bacteria decreases. Antral gastritis has symptoms very similar to gastric ulcer. 85% of all stomach diseases account for this pathology, however, only 10-15% of all patients with chronic gastritis turn to a gastroenterologist.
Causes of antral gastritis
According to the observations of specialists in the field of clinical gastroenterology, about 95% of all cases of chronic antral gastritis are associated with the detection of a bacterium called Helicobacter pylori in the gastric mucosa. This pathogen can comfortably inhabit gastric mucus at a pH of 4 to 6, although it retains its activity in a more acidic environment. Hypochlorhydria (low acidity of gastric juice) is detrimental to helicobacteria. In unfavorable conditions, the bacterium can take a special form of rest, and when it gets into a comfortable environment, it becomes active again.
Contribute to the helicobacter invasion of duodenoastric reflux (throwing the contents of the intestine into the stomach due to the weakness of the pylorus), taking certain medications (salicylates, NSAIDs, anti-tuberculosis drugs), food allergy, malnutrition, alcohol consumption, smoking. Some internal factors also predispose to the development of this pathology: foci of chronic infection, endocrine pathology, iron deficiency, heart and respiratory failure, chronic renal failure.
Pathogenesis
A feature of helicobacteria is their production of a number of enzymes that contribute to changing the environment around them. Thus, urease breaks down the urea in the stomach to ammonia, alkalizing the environment around the microorganism. Mucinase helps to reduce the viscosity of gastric mucus. In such conditions, mobile bacteria easily penetrate through the protective mucus layer to the antral epithelium of the stomach, where they begin to multiply actively, causing damage to the mucosa and disruption of the gastric glands. The pyloric department ceases to produce bicarbonates (alkalizing medium), and therefore the acidity of gastric juice gradually increases, further damaging the epithelium of the stomach and in other departments.
Symptoms of antral gastritis
Usually, inflammation of the antral part of the stomach takes place in the initial stages as a non-atrophic process without insufficient secretion of gastric juice. The clinic of this pathology is ulcerative: pain in the epigastric region, hungry or a few hours after eating; heartburn, belching with acid and air, a tendency to constipation. The appetite does not suffer at the same time. On examination, the tongue is clean, moist. On palpation of the abdomen, soreness is localized in the epigastrium on the right (pyloroduodenal zone). Weight loss occurs only in the severe course of the disease.
Diagnostics
With contrast-enhanced gastrography in patients with antral gastritis, there is a thickening of relief folds in the pyloric section, spasm of the pylorus, segmenting peristalsis, disorderly evacuation of gastric contents. With EGS, spotty hyperemia of the mucosa is visible, swelling of tissues in the antrum, hemorrhages and erosions may be detected. There is increased exudation, stagnation of the contents in the stomach due to a spasm of the pylorus. During an endoscopic examination, a tissue biopsy is necessarily performed for histological examination and isolation of the pathogen. At the same time, pronounced inflammation, a large number of helicobacteria on the surface of the epithelium are histologically determined.
Urease test for the determination of helicobacteria is carried out using special express kits during gastroscopy. To do this, a biopsy of the mucosa is placed in a special medium, which changes its color depending on the concentration of microorganisms to crimson – from an hour to a day. If the color has not changed during the day, the test is negative. There is also a C-urease breath test. To carry it out, C13-labeled urea is injected into the stomach, and then the concentration of C13 is determined in the exhaled air. If there are helicobacteria in the stomach, they will destroy urea, and the concentration of C13 will be higher than 1% (3.5% is a mild degree of invasion, 9.5% is extremely severe).
From mucosal biopsies, crops are necessarily made, incubation of which occurs at an extremely low oxygen concentration (less than 5%) on blood media. The result of sowing with sensitivity to antibiotics will be obtained in 3-5 days. The ELISA method of detecting antibodies to helicobacteria in blood, saliva and gastric juice is quite sensitive. Antibodies appear in the blood within a month after infection, and remain active also for a month after complete cure. To determine the acidity of gastric juice, intragastric pH-metry is used, a fractional study of gastric juice with the use of secretion stimulants. The disease is differentiated with functional disorders, gastric ulcer.
Treatment for antral gastritis
The treatment of this pathology is carried out by gastroenterologists, therapists, endoscopists; in case of exacerbations, the patient is in the department of gastroenterology or therapy. Treatment of antral gastritis begins with the appointment of a special therapeutic diet: during the period of exacerbation, table 1b with a gradual expansion to the first table for several weeks or months.
Antihelicobacteria drugs are necessarily prescribed. Etiotropic therapy of H.pylori is quite complicated, since this microorganism quickly adapts to popular antibiotics. Most often, a double or triple treatment regimen is prescribed, which includes metronidazole, clarithromycin, ampicillin or tetracycline. It is recommended to add proton pump inhibitors to the scheme, which inhibit helicobacteria, and carry out their complete eradication with antibacterial drugs.
Anti-inflammatory therapy can be carried out both with pharmacy drugs and herbs according to recipes of traditional medicine. So, during the period of exacerbation, it is recommended to use infusions of chamomile, mint, St. John’s wort, flax seeds. When erosions appear on the mucous membrane of the antrum of the stomach, increased acidity of gastric juice, antisecretory agents are prescribed. With pilorus spasm, myotropic antispasmodics are successfully used: drotaverine, papaverine. Metoclopramide is used to normalize peristalsis and eliminate duodenogastric reflux.
The condition for full recovery is the appointment of reparative agents. These may be drugs that stimulate protein synthesis (inosine, anabolic steroids), carnitine, sea buckthorn oil. Physiotherapy also occupies an important place: galvanization of the stomach with electrophoresis of drugs (with spasm of the pyloric department), UHF therapy, ultrasound treatment (with analgesic purpose), Bernard diadynamic currents, sinusoidal modulated currents (to eliminate pain and dyspepsia). After relieving the exacerbation, mud and paraffin therapy, treatment with mineral waters are recommended.
Prognosis and prevention
The prognosis for antral gastritis is favorable only with the timely start of treatment, compliance with all recommendations, daily routine and nutrition. If you do not consult a gastroenterologist in time, gastritis turns into a diffuse form, which can result in the formation of ulcers (with mucosal hyperfunction) or stomach tumors (with mucosal atrophy). In order to avoid the development of a severe inflammatory process in the stomach, it is necessary to eat right, give up bad habits (smoking, alcohol), avoid physical and emotional overstrain, observe the daily routine.
