Active atrophic hyperplastic gastritis. Signs and treatment of atrophic hyperplastic gastritis

Gastritis is an inflammation of the lining of the stomach. There are several forms of this disease, one of which is atrophic hyperplastic gastritis. The most dangerous type of disease that can provoke the occurrence of stomach cancer.

Description of the disease

With this form, always low acidity gastric juice. The number of cells that are involved in the production of secretion decreases. There is atrophy and thinning of the stomach lining. First initial stage the epithelium grows, and polyps appear.

In other words, atrophic hyperplastic gastritis is a pathology with benign neoplasms which, under the influence of negative conditions, are transformed into malignant (cancer).

When the mucosa is injured, autoimmune reactions are triggered, and the body perceives the secretory cells of the stomach as an “enemy”. As a result, the mucous membrane gradually atrophies.

Varieties

There are several types:

Polypous. The back wall of a stomach is usually exposed to a hyperplasia. With this pathology, atrophied areas are affected by growths in the form of polyps and folds.
Warty. It looks like formations of a warty type, localized one by one. Dangerous destruction of the mucosa of the antrum of the stomach.
Giant (Menetrier's disease). This type of pathology is expressed by multiple benign growths, similar to adenomas. The disease affects the antrum (more about).
. Are formed small foci gastric mucosa, resembling grains. Most often, the disease affects the anterior wall, less often the back.

There are also the following forms: , chronic, acute, moderate, diffuse.

Regardless of the identified form, hyperplasia and atrophy are signs of a precancerous condition.

Causes

Atrophic gastritis is formed against the background. The bacterium Helicobacter Pylori affects the exacerbation of the disease. It, penetrating deep into the gastric mucosa, causes the death of its cells.

Also adverse factors that affect the occurrence of the disease are:

eating a large number smoked, fried, fatty foods;
taking medications: analgesics, glucocorticoids, which negatively affect the gastric mucosa;
smoking and alcohol;
food poisoning;
food on the run, dry food;
chemical substances.

Symptoms

At the initial stage, the disease does not manifest itself, the development of pathology occurs slowly and is almost asymptomatic. As the disease progresses, after eating food, aching pain in the stomach, passing into the scapula and lower back. Appetite decreases. Even after taking light food, a person feels heaviness and overcrowding in the stomach. After a small portion of food, glut is felt.

Over time they appear the following signs stomach hyperplasia:

bloating;
constant belching and heartburn;
increased;
weakness and dizziness;
signs of anemia: decreased activity, weakness, dry and brittle hair and nails;
whitish or yellowish coating on the tongue;
violation of the chair;
vomiting, after great nervous excitement.

Diagnosis of hyperplastic gastritis

At different forms gastritis are most often similar, therefore, to determine the exact diagnosis, the following studies are carried out:

Fibrogastroduodenoscopy (FGDS). Most exact method diagnostics. With its help, you can not only determine the condition of the mucosa, but also take a tissue sample for analysis.
Helicobacteriosis test. Reveals pathogenic microorganisms causing chronic gastritis.
Biochemical blood test to diagnose anemia.
Abdominal ultrasound.
Serum amylase and fecal elastase to rule out pancreatitis.

Treatment

In patients with atrophy, treatment should be under the supervision of a gastroenterologist in order not to miss the moment when the disease turns into malignant tumor. This disease cannot be completely cured. Treatment is directed only at:

cessation of progression and changes in the stomach;
restoration of secret function and elimination of signs of atrophic hyperplastic gastritis;
correction of the central nervous system and stabilization of the bowels.

Treatment is medical, symptomatic. Of the drugs prescribed: antisecretory agents; antacids, as a neutralizer of hydrochloric acid; antispasmodic drugs to eliminate pain. The list of drugs includes: Almagel, Actovegin, Nolpaza, De-nol, Karinat, Omeprazole and others.

If the disease is at the last stage, then the medicines must be taken for life.

When the bacterium Helicobacter pylori is detected, a special regimen is prescribed, including antibiotics. After treatment, a re-examination for the presence of bacteria is carried out.

It is unacceptable to treat this disease with folk remedies. This will not only aggravate the disease, but is generally dangerous to health. The entire treatment regimen is prescribed only by the attending physician.

Diet

Treatment of atrophic hyperplastic gastritis is necessarily carried out using diet food. Food should be gentle both thermally and mechanically. Exclude spicy, smoked, sweet, fatty, alcohol, products that can irritate the mucous membrane.

Solid vegetables, as well as meat, are chopped. Food is cooked exclusively by steaming or in the oven. Fruits are preferably eaten in a baked form.

To develop a constant reflex to the release of digestive juice, food should be taken at the same time, in small portions at least 5 times a day.

Food temperature should not exceed 65 degrees. too low or heat causes mucosal irritation.

To increase appetite, you should eat fish and meat broths. For breakfast, you can eat pumpkin or applesauce. Here is a list of products that must be in the patient's diet:

porridge with milk;
non-greasy boiled fish or meat;
dairy products;
stewed, boiled vegetables.

From drinks you can drink: green tea, decoction of dried fruits, fruit drink, compote.

If followed, the recovery process will go much faster.

Prevention

Patients diagnosed with atrophic hyperplastic gastritis need constant medical control. As statistics show, when polyps are detected, the risk of cancer pretty high.

With the aim of atrophic gastritis you need to follow these simple rules:

adhere to the diet and normalize the number and frequency of meals, the process of digestion;
completely abandon all harmful (smoking, alcohol);
do physical education;
do not eat before bed;
spend more time outdoors;
Avoid prolonged stress.

proper nutrition, physical exercise, emotional peace of mind excellent condition digestive organs.

The information on our website is provided by qualified doctors and is for informational purposes only. Do not self-medicate! Be sure to contact a specialist!

Gastroenterologist, professor, doctor medical sciences. Prescribes diagnostics and conducts treatment. Study Group Expert inflammatory diseases. Author of more than 300 scientific papers.

Hyperplastic form of atrophic chronic gastritis differs from others in the pronounced ability of some cells of the gastric mucosa to actively grow (proliferation).

The process is accompanied by the destruction of the epithelium useful for functioning, which produces hydrochloric acid and components of gastric juice. As a result, supported chronic inflammation in the stomach, functional connections with neighboring organs involved in digestion are disrupted.

Diagnosis and treatment of atrophic hyperplastic gastritis require an assessment of structural changes formed as a result of proliferation, differentiation with malignant growth. According to the International Statistical Classification, the disease is included in the group "Other gastritis" under the code K29.6.

What is known about prevalence?

It has been established that a disease such as atrophic hyperplastic gastritis accounts for about 5% of all chronic pathology stomach. Its varieties are identified with different frequency.

For example, giant hypertrophic gastritis affects both adults and children. Moreover, men are 3.5 times more likely than women, and more typical for age category from 30 years and older. The polypous appearance is typical for women 40–45 years old.

What are hyperplastic growths formed from?

The method of examining the stomach using a fibrogastroscope and studying biopsies from different parts of the affected tissue made it possible to identify microscopic changes associated with hyperplastic cell proliferation.

In areas of inflammation, the process of mitosis (division) of cells changes. As a result, the order of the location of the excess number is violated, the folded structure of the gastric mucosa changes, thickened folds (rigid) appear, which cannot stretch and increase the volume of the stomach when food is received.

In the submucosal layer (submucosal), instead of elastin fibers, dense nodular formations are formed, different in size and crowding. Structural disorders located in different parts stomach (in the body, cardia, antrum). Against the background of the growth of the epithelium, the glandular cells that produce gastric juice are suppressed and destroyed, the surrounding mucosa atrophies.

Histological examination reveals areas of clutter and destruction of the epithelium

Causes

The occurrence of mucosal atrophy is explained by external and internal causes. External influence provided through:

violations of the regimen and the usefulness of food intake ( long periods hunger, abnormal diets, obsession with fat meat food, lack of sufficient volume of vegetables and fruits);
influence of alcohol and nicotine;
professional and household poisoning toxic acids, alkalis, salts heavy metals;
drug sensitivity.

Internal causes are combinations of unfavorable factors, which include:

infection with Helicobacter pylori;
the presence in a person of severe nervous and endocrine disorders that violate the processes of regulation of the restoration of the epithelium of the stomach;
deterioration of tissue nutrition due to damage vasculature atherosclerosis, education venous congestion with thrombosis;
unfavorable heredity.

These reasons are significant for any form of atrophy. In order for a hyperplastic process to appear against this background, you need additionally:

Anisakidosis is common among marine life, a person becomes infected in the process of eating salted fish or cooking dishes from fresh fish, which is accompanied by eosinophilia

Are there risk factors?

Among the factors contributing to the hyperplastic course of atrophic gastritis, experts consider the presence of food allergies in a person (40% of cases in children are associated with gluten intolerance - celiac disease), vitamin deficiency, hyperglycemia in diabetes and kidney disease associated with kidney failure.

Determined that long-term use in the treatment of gastritis drugs that block the production of hydrochloric acid (a group of inhibitors proton pump, Omeprazole and analogues) leads to a significant increase in the risk of excessive activation of polyps in the areas of the gastric pits and major glands.

Development mechanism

The development of hyperplastic growth of epithelial cells on the gastric mucosa causes an excess of mucus production. At the cellular level, division is stimulated by special growth factors. At the same time, acid synthesis in parietal cells is suppressed. A similar mechanism explains the parallel processes of hypertrophy in separate areas with gradual atrophy of the surrounding tissue.

Symptoms of atrophic hyperplastic gastritis

Clinical signs of atrophic hyperplastic gastritis are somewhat different depending on the type of pathology. But initial symptoms are usually the same and manifest as a feeling of heaviness in the epigastric region after eating fatty meat dishes, hot spices, pickles.

The disease proceeds for a long time without complaints. But with a retrospective survey of the patient, the doctor can identify:

frequent heartburn;
nausea;
bloating;
rarely vomiting food eaten;
the appearance of plaque on the tongue;
belching with an unpleasant odor.

Since at the initial stage the acidity remains normal or increased, pain in epigastric region may be cramping (spastic), less often described as aching or pressing

In cases of an erosive type of gastritis, the pain intensifies when the body is tilted, walking. Exacerbations are associated with spring and autumn periods. In the feces and vomiting, blood impurities are found. With giant hypertrophic gastritis, symptoms are often absent. Some patients still note nausea, diarrhea, weight loss, lack of appetite, rare stomach bleeding.

In the blood of such patients, the level of protein (albumin) is significantly reduced. This contributes to additional swelling of the stomach tissues. Hyperplastic gastritis - chronic illness. It proceeds with periods of exacerbations and remissions. These symptoms characterize the stage of exacerbation.

Types of disease

The latest classification of gastritis is called the place of its adoption, Sydney. Not all domestic gastroenterologists agree with her conclusions. In practice Russian doctors There are several types of hyperplastic gastritis.

Focal

Another name is "nodular endocrine cell hyperplasia", benign hyperplasia in the form of a tumor less than 15 mm in diameter. It is based on growth endocrine cells stimulated by an excess of the hormone gastrin.

Occurs more frequently in patients with pernicious anemia caused by deficiency of vitamin B 12 . The mutated tumor suppressor gene MEN1 is recognized as the “culprit” of tumor growth, it is related to multiple endocrine lesions.

Surface

Only the most upper layer prismatic epithelium on the gastric mucosa.

diffuse

The diagnosis is made with the multiple nature of hypertrophic changes, regardless of the etiological factor.

polyposis

According to the classification, “multifocal atrophic gastritis with focal hyperplasia”, multiple or single polyposis growths (focal and diffuse forms) consisting of glandular cells are found on the mucosa. More often associated with massive Helicobacter pylori infection, autoimmune processes, reduced acidity.

Typical for patients over 50 years of age

Erosive hyperplastic

In a different way called lymphocytic-erosive gastritis, against the background of leukocyte infiltrates and hypertrophy of the folds, nodules and areas of erosion of the mucosal tissue are visible, more often in the zone of the pits of the cardiac, pyloric sections and the body of the stomach. The index of acidity of gastric juice can be different.

Hyperplastic granular

Or "granular" - close to focal lesion, formations appear on the mucosa in the form of growing drops up to 3 mm in size, a multiple character is possible, the mucosa looks bumpy and edematous. Most often affects the antrum. Muscles become tight and inactive. It is observed in men 40-50 years old.

Hyperplastic reflux gastritis

Mandatory includes reflux and damage to the antrum mucosa alkaline composition content twelve duodenal ulcer. The most significant aggressive agents are bile acids.

Antral

Or rigid antral gastritis is distinguished by sharply disturbed folds in the antrum, they are thickened, change direction, and are covered with polyps on the surface. The pyloric part of the stomach gradually scars and narrows, peristalsis sharply decreases. The production of hydrochloric acid stops.

Giant hypertrophic

Or polyadenomatous gastritis - Menetrier's disease. It is characterized by the growth of folds along the greater curvature of the stomach, the exit of the epithelium from the pits with excessive production of mucus. Cells that synthesize mucus grow into muscle layer and form cysts. The decrease in acidity is accompanied by a loss of protein, dystrophy.

As you can see, the main differences can only be determined by the type of mucosa during fibrogastroscopy and histology of biopsy specimens.

Complications

Absence timely treatment leads to backfire hyperplastic growth:

the structure of the gastric mucosa is disturbed, atrophy of a more or less severe degree appears;
the participation of the stomach in the process of digestion decreases, since the production of gastric juice decreases in parallel with the destruction of parietal cells;
body weight is lost;
gastric motility is disturbed, which leads to paresis, reflux damage to the esophagus;
the intensity of protein metabolism decreases, the decrease in albumin affects recovery processes in all organs and tissues;
hypovitaminosis is accompanied by anemia;
greatest ability hyperplastic granular and hypertrophic gastritis have to degenerate into an ulcer and a cancerous tumor, with a polypous form, every fifth case is transformed.

Diagnostics

In addition to fibrogastroscopy, diagnostics are important X-ray examination stomach, rarely ultrasound. Indirect signs can be suspected based on laboratory tests. For this, a clinical and biochemical blood test is performed (it is important to identify eosinophilia, signs of anemia), an enzyme immunoassay blood test for Helicobacter pylori.

Tumor markers of gastric cancer, determination of gastric acidity and analysis of feces for coprology are also evaluated.

Treatment

Conservative treatment hyperplastic gastritis is carried out only upon receipt of confirmation of the diagnosis, determination of acidity.

Nutritional requirements do not differ from other forms of gastritis:

frequent consumption of food in small volumes;
freshly baked bread, culinary products are excluded;
fatty, fried, smoked foods and dishes are not allowed;
at pain syndrome switch to kissels, liquid cereals, pureed soups;
meat and fish, in the absence of pain, can be eaten boiled, in steam cutlets, meatballs, casseroles;
cottage cheese is shown;
the use of kefir and other fermented milk products is better to discuss with your doctor, it depends on the level of acidity;
vegetables with fruits are recommended in the form of diluted juice, mashed in severe forms, without any special restrictions for superficial gastritis.

Identification of Helicobacter pylori modern views, needs a course of eradication with antibiotics (Azithromycin, Clarithromycin) and Trichopolum.

With an increase in acidity, proton pump inhibitors (Ranitidine, Omez, Misoprostol) are used. The drugs are not indicated for severe achlorhydria, low acidity. Bismuth preparations are indicated to support and protect the mucous membrane: De-Nol, Ventrisol, Bismofal. Aluminum compounds are no less active: Gelusil, Gastal, Compensan.

With severe pain syndrome appoint:

Bruscopan.
Pirencepine,
Gastril.

Replenishment of protein losses is necessary due to diet, course intake of Methionine, in case of severe complications - intravenous transfusion of Albumin, frozen plasma. Surgical treatment may be needed with frequent repeated bleeding, suspected tumor transformation. Use whenever possible endoscopic interventions for electrocoagulation of polyps, laser exposure.

At large sizes removal of part of the stomach.

Alternative treatment with hyperplastic growth is contraindicated. It cannot fully take into account the condition of the mucosa, the level of acidity. herbal remedies able to activate the disturbed growth of the epithelium.

Patients are recommended vitamins, especially B 12 and P, they prevent the development of anemia

Forecast

The prognosis of hyperplastic atrophic gastritis is determined by the form of the disease. It is unfavorable for healing. The patient manages to live long enough, subject to the recommendations of the doctor. All my life you will have to follow a diet, drink maintenance medications, undergo examinations.

It is impossible to predict in advance how dangerous the transformation into a tumor is. The examples given indicate a probability, but do not mean a mandatory outcome. The many-sided nature of hyperplastic atrophic gastritis and moderate clinical manifestations pose the task of conducting mass preventive studies during the medical examination of the population.

- This special form lesions of the gastric mucosa, characterized by increased proliferation of the epithelium with the formation of thick rigid folds and polyps. Very often, the pathology is asymptomatic, and with a significant thickening of the gastric mucosa or the formation of polyps, vomiting, diarrhea, hidden bleeding, and others may occur. non-specific symptoms chronic gastritis. The main diagnostic method is endoscopy with biopsy. Treatment consists in normalizing the motor and secretory functions of the stomach, prescribing a high-protein diet.

General information

When conducting endoscopy, significantly thickened mucosal folds are found, located in the form of foci or mainly along the greater curvature of the stomach. Peristalsis of the stomach is not disturbed. Differentiate different kinds hyperplastic gastritis allows the stomach to be inflated with air - with Menetrier's disease, the folds do not straighten out even when pressure is increased above 15 mm Hg.

The diagnosis is confirmed by endoscopic biopsy with morphological examination of biopsy specimens. It should be remembered that biopsy forceps are small and often unable to capture the mucosa to its full thickness. In this case, all layers of the hypertrophied mucosa will not be included in the preparation for morphological examination, and the analysis will not be informative enough. However, it will help determine the degree and type of hyperplasia.

Auxiliary research methods are radiography of the stomach, intragastric pH-metry, clinical and biochemical analyzes blood, stool test occult blood. They allow you to supplement and clarify the diagnosis, identify complications, conduct differential diagnosis with other diseases of the stomach. Hyperplastic gastritis should be differentiated from other forms of chronic gastritis, various dyspepsia, common familial gastrointestinal polyposis, tuberculosis, syphilis, and oncological lesions of the stomach.

Treatment of hyperplastic gastritis

Etiotropic treatment does not exist, since the causes of the disease are not fully understood. Symptomatic therapy depends on the manifestations of the pathology. With increased acidity, antisecretory drugs are prescribed, with the development of atrophy - replacement therapy natural gastric juice. If endoscopic examination reveals multiple erosions or peptic ulcer, therapy will be consistent with gastric ulcer. The appointment of a diet rich in proteins and vitamins is shown.

Surgical treatment is carried out when polyps are detected (removal of gastric polyps with endoscopy), as well as with resistant hypoproteinemia, frequent recurrent bleeding (partial or complete resection of the stomach). All patients diagnosed with hyperplastic gastritis should be registered with the dispensary, undergo endoscopic examination twice a year for timely detection oncopathology.

Forecast and prevention

Prognosis is closely related to clinical form disease and degree of hyperplasia. Cases of complete regression of changes in the mucosa are quite rare, basically this disease requires lifelong observation and treatment. With the formation of polyps on hypertrophied folds of the gastric mucosa, the prognosis worsens due to an increased risk of malignancy. Prevention of hyperplastic gastritis has not been developed, since the exact causes of its development are unknown.

Chronic gastritis remains one of the most common gastroenterological diseases, affecting the young population and negatively affecting the quality of human life. Hyperplastic gastritis refers to chronic and is its variety. This subspecies is quite rare, characterized by uneven growth of the gastric mucosa and often leads to tumor processes. Difficult to treat and rarely detected on early stages.

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Characteristics of hyperplastic gastritis

The main feature of this disease is hyperplasia of the gastric mucosa, a process of excess cell production that leads to thickening of the epithelium. The thickened mucosa forms peculiar folds or polyposis growths, which are clearly visible during endoscopic examination. Men are more susceptible to this pathology. The main age is 50–60 years, it rarely develops in children, and with growing up, the reverse process occurs and full recovery. In adults, the regression of the disease does not occur, but the development of atrophic gastritis or degeneration into oncology occurs.

According to the size of hypertrophied foci, the following types are distinguished:

granular growths - very small, the size of a millet grain;
warty - up to 1 cm in diameter, single foci of hypertrophy;
giant - huge adenomas are formed, prone to manifestation and bleeding;
polypous - there is a formation of folds that strongly protrude above the surface of the stomach, polyps with atrophy around the foci.

Modern classification of hyperplastic gastritis

IN clinical practice the following nosological forms are distinguished:

Zollinger-Ellison syndrome.
Menetrier's disease.
hypertrophic hypersecretory gastropathy.

The classification is based on the type hyperplastic process- glandular, mucosal, mixed.

Syndrome Zollinger-Ellison. Under the influence increased output the hormone gastrin (responsible for stimulating the production of hydrochloric acid), there is an increase in the cells that produce gastric juice. Hyperplasia begins cellular elements, the production of hydrochloric acid increases, which leads to the appearance of extensive, rapidly progressive ulcers.

Menetrier's disease - there is a significant hypertrophy of the mucous glands of the stomach. Endoscopically, enlarged folds of the stomach are noted, which do not straighten out when the walls are stretched. Against this background, atrophy of cells that produce hydrochloric acid occurs, and the acidity of gastric juice decreases. The epithelium of the stomach begins to change its structure (metaplasia) and is replaced by intestinal type, which is the first stage of carcinoma.

Hypertrophic hypersecretory gastropathy - the rarest variant, has an intermediate position between Menetrier's disease and Zollinger-Ellison syndrome. Glandular hypertrophy (glandular) develops, the production of hydrochloric acid does not increase. Endoscopic examination of the mucous membrane reveals cysts formed from hypertrophied mucous glands.

The main causes of the development of hyperplasia

Modern science has not figured out exact reasons development of this disease. There is no one specific factor. In the development of pathology plays a role:

hereditary predisposition.
The nature of nutrition - irregular, unbalanced, fast food, spicy, salty, smoked food.
The presence of chronic allergic reactions.
Bad habits - alcohol negatively affects the mucous membrane and can be a factor in the development of hyperplastic processes.
Gastroesophageal reflux - the contents of the duodenum with prolonged exposure to the walls of the stomach causes hypertrophy.

Independently, none of the causes provokes hyperplastic gastritis, the pathology is polyetiological, therefore only a complex of factors can affect its occurrence.

Manifestations of the disease

The initial stages of the disease do not have any symptoms, and the diagnosis in such cases refers to incidental endoscopic findings. In the future, the signs of pathology depend on the nosological form, stage of the disease and on the level of acidity.

The first symptom is an increase in the acidity of gastric juice - heartburn, sour belching, a feeling of heaviness and discomfort in the epigastric region. As a result of prolonged exposure to an aggressive environment, atrophy of the mucous membrane develops, glandular cells die, and acidity decreases up to achilia. Complaints with hyperplastic gastritis are nonspecific and clinical signs very difficult to diagnose. An endoscopic examination with biopsy material can help with this.

With Menetrier's disease, patients often complain of pain in the epigastric region, a feeling of fullness, heaviness and discomfort in the stomach that appear after eating. With intense pain, vomiting and diarrhea occur. Appetite is reduced, there is a significant weight loss - up to 20 kg per month or more.

Zollinger-Ellison syndrome has symptoms similar to peptic ulcer. Patients are concerned about pain on an empty stomach, subsiding after eating. Appetite decreases, weight loss occurs, gastric bleeding from formed ulcers is possible, anemia develops, which significantly reduces the body's resistance to various infectious processes.

All variants of hyperplastic gastritis can lead to bleeding and stomach cancer.

Treatment

To date, no etiotropic treatment has been developed, since the final root cause of the disease has not been identified. Conservative therapy It is aimed at eliminating the symptoms of the disease and depends on the type of nosology and on the stage of the pathological process. With increased acidity early stages prescribed antisecretory drugs:

1. Proton pump inhibitors - Omeprazole, Rabeprazole and others.
2. H2-histamine receptor blockers - Famotidine, Ranitidine.