Chronic gastritis - symptoms and treatment

What is gastritis like?

The most common form of chronic gastritis (CG) is bacterial, it occurs in almost 70% of patients. Most often it is provoked by the bacterium Helicobacter pylori (Fig. 1). Resistant to stomach acid, it is spread by the oral-fecal route. The enzymes secreted by H. pilory contribute to the destruction of the protective mucus of the stomach, which protects the tissues from the aggressive effects of gastric juice. Helicobacter is represented by various strains - from relatively harmless to extremely dangerous, causing the formation of chronic ulcers and even stomach cancer.

Figure 1. Helicobacter pylori bacterium, which causes gastritis. Micrograph using SEM. Photo: Yutaka Tsutsumi

Harm and benefits of Helicobacter

Important! H. pylori does not always lead to gastritis and can be beneficial for our body. In recent years, the positive effect of these bacteria on the functioning of the immune system has been proven. H. pylori is able to interact with T lymphocytes, suppressing inflammation, and reducing the risk of developing allergies and asthma.

Other types of gastritis include:

• Autoimmune (15% of cases). Caused by aggression of the body's own antibodies, attacking the cells responsible for the secretion of acid in the stomach. This form of gastritis is characterized by increased pH levels and constant release of the hormone gastrin, which leads to the formation of microtumors in the stomach,
• Chemical (10% of cases). Caused by the action of various drugs (acetylsalicylic acid, non-steroidal anti-inflammatory drugs, antibacterial and other drugs) that irritate the gastric mucosa or reduce its protective properties,
• Reflux gastritis (5% of cases). They develop if bile enters the stomach. The cause of reflux gastritis can be inflammation of the duodenum or surgery to remove part of the stomach,
• Special forms (less than 1%). These include Crohn's disease, radiation, eosinophilic and other types of gastritis.

Important! The development of hCG is facilitated by the absence of teeth, foci of chronic infection in the oral cavity and pharynx (caries, inflamed tonsils), smoking, excessive alcohol consumption, stress, serious injury or surgery.

There are many classifications of gastritis: by localization (gastritis of the body of the stomach, antrum of the stomach, fundus of the stomach, pangastritis), by the degree of tissue damage (superficial, gastritis with damage to the glands without atrophy, atrophic, hypertrophic gastritis).

What can you drink?

Let's look at some common drinks:

1. Milk is easily digestible and reduces stomach acidity. However, milk should not be used as a remedy - only as an addition to solid food. The thing is that milk, being liquid, does not stay in the stomach for a long time, reducing acidity for a short time, it stimulates the secretion of gastric juice to a greater extent.
2. Weak tea - it is advisable to drink it when the tea has cooled and become warm.
3. Juices – it is advisable to exclude acidic juices: orange, grapefruit, apple, grape. Preference should be given to juices with pulp: peach, banana, apple, pear, tomato. It is not advisable to drink juices chilled; it is better to drink them warm or at room temperature.
4. Kissel – partially neutralizes the acidity of gastric juice. However, it should not be consumed as a medicine, only as part of the main meal.
5. Mineral waters - preference should be given to alkaline mineral waters: “Essentuki No. 17”, “Essentuki No. 4” and “Semigorskaya”, “Borjomi”.

Why is gastritis dangerous?

Left unattended, gastritis can develop more and more severe consequences. Over time, the superficial inflammatory process can cause deep tissue damage - erosions and ulcers, which can lead to life-threatening gastric bleeding. Certain strains of Helicobacter significantly increase the risk of developing stomach cancer. The same complications occur in patients with chemical gastritis. Autoimmune gastritis is more characterized by mucosal atrophy and pernicious anemia with vitamin B12 deficiency.

Symptoms

For many people, gastritis occurs with virtually no symptoms.
Obvious signs of the disease usually appear in the acute phase (Table 1). In this case, the leading symptom of gastritis is pain in the upper third of the abdomen (in the pit of the stomach): dull, burning, aching, gnawing, sucking, sharp. Table 1. Symptoms of chronic gastritis in the acute phase and in the remission phase.

Important! If you find at least some signs of hCG, consult a doctor. Before the examination, it is not recommended to use heating pads, enemas, or take medications.

Nutrition for low stomach acidity

For gastritis with low acidity and atrophic gastritis, an important point in the diet is the stimulation of gastric secretion. Meals should be taken at certain hours (a strict eating schedule normalizes the process of secretion of gastric juice). Food should evoke a feeling of appetite, it should be taken in a calm environment, without haste. It is important to chew food thoroughly: on the one hand, crushed food will not injure the gastric mucosa, on the other hand, while we chew, a large amount of gastric juice and saliva are produced, which contribute to the best absorption of food.

For gastritis with low acidity, you should exclude:

• salty, spicy dishes;
• mushrooms, coarse stringy meat;
• alcohol;
• foods fried in oil, baked dishes;
• cabbage, grapes and grape juice.

What can you eat if you have gastritis with low acidity:

• fish fillet from low-fat fish;
• meat: rabbit, chicken in the form of boiled meat, low-fat cutlets, meatballs; meat broths, fish soup;
• sour cream, kefir, cottage cheese, milk, cheese;
• vegetable purees, grated vegetable salads from potatoes, beets, carrots, zucchini, spinach;
• mineral water 20-30 minutes before eating.
• fruit juices (except grape), compotes, decoctions of rose hips, black currants;

Meals are taken at least 5 times a day. Therapeutic nutrition is followed for another 2-3 months after the exacerbation. The patient should be in a calm environment, with conditions for good rest and sleep. It is recommended to take vitamin and mineral supplements.

Diagnostics

Gastritis is much easier to treat if it can be diagnosed in the early stages of the disease.

Who to contact

Gastroenterologists, doctors specializing in diseases of the digestive system, are responsible for the diagnosis and treatment of chronic gastritis. Gastritis often becomes an accidental finding during a routine examination or search for other diseases. Gastroenterology is a broad branch of medicine that requires the doctor not only highly specialized training, but also interdisciplinary knowledge and good erudition.

What tests should I take?

The classic method for diagnosing gastritis is gastroscopy (esophagogastroduodenoscopy, endoscopy), which is combined with a biopsy if a malignant process is suspected. During the procedure, a special device is inserted into the patient’s stomach through the mouth - a gastroscope, consisting of a long tube with a built-in camera. It allows the endoscopist to examine in detail the condition of the mucous membrane of the esophagus, stomach and duodenum (Fig. 2).

Figure 2. Performing gastroscopy. Photo: CC0 Public Domain

Since most cases of CG are associated with the presence of the bacterium Helicobacter pylori in the body, when gastritis is detected, a urease breath test is often performed (for the enzyme urease secreted by Helicobacter), as well as a blood test for antibodies to this bacterium or a stool test for the presence of its antigens in it.

Computed tomography and magnetic resonance imaging help answer the question: is it really gastritis and does the patient have stomach cancer (Fig. 3).

Figure 3. Gastritis detected on tomography. Photo: Eigenes Werk

Reasons for development

Symptoms of the disease occur when the gastric mucosa is damaged. Various factors influence:

• irregular eating, undereating and overeating, rushing while eating;
• poor chewing of food, often associated with poor dental health;
• low-quality products, abuse of fried, hot, spicy, rough foods;
• insufficient intake of protein and vitamins, which causes less gastric juice to be produced;
• regular drinking, smoking;
• long-term use of medications: antibiotics, aspirin, hormonal drugs;
• ill health of the digestive system, impaired peristalsis, causing bile to end up in the stomach and cause inflammation of the mucous membrane;
• signs of gastritis appear in case of imbalance of intestinal microflora, penetration of viruses, bacteria, streptococci, staphylococci, salmonella.

Chronic gastritis in adults occurs with poor quality or incomplete treatment of the acute form. Intestinal infections, inflammation of the tonsils or gallbladder, infection with Helicobacter pylori maintain the chronic form. It develops in hazardous production conditions, when dust, fumes of acids or alkalis, and harmful chemical compounds are ingested every day. Constant inflammation of the gastric mucosa is associated with one or another allergy.

The gastric juice contains pepsin to break down protein foods. If a malfunction occurs, pepsin acts on the mucous membrane containing protein, causing inflammation as the stomach begins to digest itself.

Treatment

Treatment is always selected individually depending on the type of gastritis and its cause. Timely treatment can reduce symptoms, if present, and reduce the likelihood of complications.

Medicines

Drug treatment of chronic gastritis can be symptomatic or etiological - aimed at eliminating one or another cause of the disease. If H. pylori is detected in a patient with gastritis, eradication therapy is used to destroy it. In particular, the “French method” is popular today, which involves a combination of three drugs - two antibiotics plus a proton pump inhibitor. Unfortunately, it is impossible to eliminate the infection forever; after some time, the harmful microorganism again enters the body from carriers, in particular, from the patient’s relatives. Helicobacter very quickly becomes resistant to drugs, so the same antibiotics cannot be prescribed all the time.

With chemical gastritis, it is enough to eliminate its cause. For example, stopping taking medications whose side effects caused the disease. If it is not possible to refuse such a medicine, measures are taken to protect the stomach with the help of coating agents and drugs that regulate the acidity of gastric juice. The use of antacid (anti-acid) drugs helps restore damaged mucosa. It must be remembered that with the disappearance of the acid, its powerful antibacterial function disappears.

The selection of therapy for autoimmune chronic gastritis depends on the severity of inflammation. Basically, the use of medications is aimed at reducing the acidity of gastric juice. These are proton pump inhibitors, antacids and antihistamines.

Nutrition

Chronic gastritis cannot be overcome with medications alone. Radical changes are required in the patient's lifestyle, diet and diet. Therefore, already at the first appointment, the gastroenterologist necessarily recommends a certain type of diet depending on the acidity of the gastric juice: if it is low, you need acidic (berries, fruits) and juice products, if it is high, you need those that reduce the production of hydrochloric acid.

Among the products that are incompatible with the treatment of gastritis and are strictly contraindicated:

• Spices and seasonings, especially hot ones,
• Fat meat,
• Any fried food
• Smoked and canned products,
• Concentrated fruit and berry juices, especially those high in acids and sugars,
• Carbonated drinks.

Important ! It is recommended to limit the consumption of confectionery products (never on an empty stomach!), rye bread, fresh wheat pastries, strong tea and coffee.

There are quite a few approved foods for gastritis. By consuming them, you can easily create a varied and complete diet. Patients with gastritis are shown:

• Dairy products,
• Stale yeast bread,
• Lean meat, fish, soft and semi-hard cheeses,
• Soft-boiled eggs and omelet,
• Boiled cereals,
• Puree soups,
• Boiled and baked vegetables, fruits.

Diet for patients with chronic gastritis

The diet for chronic gastritis is aimed at developing favorable microflora in the gastrointestinal tract that regulates digestion and has a protective function. Meals should be fractional: regular meals 5-6 times a day. You should choose dishes that are boiled or steamed. Preferably boiled or baked meat, fermented milk products, high-fiber cereals, boiled or baked vegetables (Table 2).

The main amount of food should be consumed in the first half of the day.
It is necessary to avoid “snacks” of high-calorie foods and eating sweets on an empty stomach. Table 2. Dietary recommendations for patients with chronic gastritis.

Aids

The most recommended home remedy to alleviate the disease is a decoction of chamomile. Among plants exotic to our nature, aloe juice is used as a strong anti-inflammatory agent. Oat infusion is also useful for chronic gastritis, helping to restore the affected mucous membrane. Of course, traditional methods of treatment cannot replace qualified medical care and therapy.

Gastritis in children

Children usually get gastritis at school age due to irregular and irrational nutrition; there is even a diagnosis - “school gastritis”. Treatment in this case is aimed not only at getting rid of the disease, but also at developing healthy eating habits.

Gastritis and pregnancy

Difficulties in treating gastritis in pregnant women are associated with the possible effects of the medications used on the fetus. When selecting therapy, you have to weigh the possible benefits of the medication and the harm it can cause. This primarily concerns antibiotics, many of which are strictly contraindicated during pregnancy. Proton pump inhibitors are harmful during pregnancy.

Classification

There are several types of acute gastritis:

Gastritis has many varieties. A brief description of each type can be found below:

In professional medicine, other classifications of gastritis are also used, including according to the type of distribution of pathogenesis:

1. Autoimmune gastritis (type A);
2. Exogenous gastritis (type B), provoked by Helicobacter pylori;
3. Mixed gastritis (type A+B);
4. Gastritis (type C), provoked by NSAIDs, chemical irritants or bile;
5. Special forms of gastritis;
6. Gastritis against the background of decreased and increased secretion of hydrochloric acid;
7. Other forms of morphological and functional manifestations of gastritis.

Their differentiation involves the use of complex medical laboratory or instrumental techniques at the stage of diagnosing the disease. Therefore, a description of gastritis, which has approximately the same clinical symptoms, but differs in the underlying mechanisms of pathogenesis, is not of interest to a wide range of readers.

Let us dwell in detail on the main signs and symptoms of gastritis, which may serve as the basis for a person to contact a medical institution for help.

Forecast

As a rule, the prognosis for gastritis is positive. Among patients who only go to doctors, many people do not experience any symptoms.

Treatment of any chronic disease is a long-term struggle with varying success. A chronically ill person cannot stay in the hospital for the entire period of illness. Life conditions are constantly changing, and success in treatment depends on this. A key role can be played by a meeting with a truly professional and competent doctor who is willing and able to find and eliminate the cause of the disease.

Prevention

Prevention of chronic gastritis involves preventing factors that can cause damage to the mucous membrane. These are hygienic measures against Helicobacter infection: thoroughly washing dishes, using each family member’s own cups, plates and cutlery. Care must be taken when handling medications and chemicals that are potentially harmful to the health of the digestive system.

If you do get gastritis, it is important to take timely measures to prevent it from becoming chronic. The main goal of prevention in this case is to maintain a favorable microbiome (microflora) of the digestive tract.

To prevent the development of the disease you should:

• eat small portions often,
• avoid foods that may irritate the stomach,
• reduce or eliminate alcohol consumption,
• quit smoking
• avoid stress.