"Chronic gastritis is a risk factor for stomach cancer. In patients with a family history of gastric cancer or in those whose biopsy results show pre-malignant cell changes, we recommend endoscopic follow-up.
DR. CÉSAR PRIETO FRÍAS
SPECIALIST. DIGESTIVE DEPARTMENT
Chronic gastritis is the non-specific inflammation of the gastric mucosa, of multiple etiology and diverse pathogenic mechanisms.
When no organic lesions are found in the esophagus or stomach, there is a tendency to erroneously call ¨gastritis¨ to those pictures with symptoms of heaviness, aerophagia, abdominal discomfort, early satiety, postprandial fullness... that should be included in the term of functional or non-ulcer dyspepsia.
There are other less frequent forms of chronic gastritis, such as lymphocyte, hyperplasia of the gastric mucosa and hypertrophic gastritis or eosinophilic gastritis.
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What are the symptoms of chronic gastritis?
Chronic gastritis has no disease-specific symptoms. Some patients are asymptomatic, others present dyspeptic symptoms such as epigastric discomfort, postprandial heaviness, aerophagia...
There are studies that show that dyspeptic symptoms appear in equal proportion in gastritis produced by H. pylori that in those who do not have this germ.
Other forms of presentation may be pernicious anemia, nonspecific iron deficiency anemia ...
The most common symptoms are:
- Discomfort in epigastrium (mouth of the stomach).
- Postprandial heaviness.
Do you have any of these symptoms?
You may have chronic gastritis
What are the causes of chronic gastritis?
The etiological factors are multiple and can be grouped into infectious, chemical irritants, immunological and genetic.
As for the infectious etiology, several germs can cause inflammatory lesions of the chronic gastritis type. The germ more frequently associated with chronic antral gastritis with duodenal ulcer is the H. pylori.
It is present also in the gastritis of antrum and body (pangastritis) not associated with gastroduodenal ulcer. The gastric colonization begins in the antrum, due to the activity of the urease type, penetrating in the epithelium, with which it manages to trigger an inflammatory cascade.
Among the chemical irritants, the alkalinization of the intragastric pH due to the presence of bile can produce a chronic gastritis. This situation is frequent in patients with operated stomachs (gastrectomy).
In body gastritis with gastric atrophy that is accompanied by achlorhydria and pernicious anemia, antibodies against parietal cells and/or intrinsic anti-factor may be present.
It is also accepted that H. pylori infection in genetically predisposed patients can cause this form of chronic atrophic gastritis. Thus, patients with chronic atrophic gastritis and antibodies may suffer from other associated autoimmune diseases (thyroiditis, systemic lupus erythematosus...).
Who can suffer from it?
There are no extensive epidemiological studies of chronic gastritis in Spain that can be applied to the entire population, although it is known that the incidence increases with age.
Since it was accepted that the main etiological agent is H. pylori, there are studies on the infection by this germ. Most infected patients have some degree of chronic gastritis, so that data can be deduced from the disease by analyzing studies on the prevalence of H. pylori.
In developing countries, with a poor health system, low cultural and economic level, the prevalence of chronic gastritis associated with H. pylori is 60-80% in children and 100% in adults and the elderly.
In developed countries, with better health and cultural care and higher incomes, the prevalence in children is 5-10% and in adults 20-30%, with 60-70% in those over 40.
How is chronic gastritis diagnosed?
The differential diagnosis of chronic gastritis should be made with duodenal ulcer, hiatus hernia, biliary lithiasis, chronic pancreatitis and irritable bowel syndrome.
The gastroscopy allows to observe the gastric mucosa suggesting the diagnosis of gastritis and discards other diagnostic possibilities. The diagnosis of certainty is achieved with the histological study of the biopsy obtained by endoscopy. It informs us of the morphology of gastritis and the presence or absence of helicobacter pylori.
To detect Helicobacter pylori, anti-Helicobacter pylori antibodies, a breath test with marked urea, a rapid urease test and microbiological culture can be performed on a biopsy sample.
In chronic gastritis with gastric atrophy, serum gastrin should be determined.
How is chronic gastritis treated?
Treatment depends on the specific cause:
- Chronic asymptomatic gastritis does not require treatment. In symptomatic patients, treatment must be individualized.
- In case there is chronic antral gastritis associated with Helicobacter pylori and it is decided to eradicate it, we have several guidelines, the most frequently used being the association of proton pump inhibitors, amoxicillin and clarithromycin for 7 or 10 days.
- If anemia due to low iron levels is present, iron will be indicated to restore deposits. For gastric atrophy with low levels of vitamin B12, vitamin B12 will be administered periodically.
- There are some dietary guidelines that improve the symptoms of these patients, such as avoiding fats, sauces, spices, etc., as well as taking five meals a day, although in smaller quantities.
Where do we treat it?
IN NAVARRE AND MADRID
The Department of Digestive
of the Clínica Universidad de Navarra
The Digestive Department of the Clinica Universidad de Navarra is composed of a multidisciplinary team of specialists who are experts in the diagnosis and treatment of diseases of the digestive tract.
Our objective is that each diagnosis be carefully established and the treatment plan adjusted to each patient.
Why at the Clinica?
- Medical specialists who are national references.
- Specialized nursing team.
- Endoscopy Unit and High Risk Digestive Tumor Prevention and Consultation Unit to offer the best care to our patients.