Gastritis with low acidity

Content:

Hypoacid gastritis , or gastritis with low acidity, often does not occur overnight, but is the result of a long-lasting chronic inflammation of the stomach.
In relation to the acidity of gastric juice, all gastritis can be divided into 4 large groups:

Gastritis with high acidity (hyperacid).
Gastritis with normal acidity (normatsidny).
Gastritis with low acidity (hypoacidic).
Gastritis with zero acidity (anacid).

How does gastritis with low acidity appear?

Classic chronic gastritis

At the beginning of the development of inflammation, the gastric mucosa responds by excessive secretion of hydrochloric acid (hyperacid gastritis).
As the inflammation progresses, some of the cells that produce hydrochloric acid die off, so the total acidity of the gastric juice decreases with the course of gastritis and returns to normal (normicidal gastritis).
Gradually, the process of dying off of gastric cells due to progressive inflammation and subsequent atrophy of the mucous membrane progresses, so the stomach is no longer able to provide acidity at the proper level, and it is steadily decreasing (hypoacid gastritis).
If the atrophy of the mucous membrane continues, then in the end, the acidity of the gastric juice will generally be zero (anacid gastritis).

Thus, gastritis with low acidity is only one of the phases of chronic gastritis.

Experts believe that classic chronic hypoacid gastritis often develops as a result of infection of the gastric mucosa by bacteria H. Pylori.

Autoimmune gastritis

In this case, the immune system begins to produce antibodies to its own tissues (for example, parietal cells), which ultimately also causes damage to the cells of the stomach that produce acid.

Many researchers believe that the acidity in autoimmune gastritis is reduced much earlier than the death of these cells due to the fact that at the initial stage, the antibodies produced are connected with parietal cells and block the production of acid.

Atrophy of the mucosa due to injury

The development of hypoacid gastritis can also be caused by exposure to certain chemicals that can cause severe burns of the gastric mucosa, followed by scarring and replacement with connective tissue. Usually such a person takes the liquid by carelessness or by mistake. This gastritis with low acidity can develop in a child.

Causes of gastritis with low acidity

At present, the term “chronic gastritis” is in itself a more general concept and does not reflect all the subtleties of the course of the disease and the causes of its development. The following factors can be “guilty” in the occurrence of gastritis with low acidity:

Heredity.
Systematic violation of the diet.
Diet with a predominance of foods that cause inflammation or supporting it (spicy seasonings and spices, alcohol, etc.).
The presence of H. pylori.
Chronic stress.
Occupational hazards.
Allergy.
Autoantibodies to the cells of the stomach.

Gastric function is normal and the symptoms of hypoacid gastritis

The main functions of the stomach:

Deposition and partial digestion of food. Depending on the nature of the food, it can be in the stomach for up to 10 hours. During this time, it is well impregnated with acid, pepsin and begins to digest (partial protein breakdown). If the acidity is low, then pepsin remains in an inactive state and cannot break down proteins. In addition, the absorption of alcohol, water, and certain drugs may occur directly in the stomach.
Disposal of food lump. Hydrochloric acid has a detrimental effect on various pathogens. If the acidity of gastric juice decreases, dysbacteriosis will develop accordingly.
Food delivery to the duodenum.
Participation in blood formation (development of an internal factor of Castle, without which already in the small intestine there is no absorption of vitamin B12, which is necessary for normal blood formation).

The more acidity is reduced in hypoacid gastritis, the more pronounced the following symptoms will appear:

Dyspepsia - loss of appetite, feeling of heaviness or overflow in the stomach, belching with rotten food, bad breath (cocosmia), unpleasant taste, nausea.
Signs of overproduction of bacteria - rumbling, unstable chair, milk intolerance, bloating in the stomach. If gastritis is accompanied by frequent diarrhea, then weight loss may occur, and signs of a deficiency of minerals or vitamins may develop.
The development of anemia by reducing the absorption of iron and vitamin B ₁₂ (due to Castle factor).
Dull, aggravated after eating, without clear localization, aching pain that occurs due to stretching of the stomach.
Dystrophy - signs of deficiency of vitamins of group B, as well as C, E, D, protein deficiency (weight loss, "polished" or covered with a thick white bloom tongue).

Since gastric inflammation affects other parts of the digestive system, hypoacid gastritis is often accompanied by diseases such as enterocolitis, cholecystitis , pancreatitis .

Diagnosis of gastritis

The leading method in the diagnosis in this case is EGD (gastroscopy), during which material can be taken for histological examination.

Gastroscopy

Using a special probe, equipped with fiberglass optics (and sometimes a miniature video camera), the doctor visually examines the state of the gastric mucosa. With a video camera, a digitized image can be transmitted to a computer monitor and be available for detailed analysis later on.

Hypoacid gastritis is characterized by a pale gray color of the mucous membrane, a decrease in its folding and a more pronounced vascular pattern. Places on the mucous membrane may be marked with small or large areas of metaplasia, which is a precancerous condition.

Histological examination

When studying microscopic mucosa samples obtained as a result of gastroscopy, the following picture is observed during hypoacid gastritis:

reducing the thickness of the mucosa, including the location of the glands and the mucous epithelium,
vacuum glands,
epithelial dysplasia or metaplasia.

It is on the basis of the histological conclusion that the diagnosis of atrophic gastritis is made.

Evaluation of functional activity

A study of the functionality of the stomach includes:

pH-metry, including daily, which is the “gold standard” for assessing the state of acidity (acidity is considered to be lowered, if the basal pH is 2.1 and higher, and the stimulated one is within 2.1–3.0). Anacid gastritis is considered if the pH of the basal is above 6.0, stimulated - from 5.0 and above.
determination of the level of pepsin activity or proteolytic activity of gastric juice.

Material for conducting these tests can be obtained during gastric sensing or gastroscopy.

Additional survey methods

Most often, this ultrasound and radiography of the stomach. Using ultrasound, you can identify the pathology of the associated organs (liver, pancreas, gall bladder), estimate the thickness of the stomach walls (important for those forms of cancer when the tumor does not grow in the lumen, but into the thickness of the stomach wall). Radiocontrast study reveals changes in the cardiac region, which in some cases is a "blind spot" during gastroscopy.

Laboratory markers

To clarify the nature of cell atrophy that develops during hypoacid gastritis, the doctor may prescribe the following:

Blood serum:

determination of the level of pepsinogen I, II, as well as gastrin-17,
research on the presence of antiparietal antibodies, as well as antibodies to Castle Factor,
gastrin level.

Conduct a test for the presence of Helicobacter pylori direct or indirect method.
Scatology. Hypoacid gastritis is accompanied by the appearance in the feces of a large number of unchanged muscle and connective tissue fibers, starch, as well as signs of intestinal dysbiosis.

Treatment of gastritis with low acidity

The treatment of gastritis with low acidity is complex and long-lasting. Of great importance are factors such as patient discipline, as well as compliance with appropriate diet and diet.

Etiotropic therapy

First of all, it is desirable to find and then eliminate the cause of chronic gastritis:

As already mentioned, most often hypoacid gastritis develops due to chronic gastritis associated with Helicobacter pylori. In this case, a course of antibiotic therapy is needed, aimed at the eradication of the microorganism.
If atrophy of mucosal cells is caused by autoimmune processes, then drugs are prescribed that will reduce the activity of the immune system.
Diet. During exacerbation of chronic hypoacid gastritis, diet No. 1a is prescribed, which provides functional, thermal, mechanical, and chemical sparing of the stomach. Then after 2–3 days, the diet is expanded to table No. 1. In the remission phase, table No. 2 is recommended (stimulation of the glands by chemical irritants against the background of mechanical stomach elimination).
Quitting smoking, drinking strong coffee.

Pathogenetic therapy

1. Replacement therapy (preparations of hydrochloric acid, pepsin):

gastric juice (natural),
acidin-pepsin (tablets)
abomin (gastric enzymes),
vitamin b ₁₂ (injection).

2. Stimulants of secretion of hydrochloric acid:

mineral waters (Narzan, Essentuki №4,17, Mirgorodskaya),
dogrose decoction,
juices - lemon, tomato, cabbage,
Fitosborov - St. John's wort, plantain, wormwood, thyme,
plantaglucid, limntar.

3. Gastroprotectors, for example, solcoseryl (if there are erosion).

4. Binding and enveloping agents:

preparations of bismuth or aluminum.

5. Modifying gastric motility (prokinetics):

Domperidone,
cisapride, etc.

Diet for gastritis with low acidity

1. Eating with hypoacid gastritis should take place in a relaxed atmosphere, not in a state of stress or haste 5 times a day. It is advisable to eat at a certain time, without snacking.

2. Meals should induce appetite.

3. Food should be chewed thoroughly.

4. Excluded:

alcohol,
fried foods
salty, spicy,
smoked
mushrooms,
stringy meat
grape juice.

5. Allowed:

boiled chicken, beef, including in the form of steamed patties,
ear,
meat broth,
lean fish (fillet),
grated salads (vegetable) from beets, zucchini, potatoes, spinach, carrots,
dairy products - milk, kefir, cheese, cottage cheese, sour cream,
fruit juice (except grape),
warm mineral water with gases for half an hour before meals.

Physiotherapy and spa treatment

To stimulate the production of acid at low acidity, decimeter electromagnetic waves or sinusoidal modulated currents are prescribed.

Treatment in a sanatorium is indicated during remission of the disease. Doctors recommend resorts: Essentuki, Truskavets, Staraya Russa, Morshyn, where in addition to physiotherapy procedures it is desirable to use mineral water (chloride, hydrocarbonate-chloride, sodium).

Forecast

In general, with timely treatment and dieting, the quality of life in patients with chronic hypoacid gastritis remains satisfactory. However, in the case of development of gastritis with zero acidity (anacid gastritis), the likelihood of developing stomach cancer increases dramatically.

Prevention of the development of gastritis with low acidity

If there is inflammation of the stomach, it is necessary to treat it (including gastritis with high acidity).
When Helicobacter pylori is detected, take a course of antibiotic therapy with the obligatory determination of this microorganism before and after treatment.
Follow a diet, diet.

Give up smoking, drinking alcohol, coffee.

| November 24, 2014 | | 4 716 | Diseases of the digestive tract