Deformation of the antrum of the stomach causes and treatment. The antrum of the stomach where timely treatment is located. How to treat erosive antral gastritis and disease prevention measures

In the human stomach, food is broken down and mixed, crushed, and small lumps are formed, which then move further to the intestines. In diseases of the gastrointestinal tract, it is important to understand in which organ the pathology arose and where exactly it is localized. Below are the diseases of the antrum of the stomach, as well as methods of prevention that will help maintain its health.

What is the antrum of the stomach

The stomach is divided into five sections, each of which plays a different role in the complex process of digestion. The antral part is located after the one that is responsible for the production of hydrochloric acid and the breakdown of products. Therefore, the task of the antrum is mixing, grinding food, as well as its further pushing through the sphincter. The volume of the obtained lumps is small and is measured in millimeters.

In the area where food passes to the duodenum, the antral glands produce mucus that neutralizes aggressive hydrochloric acid. Thanks to this function, the formed lumps of food are prepared for further processing in an alkaline environment.

In addition to hydrochloric acid, another digestive enzyme, gastrin, is produced in the stomach. Its production occurs in the lower part of the hollow organ. Serotonin and somatostatin are also formed here. Together, these substances are responsible for the full digestion of food, its further promotion.

Thus, the antral part of the stomach is a department that performs the following functions:

• mechanical;
• neutralizing;
• endocrine.

Where is the antrum located

The stomach consists of three main parts:

• cardiac;
• main (body);
• pyloric.

In the last (lower) section there are two sections - antral and pylorus. There is no clear boundary between the antrum and the body, so the transition zone is lined with two types of cells. The stomach ends with a sphincter, after which the formed pieces of food enter the duodenum 12.

Diseases of the lower section occur when any of the functions is insufficient. Both incomplete digestion and slow movement of food are dangerous, as this leads to its stagnation and fermentation. Subsequently, an inflammatory process occurs, which often acquires a chronic course.

Antrum diseases

Most gastrointestinal problems appear as a result of malnutrition or a person's inattentive attitude to their health. Pathological processes in the digestive tract are successfully treated at the initial stage, but acquire a chronic course if you do not see a doctor in time. Diseases that result from dysfunction of the antrum are described below.

erosion

They are benign neoplasms. They can appear anywhere in the gastrointestinal tract and are also found in the antrum. These protrusions of the glandular epithelium are located both singly and in colonies.

Polyps are a relatively new disease. Their appearance is associated with a genetic predisposition or a consequence of chronic gastritis. Lesions are found predominantly in elderly patients.

ulcers

The mechanism of pathogenic action is based on the ability to penetrate the mucosa, attach there and produce toxic ammonia, causing ulcers or more serious complications. The result of such exposure is a large lesion, inflammatory processes and organ dysfunction.

The provoking factors of gastritis are also:

The antrum of the stomach is located after the body and in front of the duodenum 12. Signs of inflammation in this part can be:

• Violation of the digestion of food.
• Stomach bleeding.
• The appearance of an unpleasant taste or smell in the oral cavity.
• Discomfort in the epigastrium, nausea.
• Constipation or diarrhea.
• Spasmodic pains.

This is the name of a pathological increase in cell growth, which leads to a change in their functional ability and neoplasms. The antrum is the lower part of the stomach, which has a fairly strong load.

Often, in the presence of concomitant pathologies, the mucosa grows, revealing multiple growths of a small size. Provoking factors include:

• Hormonal disruptions.
• Infectious diseases.
• Exposure to carcinogens or toxic substances.
• Prolonged inflammation.
• hereditary predisposition.
• Secretory dysfunction.

Oncology

A certain percentage of neoplasms is malignant in nature. The following symptoms will help to suspect cancer:

• Sharp weight loss.
• Systematic vomiting.
• Aversion to protein foods.
• Soreness after eating.

More often, polyps, erosions and ulcers that have not been eliminated at the initial stage of development lead to life-threatening consequences. The prognosis of treatment depends on the identified phase of the cancer, as well as the presence of metastases. Modern medicine continues to look for effective drugs in this area and improve the methods of radiation and radiotherapy, however, no one approach gives a 100% guarantee.

Disease prevention

Inflammatory processes and erosion over time lead to a change in the structure of tissues and functional insufficiency, which can no longer be cured. Doctors recommend time to think about the health of the digestive tract. Since the work of other organs and the well-being of a person depends on the quality of the breakdown of products, the absorption of nutrients and the elimination of toxins.

To prevent damage to the gastric mucosa, follow these rules:

1. Eat regularly, preferably by the hour. This will help to establish the production of gastric juice and synchronize it with intestinal motility.
2. Eat more often, but in small portions. Fractional nutrition does not overload the work of the digestive tract and prevents stagnation of bile.
3. Consider possible mechanical irritants - spicy seasonings, high temperature of dishes, alcohol content in alcohol.
4. Make a predominance in the diet of dairy products and fiber. They are useful for maintaining motor function and the balance of the microflora of the gastrointestinal tract.
5. Water is the basis of the diet. Drink it throughout the day in sufficient quantities to prevent constipation, thickening of bile, or difficulty digesting.
6. Do not self-medicate - many drugs, as a side effect, adversely affect the gastric mucosa, causing gastritis or erosion. These include non-steroidal anti-inflammatory drugs, antibiotics, analgesics.

Antral gastritis(or antrum-gastritis) is a chronic inflammatory process concentrated in the mucous membrane of the output (lower) section of the stomach. According to ICD-10 - type B gastritis, that is, due to bacterial activity in the organ. Insidious "blurred" symptoms, due to which it is rarely detected in targeted diagnostics. It is dangerous with serious complications, up to stomach cancer.

Antrum-gastritis is provoked by penetration into the outlet section of the stomach Helicobacter pylori (Helicobacter pylori)- a specific bacterium, which is etiologically associated with the vast majority of diseases of the stomach and duodenum, including ulcers and tumor processes.

The outlet section of the stomach (antrum) performs important functions. It alkalizes the gastric juice before it enters the intestines. In addition, mucus is produced in the antrum of the stomach (its epithelium), covering the organ cavity as a protective lubricant. By producing bicarbonates, the antrum epithelium reduces the acidity of gastric juice. With chronic inflammation, this process is disrupted, and therefore acidic chyme (gastric juice) penetrates into the duodenum, destroying its walls and forming ulcers.

In chronic antral gastritis, an outbreak of Helicobacter pylori activity occurs - its record number is noted in the output section. With the spread of the inflammatory process to other parts of the stomach, the number of pathogenic microorganisms decreases.

Antrum-gastritis without Helicobacter pylori occurs only in 5% of cases out of 100%.

Helicobacter pylori gastritis is also provoked by "indirect" triggers:

• History of duodenogastric reflux;
• Allergic reactions to food;
• Systematic use of non-steroidal anti-inflammatory drugs;
• Long-term treatment with salicylic acid preparations;
• Iron deficiency in the body and iron deficiency anemia as a consequence;
• Hormonal imbalance;
• Pulmonary, cardiac or renal insufficiency;
• Decompensated diabetes mellitus;
• Chronic cholecystitis;
• Unauthorized use of systemic antibiotics;
• Severe infectious pathologies;
• Alcohol abuse;
• Active smoking.

Although the main cause of type B chronic gastritis lies in the infection of the stomach with Helicobacter pylori, irrational nutrition contributes to its development and progression. This applies to addiction to fast food and other junk food, frequent snacking with snacks and pastries, high speed of eating, as well as the habit of including excessively spicy and spicy dishes in the menu.

- the main cause of the development of chronic gastritis type B

Antrum-gastritis develops according to the following algorithm:

• An organ becomes infected with a bacterium;
• Bacteria that have entered the stomach produce specific enzymes - urease and mucinase;
• Developed enzymes locally alkalize the environment and “loosen” the normal structure of gastric mucus;
• Having created a comfortable environment, the bacteria penetrate to the epithelium of the output section of the organ and penetrate into it, provoking constant irritation of the mucosa and destabilizing the activity of the glands;
• In the affected section of the stomach, persistent glandular dysfunction occurs, and therefore the acidity of the chyme increases, further damaging the walls of the organ.

Helicobacter pylori gastritis, ignored by the patient, leads to a number of serious complications, therefore, if there is the slightest suspicion of a disease, a comprehensive examination by a gastroenterologist should be performed.

Antral gastritis: symptoms and signs

A feature of Helicobacter pylori gastritis is a frequent asymptomatic course. More precisely, the signs of pathology appear, but very mildly - so that the patient writes them off for a banal malaise or mild poisoning with a stale product.

According to WHO statistics, this disease accounts for over 87% of all stomach diseases, but about 10 out of 100 patients seek timely medical help.

Antrum-gastritis occurs mainly at the age of 45-55 years, in most cases - in men. Therefore, people at risk should be on the alert and undergo preventive diagnostics every 6 months.

Signs of chronic Helicobacter pylori gastritis:

• Pulling or constraining sensations in the epigastric zone (upper abdomen closer to the center);
• Seizures and spasms of the stomach;
• Minor dull pain in the stomach;
• Regular occurrence of nausea (rarely accompanied by vomiting);
• Feeling of heaviness, fullness, fullness in the stomach;
• Stool disorders - diarrhea or constipation;
• Anorexia (loss of appetite);
• Heartburn;
• Flatulence;
• Coating of the tongue with a gray or whitish coating;
• Dryness and fever of the tongue;
• Subfebrile condition;
• Fatigue, weakness and drowsiness (associated with eating).

Acute symptoms occur at the initial stage of the development of the disease. In this case, the symptoms may be similar to those of an ulcer. A person has severe pain in the left hypochondrium, "hunger pains", nausea after eating, persistent constipation, belching with a sour smell and a sour taste in the mouth.

Varieties of pathology and their clinical features

Gastritis caused by Helicobacter pylori is conventionally divided into three types:

• Superficial (non-atrophic);
• erosive;
• atrophic.

First form - the simplest. With it, only the surface of the gastric mucosa is affected. But you should not consider it completely “harmless” - along with other types of the disease, it destabilizes the functioning of the organ and the gastrointestinal tract as a whole, forms cicatricial defects on the surface and progresses over time if not treated.

Second form characterized by a more aggressive course and affects the deep layers of the epithelial tissue. Erosive gastritis is a consequence of superficial. It proceeds with erosion - single or multiple. Symptoms are standard, but become more pronounced. Sometimes there is vomiting with bloody inclusions, as well as the inclusion of black blood in the stool, which indicates ulceration of erosions.

Third form the most dangerous and difficult of all listed. It differs by joining the typical mechanism for the development of antrum-gastritis of autoimmune reactions. The latter negatively affect the cells of the gastric glands, completely suppressing their secretory functions. Pathological regeneration of organ cells occurs, leading to the formation of a malignant tumor. Most gastroenterologists express the opinion that already atrophied stomach cells cannot be restored and cured. However, drug therapy and a therapeutic diet help patients with gastric atrophy protect themselves from oncology.

Focal atrophic gastritis, localized in the antrum, is almost always accompanied by the formation of ulcers. Its course is complicated by intolerance to a number of products:

• Milk fats;
• red meat;
• Chicken eggs.

Also, with this form of the disease, there is an increase in pain in the solar plexus, increased heart rate, a feeling of weakness, bouts of morning sickness, and rapid weight loss.

Diagnosis of Helicobacter-associated gastritis

Diagnosis of pathology begins with a full-time examination, study and evaluation of the clinical history, questioning the patient about the duration and severity of complaints. For differential diagnosis, functional, laboratory and instrumental studies are used.

When diagnosing gastritis of the antrum, the most informative are those research methods that involve contrasting. Classical ultrasound, and even MRI does not give the doctor an idea of ​​the localization, specificity and form of the lesion. In some cases (for example, with focal antrum-gastritis of an atrophic form), changes are not visualized at all.

In the diagnosis of diffuse and focal antral gastritis, the following procedures are relevant:

• X-ray of the stomach with contrast;
• Endoscopic studies (gastroscopy, esophagogastroduodenoscopy, chromoscopy);
• Urease tests with a biopsy taken during endoscopy;
• C-urease breath test for Helicobacter Pylori;
• Analysis of blood, saliva and chyme by ELISA;
• Blood test for gastropanel (determination of antibodies to bacteria, gastrin 17 and pepsinogen I);
• Electrometric intragastric pH-metry.

During gastroscopy, the color, density, structure of the gastric mucosa is assessed, the presence of erosive defects is identified, the degree of swelling is established, certain parts of the organ are examined for hemorrhages.

When conducting endoscopic studies, a biopsy specimen is necessarily taken from the gastric mucosa for subsequent histological examination. Rigid antral gastritis is characterized by thickening and enlargement of the tissues of the stomach outlet, so it is often confused with a cancerous tumor. The final verdict is made after histology.

General diagnostic goals:

• Determination of the pathological focus;
• Assessment of the degree of spread of the disease (focal or diffuse form);
• Establishing the nature and duration of the pathology;
• Study of fermentation and secretory functions of the stomach;
• Differentiation with peptic ulcer.

Based on the results of the studies, an individual treatment regimen for gastritis with Helicobacter pylori is developed for the patient.

Antral gastritis: treatment

With exacerbations, it is customary to treat antral gastritis in a hospital setting. After hospitalization, the patient is prescribed a therapeutic diet (table No. 1B). Depending on the course and dynamics of the disease, the diet expands to treatment table No. 1 in 2-3 weeks or 1-2 months.

Diet for antral gastritis includes the following products:

• Pureed cereals cooked on a mucous broth;
• Rusks in an amount of not more than 100 g per day;
• Fish and meat only low-fat varieties;
• Dairy products, with the exception of sour-milk drinks, low-fat cottage cheese and cheeses;
• Buckwheat, semolina, oatmeal in pureed form;
• Chicken eggs in an amount of not more than 3 per day;
• Starchy vegetables in the form of puree;
• Berry and fruit soufflés, jellies and mousses (fresh fruits are not allowed);
• Vegetable or butter as an additive to main dishes;
• Weak teas, milk jelly, natural juices diluted with water (in a ratio of 1: 1), rosehip broth.

When expanding the diet to the treatment table No. 1, the menu includes light vegetable and meat soups, dry biscuits and dried bread, biscuits, yogurt and acidophilus, fatty non-acid kefir, some vegetables - zucchini, pumpkin, green peas, cauliflower. Cold and warm snacks with a creamy texture on a protein basis are allowed: pates, doctor's sausage, mincemeat, etc.

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A prerequisite for effective therapy is the treatment of antral gastritis with medications aimed at the destruction of pathogenic microorganisms - the causative agents of the disease. Unfortunately, Helicobacter pylori quickly adapts to common antibacterial drugs, so they have to be varied and dosed.

The treatment regimen for Helicobacter pylori includes taking antibiotics of the following groups:

• Nitroimidazoles;
• macrolides;
• Penicillins;
• Tetracyclines.

Proton pump inhibitors - omeprazole, lansoprazole, esomeprazole, rabeprazole, etc. (trade names - Omez, Neo-Zext, Hairabezol, Emanera, etc.) can be added to antibiotics for antral gastritis.

Patients are prescribed anti-inflammatory therapy. With severe spasms, antispasmodics are prescribed - mainly papaverine and drotaverine. To optimize peristalsis, antiemetics are indicated - for example, dopamine receptor antagonists. Nucleosides and anabolic steroids are used as reparative drugs.

Physiotherapy plays an important role in the treatment of type B gastritis:

• Medicinal electrophoresis and galvanization of the stomach;
• Pain relief ultrasound therapy;
• Diadynamic therapy to eliminate dyspeptic symptoms;
• Drinking therapy with mineral waters;
• Mud cure.

When gastritis with high acidity is additionally prescribed:

• Antisecretory agents ("Almagel", "Ranitidine", "Gastrin", "Pyren", etc.);
• Enzymatic agents ("Festal", "Mezim", "Pancreatin", etc.);
• Enveloping agents ("Smecta", "Diosmectite", etc.).

Otherwise, the therapy follows the classical scheme.

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Gastritis with low acidity - atrophic. His treatment is fundamentally different, and involves taking the following medications:

• chyme enzymes;
• hydrochloric acid preparations;
• "Plantaglucid" (a drug based on plantain);
• Injection vitamin therapy (for B12 deficiency);
• Bismuth or aluminum preparations.

The similarity with the treatment of the first type of pathology lies only in the use of antibiotics and proton pump inhibitors, and sometimes dopamine receptor antagonists.

Often, traditional therapeutic tactics include traditional medicine. It should be understood that they are only an additional and auxiliary option, and cannot fully replace drug treatment.

Among folk remedies in the treatment of Helicobacter pylori gastritis, the following are used:

• Decoctions of flax seeds;
• Decoctions of chamomile, mint and St. John's wort;
• Sea buckthorn oil;
• Koalin (white clay);
• Carnitine;
• Potato and cabbage juice;
• An infusion of burdock roots.

The listed products are taken orally. The multiplicity, dosage and duration of the course is agreed with the doctor, as well as the expediency of using traditional medicine.

Complications, prognosis and prevention of the disease

The main complications of antral gastritis are peptic ulcer (including perforated), pangastritis, cancer of the gastric outlet (in 1-2% of cases).

With a timely visit to the doctor, the prognosis is regarded as favorable. In other situations, the disease takes a diffuse form and spreads to the entire organ, proceeds more aggressively, and increases the likelihood of severe complications. As a preventive measure, correction of the diet, rejection of bad habits, avoidance of stress and overwork are recommended.

In the early stages, the disease flows almost without symptoms. Then discomfort and mild pains in the esophagus and in the stomach area are born. They can be observed during hunger, immediately after eating or after 1.5-2 hours. Belching, nausea, not always vomiting, very high secretion of gastric juice, heaviness after eating, non-compliance with the stool are almost always connected to painful sensations.

The progression of antral gastritis causes an increase in the pain syndrome. According to the pain symptom, they become similar to ulcers, however, in the advanced stage, the sensation of pain becomes more dull - this is due to the appearance of scars at the site of erosive damage to the mucosa.

From the bottom of the stomach there is a huge number of glands that produce hydrochloric acid (the main component of gastric juice). It also maintains a specific level of acidity in the stomach and is responsible for the first stages of food digestion. An increase in the acidity of the stomach can occur with a sour taste in the mouth and digestive disorders (flatulence, belching, bloating, etc.).

Usually inflammation of the antrum of the stomach passes in the initial stages as a non-atrophic process without insufficiency of secretion of gastric juice. The clinic of this pathology is ulcer-like: pain in the epigastric region, hungry or a few hours after eating; heartburn, eructation of sour and air, tendency to constipation.

This pathology is treated gastroenterologists, therapists, endoscopists; during 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 over several weeks or months.

Helicobacter pylori drugs are required. Etiotropic therapy of H. pylori is quite complicated, as this microorganism quickly adapts to popular antibiotics. Most often, a dual or triple regimen is prescribed, which includes metronidazole, clarithromycin, ampicillin, or tetracycline. It is recommended to add proton pump inhibitors to the scheme, which inhibit Helicobacter pylori, and complete eradication with antibacterial drugs.

Anti-inflammatory therapy can be carried out both with pharmaceutical preparations and herbs according to traditional medicine recipes. So, during the period of exacerbation, it is recommended to use infusions of chamomile, mint, St. John's wort, flax seeds. With the appearance of erosion on the mucosa of the antrum of the stomach, hyperacidity gastric juice prescribed antisecretory agents. With spasm of the pylorus, myotropic antispasmodics are successfully used: drotaverine, papaverine. Metoclopramide is used to normalize peristalsis and eliminate duodenogastric reflux.

The condition for complete recovery is the appointment of reparative agents. These can 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 region), UHF therapy, ultrasound treatment(for analgesic purposes) diadynamic currents Bernard, sinusoidal modulated currents (to eliminate pain and dyspepsia). After stopping the exacerbation, it is recommended to carry out mud and paraffin therapy, mineral water treatment.

General information

Antral gastritis is a chronic inflammation of the gastric mucosa, localized in the pyloric region. This section of the stomach performs the function of alkalization of food chyme before passing into the intestine. Inflammation in the antrum causes a blockage in the production of bicarbonates, the acidity of the 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, Helicobacter pylori 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.

Pathogenesis

A feature of Helicobacteria is their production of a number of enzymes that contribute to a change in the environment around them. So, 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. Under such conditions, mobile bacteria easily penetrate through the layer of protective mucus to the antral epithelium of the stomach, where they begin to actively multiply, causing damage to the mucosa and disruption of the gastric glands.

Grandma's remedy

Gastritis of the antrum of the stomach is considered the mildest form of the disease, as it does not cause strong changes and damage to the glands. The cure first of all involves the removal of the causative agent of the infection (Helicobacter pylori), and then the resumption of the mucous membrane and the good functioning of the stomach.

To establish the degree of activity of bacteria allows a special urease analysis. The elimination of pathogenic microflora is carried out using two options for antibacterial drugs and a proton pump inhibitor. If the cure did not bring the expected result, then a four-component therapy regimen is used. It consists of bismuth preparations, proton pump inhibitors, tetracycline and metronidazole.

If there is a sensation of pain, painkillers may be prescribed; to reduce the production of gastric juice and reduce its acidity - antisecretory drugs; antacids - to protect the gastric mucosa from damage; coating drugs. In most cases, additional preparations are prescribed to accelerate tissue regeneration, vitamin complexes, sedatives, etc.

In alternative medicine, there are a lot of remedies for gastritis, but you need to remember that the defeat of the antrum of the stomach by pathogenic microflora must begin with its elimination, otherwise all efforts will be meaningless. Due to this, non-traditional methods of treatment should be used in parallel with conservative antibiotic therapy.

• To restore good functioning mucous membrane stomach can be taken: freshly squeezed cabbage or potato juice? glass 30 minutes before meals.
• Aloe juice (agave) has good antibacterial and enveloping qualities. The plant must be at least 5 years old. 1 teaspoon of juice is taken half an hour before meals 3 times throughout the day.
• For the purpose of enveloping, mucus (decoction) of flax seed is also used.
• Herbal decoctions have a beneficial effect on the stomach: chamomile, calamus rhizomes, burdock, calendula, mint, linden.
• You can reduce the acidity of the stomach with ordinary baking soda. ? a teaspoon is boiled with boiling water, then topped up to 250 ml of cold water. Take warm at least 30 minutes before meals. For the same purpose, table mineral alkaline waters (Borjomi, Essentuki, Narzan, etc.) can be used.

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Forecast 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 turn to a gastroenterologist in time, gastritis turns into a diffuse form, which can result in the formation of ulcers (with hyperfunction of the mucosa) or tumors of the stomach (with atrophy of the mucosa).

According to the anatomical structure and functional purpose, the stomach is divided into 3 parts:

• upper - connects to the esophagus, called "cardial", contains a dome or bottom, a towering formation;
• middle - body;
• the lower - pyloric, located on the border with the duodenum, in turn, is divided into the antrum and the pyloric canal, which ends with a muscular sphincter.

The antrum accounts for up to 30% of the volume of the stomach. It is impossible to visually determine exactly where the antrum is located, since the border is very conditional. According to the histological picture of the epithelial layer, it is more likely to establish that the tissue belongs to a certain part of the organ.

The antrum of the stomach is involved in the general functions of the organ, but also has its own characteristics. Their violation causes various diseases. Therefore, it is worth dwelling on the specifics of the work of the antrum.

Physiological "duties" of the antrum

All functions of the antrum of the stomach are associated with the process of digestion. Here's what's going on:

• crushing food particles to 2 mm or less with simultaneous mixing, the result should be a homogeneous mass without separating pieces;
• pushing the formed lump towards the pylorus and duodenum;
• preparation for further digestion in the intestine means a decrease in acidity, which was provided by the body of the stomach, because in the small intestine there should be an alkaline reaction, the maximum concentration of alkaline mucus is produced in the pylorus;
• to eliminate hydrochloric acid in the cells of the mucous membrane there is a hormonal substance - gastrin, it is also called the "informant hormone", since the action is associated with the transmission of an impulse to higher centers about the appearance of food;
• the production of serotonin allows for reliable evacuation of the food bolus by stimulating the muscular apparatus of the stomach;
• the synthesis of somatostatin, which, if necessary, is able to suppress the secretion of enzymes.

What are the causes of antrum disease?

All variants of the pathology of the antrum are united by a single most common cause - the presence of a special pathogen Helicobacter pylori or Helicobacter pylori. The fact is that the antrum is a favorite place for the localization of this microorganism.

Human infection occurs through the mouth. And, getting into the stomach, in the pyloric part, the pathogen finds the most convenient conditions for life. It tolerates the acidity of gastric juice well. Independently neutralizes it with the help of enzymes that release ammonia. Actively breeds.

Due to the presence of antennae, the bacterium is able to move in a gel-like environment of mucus.

Excessive alkalization is considered a mechanism that triggers pathological changes in the antrum, further leading to stomach diseases.

In addition to Helicobacter pylori, risk factors are involved in the pathology of the antrum:

The frequency of stomach damage was associated with diseases of the endocrine organs, bronchi, lungs and heart, iron deficiency, diseases of the urinary system, as well as the presence of chronic foci of infection (tonsillitis, sinusitis, caries, adnexitis in women and others).

Chronic pathology is accompanied by the suppression of the body's defenses. In combination with Helicobacter pylori, these factors cause a stomach lesion that is different in prevalence and depth. Consider the most common diseases with features of symptoms and treatment.

Diagnosis is based on the identified morphological changes in tissues, endoscopic examination

Antral gastritis

The morphology of the inflammatory response includes step-by-step processes:

• infiltration of the mucous membrane of the antrum with lymphocytes, neutrophils, macrophages, plasma cells;
• formation of follicles from lymphoid tissue (lymphoid hyperplasia);
• destruction of the epithelium in the form of individual foci (focal gastritis) or massive damage zones.

Antral gastritis is basically a chronic disease. Unlike gastritis of the body, the stomach is rarely acute. It starts with high acidity. The production of hydrochloric acid by parietal cells is stimulated by Helicobacter pylori.

Gradually, the functions of the epithelium are depleted, the processes of atrophy begin. This means replacing epithelial cells with non-functioning fibrous ones. Another option is the transformation of the gastric epithelium into an intestinal epithelium, atypical in location. The process is dangerous degeneration into a cancerous tumor.

Depending on the violation of secretion, there are:

• atrophic gastritis - accompanied by a gradual loss of the gastric mucosa of the ability to synthesize acid, hormonal substances, mucus, death of the epithelium, thinning of the stomach wall, is considered a precancerous disease;
• hyperplastic - characterized by the formation of large folds, cysts, small polyps, activation of the process of cell growth.

The type of antral gastritis depends on the depth of the lesion. The most favorable form of the flow is considered superficial, the changes concern only the surface layer of the mucosa, are not accompanied by scarring, pronounced violations of the secretory function.

With fibrogastroscopy, hyperemic and edematous mucosa is revealed, petechial hemorrhages are possible.

Superficial inflammation reaches the muscles, but does not touch them

Erosive gastritis - an inflammatory reaction goes deep into the wall of the stomach. As a result, first surface erosion, cracks are formed. The chronic course of erosion without treatment leads to the formation of ulcers. With a favorable outcome, a scar appears in the focus of inflammation.

Symptoms of antral gastritis with superficial lesions may not bother a person or occur after overeating, drinking alcohol. Other forms are more persistent. More often patients are concerned about:

• pain of varying intensity immediately after eating or on an empty stomach;
• heartburn and belching;
• taste in the mouth;
• breath odor;
• bloating;
• stool disorder (diarrhea or constipation).

With a massive lesion, manifestations of general intoxication are possible: nausea and vomiting, weakness, loss of appetite, weight loss.

The appearance of blood in the feces and vomit indicates an erosive form of gastritis. Accession of anemia is accompanied by increased weakness, headaches, pallor. Persistent symptoms that do not respond well to treatment should be alarming due to the transformation of gastritis into peptic ulcer, tumor, inflammation of the pancreas, bulbitis of the duodenal head.

ulcers

Ulcerative damage to the antrum is possible after the stage of inflammation, when focal atrophy of the mucosa passes through the stage of erosion to a deep lesion of the submucosal and muscular layers.

Ulcers located in the antrum account for up to 10% of all gastric ulcers.

The mechanisms of the disease, in addition to inflammation, are added:

• low contractile function of the antrum;
• stagnation and fermentation of the food bolus;
• increased production of enzymes.

The presence of risk factors provokes the transition of inflammation into an ulcer. Typical symptoms:

• pain in the epigastric region, becoming more intense at night;
• heartburn of a permanent nature;
• nausea and vomiting;
• belching after eating;
• blood impurities in feces, vomit.

Benign neoplasms of the antrum

Noncancerous antrum formations include polyps and lymphofollicular hyperplasia. Polyps arise from the growth of glandular epithelial cells. The antrum accounts for 60% of all gastric polyps.

They are characterized by a single growth or the formation of a whole colony. The shape differs in size (up to 30 mm). Detected against the background of other diseases of the stomach. They pose a risk of cancer. Virtually no symptoms. Pain is provoked by malnutrition. They can twist or pinch, then blood appears in the stool.

Three types of antral polyps are distinguished by origin:

• inflammatory - begin with lymphoid follicles (from 70 to 90%);
• adenomas - grow from the glandular epithelium;
• specific - neoplasms in the Pates-Jeghers-Touraine syndrome, which is a hereditary pathology including hyperpigmentation of the skin and polyposis of the intestines, stomach, differ in glandular structure, pigment content (melanin), rarely - muscle fibers.

The first two types of polyps develop in the elderly and senile age, specific ones are usually detected before the age of 30.

The Pates-Jeghers-Touraine syndrome is also characterized by the appearance of spots on the face (xanthoma), in which the melanin pigment is located at the level of the basal layer of the epidermis and in the mucous membrane. Pigmentation appears in childhood, with adulthood it may decrease or disappear.

Polyps can "sit on a leg" or be attached with a wide base to the wall

Lymphofollicular hyperplasia is accompanied by the growth or formation of follicular tissue in the submucosal layer of the stomach. The disease has no age advantages. Among the reasons, in addition to those described above, a special place is given to:

• herpes infection;
• autoimmune diseases;
• disorders in the endocrine sphere;
• contact with carcinogens.

It is important that, according to observations, this type of hyperplasia most often precedes the formation of polyps.

Cancer tumor

Cancer (cancer in Latin or abbreviated c-r) of the antrum accounts for up to 70% malignant. Distinguish:

• adenocarcinoma - formed from glandular cells, the most common tumor (90%);
• solid cancer - a rare neoplasm, the structure is not related to the glandular elements;
• cancer-skirr - an even rarer form, is formed from connective tissue.

Specifics of antral localization of cancer:

• infiltrative growth without the formation of clear boundaries;
• aggressive course with rapid metastasis;
• frequent relapses after resection of the stomach.

The stage of cancer development is determined by the depth of the lesion and the presence of metastasis

The most common cause of cancer is chronic atrophic gastritis. It causes morphological changes of three types:

• glandular atrophy - the disappearance of mucosal cells;
• dysplasia - the appearance in the stomach of an epithelium characteristic of the intestine () with correspondingly impaired properties;
• neoplasia - transformation into malignant cells.

Symptoms of antrum cancer, compared with those described above, differ:

• a constant feeling of fullness or fullness in the stomach area;
• nausea and vomiting that patients cause themselves to alleviate the condition;
• aversion to food;
• significant exhaustion;
• irritability of the patient;
• rise in temperature.

Tumor infiltration of stomach tissue is accompanied by destruction of blood vessels. Therefore, one of the signs is (vomiting blood, black loose stools).

The role of diagnostics

In the detection of diseases of the antrum of the stomach, diagnosis is of decisive importance, since the symptoms do not reflect the prevalence and severity of the lesion.

Fibrogastroduodenoscopy is an endoscopic method that allows you to visually examine all parts of the esophagus, stomach and the beginning of the duodenum, in addition, it is used when choosing a mucosal site for sampling cytological examination, microscopy to detect Helicobacter pylori.

To detect the root cause of the lesion and prescribe treatment, it is necessary to confirm the presence of Helicobacter pylori in the stomach. To do this, use the methods of enzyme-linked immunosorbent assay, polymerase chain reaction for typical antibodies and immunoglobulins, urease breath test and fecal analysis.

The presence of a bleeding ulcer or a decaying tumor can be indicated by a timely reaction of feces to occult blood.

Undeservedly, some doctors have forgotten the X-ray method of diagnosis. It allows you to judge the ulcer niche or the presence of polyps, cancer by folding, deficiency or excess of tissue, altered contours.

An x-ray can be used to diagnose a benign tumor.

According to the daily analysis of urine, it is possible to determine the amount of excreted uropepsin and calculate the acidity of gastric juice. There are no characteristic signs in the general blood test. Anemia, eosinophilia, leukocytosis can speak for the severe course of the disease. Analyzes are carried out both during the period of diagnosis and to monitor the effectiveness of treatment.

Features of the fibrogastroscopic picture: erosion and gastropathy

Consideration of the erosive lesions of the antrum became possible only with the development of a fibrogastroscopic type of diagnosis. This pathology complicates gastritis and serves as the beginning of an ulcer, tumor degeneration.

Erosion is a violation of the integrity of the mucous membrane without penetration into the deep sections of the stomach wall. There are the following varieties:

• acute erosion - limited to seals, cured in 10 days;
• chronic - look like spots up to 10 mm in diameter, require long-term treatment;
• hemorrhagic erosions - give a picture of the consequences of needle injections, the size of the focus remains within 10 mm in diameter, the color takes on shades from scarlet to cherry red (depending on the affected vessel, the vein gives dark spots), the mucous membrane surrounding the lesions is edematous, in it contains blood.

Erosion, unlike ulcers, is located superficially

In the antrum, one can find a single erosion with all the described signs, as well as a complete type of erosion - it is distinguished by the spread along the crests of the folds of the stomach, the formation of black plaque. Antrum gastropathy - described by a doctor, if there are no signs of inflammation, the entire mucosa is hyperemic, but the specific form of the disease is unclear.

Treatment

Each of the diseases of the antrum requires the choice of an individual approach to therapy. A prerequisite is the cessation of smoking and alcohol, the implementation of dietary appointments for the rest of your life. Nutrition should be as sparing as possible, not allowing breaks, the use of frying and hot spices.

To normalize the acidity of gastric juice, enveloping drugs are used (Almagel, Denol, Gefal). Patients with chronic pathology need to get rid of Helicobacter pylori as the source of the disease. For this, a course of eradication with antibiotics is used.

To reduce pain, antispasmodics, proton pump blockers are indicated.

In the recovery stage for gastritis and ulcers, drugs are used that promote tissue healing. Among them:

• Solcoseryl,
• Riboxin,
• Gastrofarm.

With a peptic ulcer, it is very important to make sure that there are no signs of bleeding, as well as suspicions of tissue degeneration. With a successful course, physiotherapeutic methods are used (electrophoresis and phonophoresis with drug solutions, diadynamic currents).

Surgical treatment is required in the following cases:

• persistent pain syndrome;
• bleeding;
• lack of effect from conservative therapy;
• detection of polyps of the stomach;
• cancerous tumor.

Both laparoscopic and abdominal surgeries are performed

One of the low-traumatic methods of treatment - endoscopic laser coagulation - allows you to remove single polyps and eliminate bleeding. Perhaps the gradual removal of a group of polyps. Suspicion of malignancy requires prompt excision of tissues along with an ulcer, polyp, area of ​​lymphofollicular hyperplasia or tumor.

Cancer treatment includes chemotherapy and radiation therapy. During the period of remission with various antrum pathologies, doctors prescribe immunomodulators, vitamins, and allow the use of herbal decoctions. All methods of treatment must be agreed with the doctor. Observation of the revealed pathology by the method of fibrogastroscopy and fecal occult blood analysis seems to be the most informative ways of early detection of exacerbation.

The first among other types of malignant lesions of the digestive organ in terms of frequency of occurrence is cancer of the antrum of the stomach. Pathology is characterized by a specific clinical picture, which can be used to judge the degree of prevalence and stage. Cancer of the antrum is accompanied by pain, loss of appetite and weight loss against the background of refusal to eat, vomiting, and a disorder in the evacuation capacity of the organ. Diagnosed radiographically. A cancerous lesion is treated in a complex manner, taking into account the prevalence and stage of the lesion of the stomach, the presence of metastases.

What is antrum?

The antrum in the stomach is located below. Its main function is not related to the digestion of food, but lies in the transformation of the resulting food mass into a grated lump, which will consist of particles of a maximum of 2 mm. After such processing in the antrum, the food bolus passes unhindered further - through the pyloric sphincter into the duodenum 12. Due to the specific location and functionality of the antrum, it is prone to such diseases:

• erosive lesion;
• inflammation like gastritis;
• ulcerative lesion;

Cancer is considered the most severe disease. At risk are people whose age exceeds 50 years. Men are more often ill than women.

Types of gastric cancer of the antrum

Adenocarcinoma of the stomach is a dangerous disease.

Of the total number of cases of diseases, cancer in the antrum of the stomach occurs in 70% of cases, which indicates the prevalence of pathology. Cancer cells can spread to any part of the stomach, for example, 10% of tumors are localized in the cardiac zone, and only 1% of all diagnosed cases are located at the bottom of the organ. The morphology of these tumors varies and depends on the tissues that are involved in the malignant process. According to the classification of neoplasms in the gastric antrum, three types of cancer are distinguished:

1. adenocarcinoma - develops in 90% of cases, therefore it is considered the most common, it is formed from glandular structures;
2. solid cancer - characterized by a non-glandular structure and a rarity of occurrence;
3. skirr - is formed from connective tissue elements, belongs to the rarest types of pathology.

All types of cancerous tumors in the antrum of the stomach have one specificity. Basically, cancer is infiltrative, without clear boundaries, aggressive with a special malignancy that gives rapid metastases. Such exophytic tumors after gastric resection are characterized by the maximum risk of recurrence, in comparison with other morphological types of cancer. Therefore, the prognosis is disappointing.

Symptoms

A localized neoplasm in the antrum of the stomach, due to its aggressiveness and intensive growth rates, gives a bright, rapidly developing clinical picture. As the lower part of the stomach grows and fills, the tumor affects the pyloric area, which leads to difficulty in the evacuation of the food bolus further into the duodenal process of the intestine. Against the background of chronic food delay, the corresponding symptoms develop:

• eructation with a sharp, unpleasant amber;
• heartburn and a feeling of pressure in the chest;
• feeling of fullness and fullness in the stomach;
• bloating;
• nausea, which often turns into vomiting.

Refusal to eat and wasting due to refusal causes vitamin deficiencies.

As the symptoms intensify, patients begin to independently induce a gag reflex, since relief occurs when the food masses exit through the esophagus. As a result, the body does not receive the necessary set of microelements and vitamins from the absorbed food. On the contrary, food blockage of the stomach causes rotting, fermentation of undigested products, severe intoxication develops. This causes other, more pronounced symptoms:

• exhaustion due to refusal to eat and vitamin deficiency;
• disability;
• irritability due to helplessness;
• refusal to eat;
• sudden weight loss, turning into severe anorexia.

Infiltrated gastric cancer in the antrum, as it grows, is manifested under the action of acidic digestive juice in the stomach. Tumor tissues begin to disintegrate, causing frequent bleeding from the vessels into the gastric lumen. Since decomposing food is simultaneously located in the organ, toxic substances are formed as a result of interaction with the blood. The gradual accumulation of toxins causes:

• fever, fever;
• vomiting with bloody impurities of a dark or scarlet color;
• the appearance of tarry (blackened) stools.

An overgrown tumor, fed by the living tissues of the stomach, provokes wrinkling and a decrease in the size of the organ. At the same time, the cancer patient feels constant pressure, bursting, heaviness after a slight bite. The patient is satiated from small amounts of food. In the last stages of cancer, signs of metastasis to other organs are added to the already existing symptoms. Depending on which organ is affected, the corresponding picture will appear. But more often than not, the duodenum is affected first, against which a rotten eructation, obstructive jaundice appears.

Cancer treatment

The complexity of the malignant disease of the antral zone of the stomach lies in the specificity and speed of development of the pathological process. To stop the anomaly, a complex technique is used, which is developed taking into account the stage, extent of the lesion, and the presence of metastases. The main methods of treatment are surgery, radiation and chemotherapy. The choice of a therapeutic regimen is selected individually. More often, an operation with a radical removal of the tumor with further chemotherapy and radiation is recommended. In case of inoperability, only radiation and chemotherapy are used.

Cancer in the antrum of the stomach is treated with several courses of chemotherapy.

The essence of the treatment is the use of powerful chemicals that stop the processes of abnormal cell division in the stomach. Popular remedies for cancer in the antrum of the stomach are:

• "5-Fluorouracil";
• "Doxorubicin";
• "Cisplatin";
• "Mitomycin";
• "Epirubicin";
• "Oxaliplatin";
• "Irinotecan";
• "Docetaxel".

Combinations of "Cisplatin" and "5-Fluorouracil" with "Epirubicin", "Docetaxel" or "Irinotecan" are more often prescribed. Due to its aggressiveness and tendency to frequent relapses, even after surgery, cancer in the antrum of the stomach is treated with several courses. According to the indications of the technique, it is used before / after resection, which makes it possible to increase the effectiveness of treatment.