Currently, it is established that autoimmune gastritis is often inherited, and its prevalence in different regions of Ukraine varies from 2 to 15% of all incidence of chronic gastritis. It occurs in all age groups.
Autoimmune gastritis (gastritis type A) develops if the immune system fails and begins to produce antibodies that damage the cells of the gastric mucosa that produce hydrochloric acid. As a result, acidity decreases and degrades the process of digestion of food. This disease can occur at any age.
Mechanism of development of autoimmune gastritis
Launches the mechanism of the autoimmune process is usually mechanical traumatism of the stomach mucus coarse food, combined with the chemical influence of its components (sour, pickled, sharp dishes). As a result, on the background of burdened heredity, the body tries to cope with this problem, but the restoration reactions are distorted immune. This is manifested in the inadequate production of secretory protein - immunoglobulin A, as well as in the development of antibodies not inherent to the healthy organism on the coating cells (they produce hydrochloric acid) of the mucous membrane of the own stomach.
At the same time, antibodies to another important component of the stomach protection - the factor of Kasla (protein gastromucoprotein) - which affects the absorption of vitamin B12, which is involved in hematopoiesis, begin to be produced. These antibodies break down the cells of the gastric mucosa, disrupting their natural regeneration, and there is an atrophy of the mucous membrane. This leads to a violation of the production of digestive enzymes (hydrochloric acid, pepsinogen, gastromoprotein, and others). As a result, not only the digestive process is disturbed, but also occurs B12-deficiency anemia.
How does autoimmune gastritis manifest?
Patients are disturbed by discomfort in the epigastric region, a feeling of heaviness and a feeling of overflow of the stomach, nausea, heartburn, but pain in the stomach is small or completely absent. Sometimes there is a blister of air, less often - acid or bitterness, flatulence develops, and often constipation is replaced by diarrhea.
Subsequently, in patients there is a decrease in appetite, gradual weight loss, and due to violation of the processes of absorption in the intestine develops hypovitaminosis. There is weakness, dizziness, dry and pale skin, hair becomes dull, thinning, there is brittle nails, bleeding gums and loosening in the corners of the mouth appear Zayed (angular stomatitis), increased sweating.
The work of the cardiovascular system is broken: arterial pressure decreases; signs of a violation of metabolic processes in the cardiac muscle appear on the ECG. In some cases, the work of the adrenal glands is broken, pigmentation of the skin appears in the area of the face, neck.
Simultaneously, the patient suffers nervous system: there asthenia, headache, insomnia, irritability, emotional lability, fatigue, constant mild fever.
Diagnosis of autoimmune gastritis
In addition to the standard procedure for the examination of therapeutic patients undergo additional, refinement studies:
- Fibrogastroduodenoscopy with biopsy and determination of the presence of bacteria. In this case, in the early stages of the disease, there is a mucosal edema, its hyperemia, the presence of erosions (30%) and ulcers (11%). In the process of long-term existence of the gastric mucosa atrophic, pale, with small areas of degeneration of epithelial cells (apparently it looks like "semolina"), and during the biopsy of erosions and ulcers sometimes find cancer cells;
- X-ray of the esophagus, stomach and duodenum;
- Gastric sensing with the definition of gastric acidity and the presence of bacteria;
- Immunological examination of blood, since in 30% of patients there are autoimmune disorders in other organs (for example, manifestations of autoimmune thyroiditis, rheumatoid polyarthritis, etc.), and in some patients antibodies are detected in the lining of the mucous membrane of the stomach, the Kasla factor;
- In a number of patients there is a significant increase in gastrin in serum, which over time may lead to the development of malignant tumors of the stomach;
- Often in patients with autoimmune gastritis it is possible to detect the presence of herpesvirus infection, the Epstein-Barr virus, which can lead to the development of malignant tumors (carcinoma) of the stomach, duodenum, nasopharynx and other organs;
- Great help in the diagnosis of autoimmune gastritis - a polymerase chain reaction (PCR), which determines the DNA components of viruses and other microorganisms in the tissues and liquids of the patient; In 7.1% of patients with autoimmune gastritis, the presence of the Epstein-Barr virus (causes mononucleosis) is diagnosed;
- In analyzes of blood of almost all patients with autoimmune gastritis - a different degree of severity of iron deficiency anemia;
- Ultrasonography of the abdominal cavity: in 80% of patients there is an increase in the size of the liver with a change in its structure, in 17% of cases - enlargement of the spleen, sometimes - the consolidation and increase of peripheral lymph nodes.
Treatment of autoimmune gastritis
Treatment is individual in nature, depending on the form of the disease, the secretory function of the stomach, the stage of the process, the severity of symptoms and associated changes in other organs and systems. In this treatment, primarily aimed at eliminating the causes of the disease, the fight against viral infection and bacteria, correction of anemia, changes from the cardiovascular and nervous systems.
Basic principles of treatment for autoimmune gastritis:
- The diet of such patients is based on the elimination from the diet of hot or cold food, it must be thermally, mechanically and chemically sparing, neutral in nature (spicy, spicy, salty, roasted, irritating mucus products are excluded), contain a sufficient amount of proteins (fish, fat-free Boiled or cooked on a couple of meat), fiber and vitamins (porridges, mousse, jelly, dairy products, boiled or rubbed vegetables and fruits). Coffee, tea, sweet dishes, cakes, pastries, sweets are forbidden. Meals are accepted only in the warm state.
- In severe pain, prescribe cholinolytics (platyphilin, metacin) and antispasmodics (no-spas, papaverine), as well as drugs that reduce the motor activity of the stomach and intestines (motilium and cerukal).
- To improve the condition of the gastric mucosa, prescribed bismuth, venter, plantaglycide, if the acidity is increased - ranitidine, almagel and others.
- If the expressed mucosal atrophy is prescribed substitution therapy: acidine-pepsin, oralin, panzinorm, mezim, Punkurmen, preparations for the normalization of intestinal microflora, as well as multivitamins, B12 and folic acid.
- If necessary, prescribe antiviral and antimicrobial drugs.
- According to the testimony of physiotherapy, phytotherapy, reflexotherapy, massage and exercise therapy, balneotherapy.
But in any situation, treatment should only be carried out under the supervision of a doctor, self-treatment is unacceptable.