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Atrophic Gastritis – Causes, Symptoms and Treatment

Atrophic gastritis is a chronic inflammation of the stomach lining in which the gastric tissue is progressively damaged and lost. It can lead to digestive problems and nutritional deficiencies.

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Things worth knowing about "Atrophic Gastritis"

Atrophic gastritis is a chronic inflammation of the stomach lining in which the gastric tissue is progressively damaged and lost. It can lead to digestive problems and nutritional deficiencies.

What is Atrophic Gastritis?

Atrophic gastritis is a chronic form of stomach inflammation in which the lining of the stomach (gastric mucosa) gradually thins and degenerates over time. Specialized cells responsible for producing stomach acid, digestive enzymes, and the intrinsic factor are lost. This can have serious consequences for digestion and the absorption of key nutrients, particularly vitamin B12.

Causes

There are two main forms of atrophic gastritis, each with different underlying causes:

Type A (Autoimmune Atrophic Gastritis): The immune system mistakenly attacks the body's own gastric mucosal cells. This form primarily affects the corpus and fundus of the stomach and is associated with an increased risk of pernicious anemia.
Type B (Bacterial Atrophic Gastritis): This more common form is caused by infection with the bacterium Helicobacter pylori. The bacterium colonizes the gastric mucosa and triggers a chronic inflammatory response that leads to atrophy over time.

Additional risk factors include:

Chronic alcohol consumption
Long-term use of non-steroidal anti-inflammatory drugs (NSAIDs)
Smoking
Advanced age
Genetic predisposition

Symptoms

Atrophic gastritis often progresses for a long time without noticeable symptoms. When symptoms do occur, they may include:

Upper abdominal pain or a feeling of pressure in the stomach area
Nausea and vomiting
Loss of appetite and unintentional weight loss
Bloating and a feeling of fullness after eating
Fatigue and general weakness (as a result of nutrient deficiencies)
Tingling or numbness in the hands and feet (in cases of vitamin B12 deficiency)
Pale skin and dizziness (in cases of anemia)

Diagnosis

Several diagnostic methods are available to confirm atrophic gastritis:

Gastroscopy (upper endoscopy): Direct visualization of the stomach lining using a flexible endoscope. Tissue samples (biopsies) can also be taken during this procedure.
Histological analysis: Microscopic examination of biopsy tissue to assess the extent of mucosal changes.
Blood tests: Detection of autoantibodies (e.g., against parietal cells or intrinsic factor), measurement of vitamin B12 levels, ferritin, and a complete blood count.
Helicobacter pylori testing: Detection of infection via breath test, stool test, or biopsy.
Serum gastrin levels: Elevated gastrin in the blood may indicate atrophic gastritis.

Treatment

Treatment depends on the underlying cause and associated complications of the condition:

Treatment of Helicobacter pylori Infection

When a Helicobacter pylori infection is confirmed, eradication therapy is performed. This typically involves a combination of antibiotics and a proton pump inhibitor to eliminate the bacteria and reduce inflammation.

Treatment of the Autoimmune Form

In autoimmune atrophic gastritis, the main focus is on correcting nutritional deficiencies. Since the absorption of vitamin B12 through the stomach is impaired, vitamin B12 is often administered as an intramuscular injection or in high-dose oral supplements. Iron and other micronutrients may also need to be supplemented.

General Measures

Avoiding alcohol and tobacco
Dietary adjustments (easily digestible foods, smaller meals)
Regular endoscopic monitoring, as there is an increased risk of gastric cancer

Risks and Complications

Atrophic gastritis is associated with an increased risk of several secondary conditions:

Pernicious anemia: Severe anemia caused by vitamin B12 deficiency due to the absence of intrinsic factor
Gastric carcinoma: Chronic inflammation and mucosal changes increase the long-term risk of stomach cancer
Gastric polyps: Benign growths of the stomach lining
Iron deficiency anemia: Due to reduced stomach acid production and impaired iron absorption

References

Sipponen P, Maaroos HI. Chronic gastritis. Scandinavian Journal of Gastroenterology. 2015;50(6):657-667.
Zullo A, Hassan C, Romiti A et al. Follow-up of intestinal metaplasia in the stomach: When, how and why. World Journal of Gastrointestinal Oncology. 2012;4(3):30-36.
World Health Organization (WHO). Helicobacter pylori and gastric cancer: Report of a WHO Consultation. Geneva, 1999.

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