Generality
Antral gastritis is the inflammation of the inner wall of a specific portion of the stomach, called the gastric antrum or pyloric antrum.
Inducing the phenomenon of antral gastritis is the weakening of the mucus layer, which covers the inner surface of the gastric antrum, and the simultaneous erosive action of the aforementioned surface, exerted by the acid juices necessary for the digestive process.
Among the main causes of antral gastritis (and of the aforementioned upheavals) are: the infections sustained by Helicobacter pylori, the abuse of common drugs such as NSAIDs, the abuse of alcohol and the excessive psychophysical stress.
To properly treat a condition such as antral gastritis, an accurate diagnostic investigation is essential, which will bring to light the triggering causes.
Brief review of the term gastritis
In medicine, "gastritis" is the word that indicates inflammation of the inner wall of the stomach.
Also known as internal gastric mucosa, the inner wall of the stomach is the complex of cell layers deputed to:
- Production of acidic digestive juices, necessary for the digestive process;
- The secretion of the mucus intended to protect the stomach from the aforementioned acidic digestive juices;
- Gastrin hormone production.
| Cellular layers that make up the inner wall of the stomach | Features |
| Epithelial layer | it is the most superficial layer (therefore in direct contact with the lumen of the stomach). It secretes the protective mucus. |
| Lamina propria | is the middle layer. It has a dense network of glands, responsible for the production of acidic digestive juices. |
| Muscolaris mucosae | is the innermost layer. It contains muscle cells, which guarantee the stomach the ability to move food towards the intestine and proceed with the digestive process. |
What is Antral Gastritis?
Antral gastritis is the inflammation of the inner wall of the stomach portion called the gastric antrum or, more simply, the antrum .
To understand: what is the gastric antrum?
To fully understand what antral gastritis is and why its consequences are symptomatic, it is necessary to briefly review stomach anatomy and provide readers with a brief description of the gastric antrum.
- Following the esophagus and previous to the intestine, the stomach is the equal organ of the digestive system, within which the foods ingested at the level of the mouth are collected and within which the digestion of proteins and carbohydrates takes place;
- According to the most classical of anatomical descriptions, the stomach can be divided into 4 large portions, which are: the cardia, the fundus, the body and the pylorus .
The cardia corresponds to the valve that connects the stomach to the esophagus; the bottom is the upper left portion of the stomach, to the right of which is the aforementioned cardias; the body is the largest portion of the stomach, with an extension immediately below the bottom; finally, the pylorus is the terminal portion of the stomach, preceded by the aforementioned body and including the homonymous valve that regulates the passage of food towards the intestine;
- Within the anatomical picture described above, the gastric antrum represents the initial part of the pylorus, immediately preceding the part of the latter called the pyloric canal and the homonymous valve.
Also known as pyloric cavern, the gastric antrum is characterized by being the most voluminous part of the pylorus and for being particularly rich in mucus-producing and gastrin-producing cells.
In light of what has just been stated, antral gastritis is the inflammation of the initial section of the gastric pylorus, a section that happens to the gastric "bottom" and includes a large number of mucus-producing and gastrin-producing cells.
Causes
The inflammation that characterizes the antral gastritis is the result of the combination of two processes: the weaker or weaker mucus layer responsible for protecting the inner wall of the gastric antrum and the corrosive action that acidic digestive juices have against the portion of gastric wall just mentioned.
In other words, antral gastritis is the consequence of the damage that acidic digestive juices of the stomach cause to the internal mucosa of the pyloric antrum, when the latter loses some of its protective mucus layer.
Causal and Risk Factors of Antral Gastritis
A number of factors can weaken the protective mucus layer of the gastric antrum and consequently cause / promote antral gastritis; specifically, among the causes / risk factors of antral gastritis, there are:
- Infections supported by Helicobacter pylori . Helicobacter pylori is a bacterium normally present inside the stomach (it bears very well the acid environment) and has no health consequences. However, if the human body's immune defenses lose their effectiveness, this micro-organism is free to proliferate uncontrollably and colonize its host, causing an infection.
Encouraged by cigarette smoking and high psychophysical stress, Helicobacter pylori infection is very likely the main causative factor of antral gastritis;
- Prolonged and improper use of certain drugs, such as NSAIDs (eg aspirin, ibuprofen, naproxen, etc.), chemotherapy and colchicine .
- Prolonged alcohol abuse ;
- A diet with the undesirable effect of raising the acidity of the stomach . Such a diet generally consists of the excessive consumption of: fats, oils subjected to cooking, citrus fruits and coffee;
- Some viral infections, such as cytomegalovirus infections and AIDS ;
- Some fungal infections, such as candidiasis (or candidiasis ), histoplasmosis or zygomycosis ;
- Some parasitic (or parasitic ) infections, such as anisakiasis ;
- A past history of radiotherapy for the treatment of a tumor;
- Very intense stress . Stressful circumstances to the point of favoring antral gastritis are, just to mention a few examples, major surgery, chronic diseases and serious injuries.
The forms of antral gastritis resulting from stress are examples of nervous gastritis ;
- Bile reflux . Bile reflux is the rise of bile from the duodenum to the stomach and, in the most severe cases, also to the esophagus;
- Autoimmune diseases of the gastrointestinal tract, such as Crohn's disease or pernicious anemia . Autoimmune diseases are morbid conditions characterized by an exaggerated and improper response of the immune system (in individuals with an autoimmune disease, the components of the immune system attack perfectly healthy tissues and organs, causing even very serious damage);
- Food poisoning .
Types of Antral Gastritis
There are two forms of antral gastritis: a less severe form, called superficial antral gastritis (or non-erosive antral gastritis ), and a more severe form, called erosive antral gastritis .
ANTRAL SURFACE GASTRITIS (OR NON-EROSIVE)
Superficial antral gastritis is the less severe form of antral gastritis; this condition represents, in fact, a suffering limited to the most superficial cells of the epithelium that constitutes the inner wall of the gastric antrum (remember that the aforementioned epithelium is the cellular layer in direct contact with the lumen of the stomach).
Relatively uncommon, superficial antral gastritis is usually disturbing only after meals.
Did you know that ...
In addition to non-erosive antral gastritis, superficial antral gastritis is also known as catarrhal antral gastritis and simple antral gastritis.
EROSIVE ANTRAL GASTRITIS
Antral erosive gastritis is the most severe form of antral gastritis; due to its presence, in fact, it is possible to observe scars-like lesions (ulcers) on the inner wall of the gastric antrum as well as a consistent numerical decrease in the glands responsible for the production of digestive digestive juices.
Erosive antral gastritis is a clinically delicate condition and therefore requires appropriate treatment.
Did you know that ...
Most cases of erosive antral gastritis are caused by Helicobacter pylori infection .
Symptoms and Complications
The typical symptoms and signs of antral gastritis are:
- Indigestion (or poor digestion ). It is the most characteristic manifestation of antral gastritis.
Its presence is the result of the inevitable interference that inflammation has towards the digestive process at the gastric level and the emptying of the stomach;
- Heartburn . To highlight this symptom is a localized pain in the upper part of the abdomen (epigastric pain or stomach ache), whose intensity varies from patient to patient.
At the base of heartburn there is a significant increase in levels of gastric acidity (or stomach acidity);
- Nausea, vomiting and decreased appetite . These are the three classic symptoms that accompany indigestion; therefore, they represent three quite common disorders of antral gastritis.
Among these manifestations there is the following close relationship: nausea triggers vomiting and vomiting induces decreased appetite;
- Flatulence and abdominal bloating and / or abdominal heaviness . Abdominal flatulence and a sense of swelling / heaviness depend, once again, on the bad digestive process; bad digestion, in fact, causes the food to pass to the digested intestine only in part and this causes its fermentation (which is the real responsible for flatulence and abdominal bloating / heaviness);
- General malaise and sense of weakness . These are the direct consequences of the previous symptoms.
Other symptoms of Antral Gastritis
Sometimes, in addition to the disorders just mentioned, antral gastritis can also cause: irritability, hypotension, changes in heart rhythm, pallor and strange sensation of swelling / burning of the tongue.
Complications of Antral Gastritis
In the most severe cases or in the absence of adequate treatments, antral gastritis can degenerate to the point of causing the formation of peptic perforating ulcers ; in the medical field, a piercing peptic ulcer is the expression that indicates any lesion of the digestive mucosa that has reached so deep that it has compromised the integrity of the underlying blood vessels and caused blood loss ( gastrointestinal hemorrhage ).
The classic manifestations of a perforating peptic ulcer are: persistent pain in the abdomen, black stools due to the presence of blood, loss of blood from the rectum and vomiting with blood ( hematemesis ).
When should I go to the doctor?
An individual should contact their doctor when they suffer from the symptoms listed above for more than a week.
In case of complications, it is good practice to go immediately to the nearest medical-hospital center and undergo all the treatments provided.
Diagnosis
In general, the process of investigations necessary for the diagnosis of antral gastritis and its causes begins with an accurate physical examination and a scrupulous medical history . Thus, it continues with a test for the tracing of Helicobacter pylori (because it is the main cause / factor favoring the condition in question), blood tests and a stool test . Finally, it ends with an endoscopy .
In doubtful circumstances and when it is necessary to study the situation further, the doctors could prescribe, in addition to the previous tests, also the execution of a radiograph of the digestive tract with barium sulfate contrast agent .
Why is an accurate diagnosis and the discovery of the triggers important?
The accurate diagnosis of antral gastritis and the identification of the factors that caused it are fundamental to the planning of the most adequate and effective therapy.
Therapy
The practice is that the treatment of antral gastritis includes a therapy focused on treating the causes / factors favoring the condition ( causal therapy ), a purely pharmacological symptomatic therapy and, finally, the adoption of a dietary plan aimed at containing production of digestive acid juices from the gastric mucosa (as this production would lead to a worsening of the symptoms).
Causal therapy
The causal therapy varies according to what the doctor has identified as the triggering factor antral gastritis; causal therapy, therefore, differs from patient to patient.
If from diagnostic investigations it emerges that antral gastritis is due to a reckless use of NSAIDs, causal therapy will foresee the immediate abolition of the intake of the aforementioned drugs.If antral gastritis is related to a Helicobacter pylori infection, causal therapy will consist of a specific antibiotic treatment against the aforementioned pathogen.
Pharmacological symptomatic therapy
Medicines for symptomatic treatment of antral gastritis are medicines for the control and limitation of gastric acidity.
Specifically, these drugs consist of:
- Antacids . They are useful in buffering gastric acidity and in alleviating heartburn, resulting from poor digestion.
Often, doctors associate them with the two following pharmacological categories.
Examples of classically used antacids in the presence of antral gastritis are: magnesium hydrate and aluminum hydroxide.
- Anti-H2 (or H2-receptor antagonists ). They have the effect of reducing the production of acid digestive juices from the stomach.
A typical anti-H2 used in a context of antral gastritis is ranitidine.
- Proton pump inhibitors ( IPP ). They act in a similar way to anti-H2, therefore they reduce the production of acid secretions in the stomach.
The classic IPPs administered during the management of antral gastritis are omeprazole and lansoprazole.
Recommended Dietary Plan
In the presence of antral gastritis, the foods to avoid are: fried foods (because they contain a high percentage of fat), fatty foods, citrus juices, coffee and spirits; the foods recommended are: all vegetables, fruit (except citrus fruits, of course), low-fat food products, lean meats (eg chicken or turkey), pasta and rice (NB: pasta and rice prepared, of course, in a "light" manner).
In a context of antral gastritis, careful control of the diet can have unexpected beneficial effects.
Prognosis
The prognosis in case of antral gastritis depends on:
- The traceability of triggering factors . An antral gastritis resulting from an easily treatable cause will have a better prognosis than an antral gastritis resulting from a difficultly controllable cause.
- The timeliness with which the treatment began . An antral gastritis subjected to treatment at onset is less likely to give rise to complications and / or chronicity (chronic gastritis).
Prevention
Avoid the intake of foods that stimulate the production of acidic digestive juices, limit alcohol consumption, take NSAIDs only when strictly necessary and learn to control stress are the main medical indications, when the topic of discussion is the prevention of gastritis antral.
