Chronic atrophic gastritis classification

Chronic atrophic gastritis is a very common stomach disease, which is related to Helicobacter pylori infection, eating habits, genetic factors and other factors. The condition of chronic atrophic gastritis is very complicated and can be divided into different types according to the condition. In order to better treat it, we need to have a certain understanding of the classification of chronic atrophic gastritis. So, what are the types of chronic atrophic gastritis? Let’s take a look below.

As early as 1973, Strickland et al. divided atrophic gastritis into two independent types, type A and type B, based on serum immunological examinations and the distribution of gastric lesions. Type A atrophic gastritis lesions are mainly seen in the gastric body and are mostly diffusely distributed. The gastric antral mucosa is generally normal, serum parietal cell antibodies are positive, serum gastrin is increased, gastric acid and intrinsic factor secretion are reduced or absent, and pernicious anemia is prone to occur. It is also called autoimmune gastritis. Type B atrophic gastritis lesions are mostly found in the gastric antrum, with a multifocal distribution. Serum parietal cell antibodies are negative, serum gastrin is mostly normal, gastric acid secretion is normal or slightly reduced, there is no pernicious anemia, and it is more likely to be complicated by gastric cancer. This is a simple atrophic gastritis. Since then, Glass has called atrophic gastritis that affects both the gastric antrum and the gastric body type AB.

In my country, according to the Strickland classification, type B atrophic gastritis is more common, while type A atrophic gastritis is rare. In addition, some patients with atrophic gastritis have both antral inflammation and parietal cell antibodies, and cannot be included in the above two types. Therefore, many domestic scholars have proposed a classification method suitable for the specific situation in my country, dividing chronic atrophic gastritis into type A1, type A2, type B1 and type B2. Its classification is mainly based on the situation of autoantibodies. Serum parietal cell antibody positive belongs to type A, and serum parietal cell antibody negative belongs to type B. Type A is further divided into two subtypes: type A1, which is when there is no lesion in the gastric antrum; type A2, which is when there are lesions in both the gastric antrum and the gastric body. Type B is divided into two subtypes according to the severity of the lesions in the gastric body and gastric antrum: type B1 (lesions in the gastric antrum are heavier than those in the gastric body) and type B2 (lesions in the gastric body are heavier than those in the gastric antrum or lesions in the gastric body and gastric antrum are similar).

treat

1. General treatment

Quit smoking and drinking, avoid using drugs that damage the gastric mucosa such as aspirin, indomethacin, erythromycin, etc., eat regularly, avoid overheated, salty and spicy foods, and actively treat chronic oral, nasal and pharyngeal infections.

2. Weak acid treatment

Patients with low or no acidity confirmed by pentagastrin test can take rice vinegar in appropriate amounts, 1 to 2 spoons each time, 3 times a day; or 0.5 to 1.0 ml of 10% dilute hydrochloric acid, before or during meals, and take pepsin mixture at the same time, 10 ml each time, 3 times a day; multi-enzyme tablets or pancreatic enzyme tablets can also be used for treatment to improve indigestion symptoms.

3. Anti-Helicobacter pylori treatment

In atrophic gastritis, gastric acid is reduced or lacking, and bacteria multiply in the stomach, especially Helicobacter pylori, which has a high detection rate. Anti-Hp treatment should be carried out.

4. Inhibit bile reflux and improve gastric motility

Cholestyramine can complex bile salts that reflux into the stomach and prevent bile acids from damaging the gastric mucosal barrier. Sucralfate can bind to bile acids and lysolecithin and can also be used to treat bile reflux. Ursodeoxycholic acid may also be given. Drugs such as metoclopramide, morphine, and cisapride can enhance gastric motility, promote gastric emptying, assist gastric and duodenal motility, prevent bile reflux, and regulate and restore gastrointestinal motility.

5. Increase mucosal nutrition

Albizzia geranyl can increase gastric mucosal renewal, improve cell regeneration ability, and enhance the resistance of gastric mucosa to gastric acid, thereby protecting the gastric mucosa. You can also use blood-activating agent; or sucralfate, urea capsules, carbenoxolone, prostaglandin E, etc.

6. Pentagastrin

In addition to promoting the secretion of hydrochloric acid by parietal cells and increasing the secretion of pepsinogen, pentagastrin also has a significant proliferative effect on the gastric mucosa and other upper gastrointestinal mucosa. It can be used to treat patients with atrophic gastritis with low acid or no acid or gastric atrophy. It is injected intramuscularly half an hour before breakfast, once a day. In the third week, change to once every other day. In the fourth week, change to twice a week. Thereafter, change to once a week. A course of treatment is 3 months. It is used for mild to moderate atrophic gastritis, has good therapeutic effect and effectively promotes gland repair.