Did you know that gastritis can be acute or chronic? Our expert in General Surgery in Avellino , Dr. Luca Covotta, explains the difference between these two conditions
The different functions of the mucous membrane of the stomach
The stomach can be divided into several parts and in each of these areas the mucosa is made up of different cells, determining different functions in the various areas:
- Cardias: passage area through which the esophagus connects to the stomach where there is that complex mechanism that allows the stomach to close, so as to avoid the ascent of acid or food into the esophagus. In this area we find the cardial glands with a prevalent mucous secretion.
- Bottom and Body: it represents the true reservoir of the stomach where the two fundamental processes of gastric activity take place. Here we find two cell types:
- Parietal or oxyntic cells, which secrete both hydrochloric acid and intrinsic factor (a substance that allows the absorption of vitamin B12 and iron in the intestine).
- Main cells, which secrete pepsinogen which, in contact with hydrochloric acid, turns into pepsin, an enzyme capable of breaking down proteins into amino acids.
- Cave: we can consider it the most endocrine part (hormone production) and is made up of:
- Mucosecretory cells, which produce a mucous film that prevents acid from “burning” the stomach itself.
- Gastrin-secreting G cells, a hormone that induces the synthesis of hydrochloric acid.
- Enterochromaffin cells secreting serotonin, which stimulates the contraction of smooth muscle.
- Endocrine cells of different types that deal with the production of hormones (e.g. somatostatin, glucagon and histamine).
- Pylorus: orifice that connects the stomach with the duodenum in the first part of the intestine.
What is gastritis?
The term ” gastritis ” generically indicates an inflammatory process of the mucous membrane of the stomach and is divided into two completely different inflammatory processes: acute and chronic gastritis.
Acute gastritis: what is it?
It is characterized by hyperemic and / or erosive lesions of the mucosa mainly affecting the antrum, which usually causes a severe burning sensation (heartburn). In some cases it can be accompanied by nausea, vomiting, a reduction in the sense of hunger, a feeling of full stomach after meals, abdominal bloating, belching, slimming etc. The causes are manifold:
- Taking gastrolytic drugs;
- Excessive consumption of alcohol and / or smoking;
- Ingestion (accidental or voluntary) of highly acidic or alkaline substances, or with a high corrosive action;
- Infections originating from the presence of Helicobacter Pylori ;
- Ischemia (reduction of the arrival of blood) generally caused by trauma, burns, hypovolemia and states of shock.
The diagnosis is mainly entrusted to gastroscopy , which also allows you to make a histological assessment of the degree and nature of the inflammatory process. The therapy is obviously related to the triggering factor that must be identified and suspended. In addition to the suspension, there is associated therapy with drugs that can block the production of acid by the stomach, the so-called gastroprotectors.
And what about chronic gastritis?
The chronic gastritis is divided into two types:
- Type A gastritis: not particularly frequent, this is an autoimmune based disease in which there is the production of autoantibodies directed against the parietal cells of the stomach. This condition can cause mucosal atrophy, pernicious anemia, achlorhydria and an increased risk of contracting a gastric tumor;
- Type B gastritis: it is the most common chronic form (80-90% of cases). This condition is characterized by the presence of a Gram negative bacterium, Helicobacter Pylori. The presence of this bacterium induces a chronic inflammatory state which in some cases can trigger an evolution of cascade events (“Correa Cascade”) in which two conditions are determined that can be in progression: the complete absence of glands in the gastric epithelium (which is called “gastric atrophy”) and the transformation of the mucosa from gastric to intestinal ( metaplasia). Some forms of metaplasia can be considered precancerous lesions, therefore an endoscopic check with biopsy and histological examination every 24/36 months is appropriate, depending on the specific clinical case and the extent of the histological pathology.