Atrophic Gastritis: Symptoms, Diagnosis, and Treatment of Pain

Atrophic gastritis (AG) is a chronic inflammatory disease of the gastric mucosa characterized by the loss of glandular cells and their replacement by fibrous tissue or intestinal metaplasia. This condition is considered precancerous, which emphasizes the importance of timely diagnosis and adequate treatment [3]. AG is most frequently associated with Helicobacter pylori (H. pylori) infection [3, 4, 8]. Understanding the symptoms, causes, and modern therapies allows for effective management of this disease and the prevention of its serious complications.

Symptoms of Atrophic Gastritis

Symptoms of atrophic gastritis can be non-specific and often overlap with other dyspeptic disorders. Patients may complain of epigastric pain, nausea, abdominal discomfort, heartburn, and constipation [8]. These manifestations are caused by impaired gastric digestive function, decreased production of hydrochloric acid and enzymes. In atrophy of the gastric body, where acid-producing glands are located, treatment with proton pump inhibitors (PPIs), which reduce acidity, may be inappropriate since acidity is already reduced [1]. It is important to note that the presence or absence of gastric mucosal atrophy can influence the choice of therapeutic strategy.

Causes and Diagnosis of Atrophic Gastritis

The primary cause of atrophic gastritis development is a long-standing Helicobacter pylori infection [3, 4, 8]. Studies show that the prevalence of mucosal atrophy is significantly higher in H. pylori-positive patients (22.2%) compared to H. pylori-negative patients (1.3%) [3].

Diagnosis of AG involves a comprehensive examination:

• Endoscopy with biopsy: This is the gold standard of diagnosis. During gastroscopy, the doctor examines the gastric mucosa and takes tissue samples for histological examination. Histological profiling based on six biopsies allows for staging atrophy using the OLGA (Operative Link for Gastritis Assessment) system [3].
• Kimura-Takemoto Atrophy Classification: This endoscopic classification is used to assess the degree of atrophy and may influence the success of H. pylori eradication [2]. Closed (C-type) and open (O-type) atrophic gastritis are distinguished [2].
• 13C-Urea Breath Test and Rapid Urease Test: These methods are used to confirm the presence of H. pylori infection [2, 3].
• Serological markers: Evaluation of pepsinogen I (PG I) levels, the PG I/PG II ratio, and gastrin-17 (G-17) can provide additional information on the state of the gastric mucosa and its functional activity [6, 7].

Modern Approaches to Treating Atrophic Gastritis

Treatment for atrophic gastritis aims to eradicate Helicobacter pylori, restore the mucosa, and relieve symptoms.

Helicobacter pylori Eradication

Eliminating H. pylori is a key step, as this bacterium is the main factor in the development and progression of atrophy [3, 4, 8].

• Standard regimens: Bismuth-containing quadruple therapy is frequently used [2, 4].
• Considerations in gastric body atrophy: In gastric body atrophy characterized by reduced acidity, the use of proton pump inhibitors (PPIs) may be ineffective or even undesirable [1]. In such cases, modified eradication regimens without PPIs are being studied. For instance, one study utilized amoxicillin-based regimens (concomitant or sequential therapy) or single-tablet bismuth monotherapy. These approaches demonstrated good tolerability and efficacy [1].
• Influence of atrophy degree: Studies show that the endoscopic degree of atrophy according to the Kimura-Takemoto classification can affect the likelihood of successful first-line H. pylori eradication [2].

Additional Treatments and Symptom Relief

In addition to H. pylori eradication, complementary methods, including traditional Chinese medicine (TCM), are actively used to improve mucosal condition and relieve symptoms.

• Qingyoufang Decoction (QYFD): Used as adjunctive therapy in H. pylori-positive AG, particularly in patients with spleen-stomach damp-heat syndrome (SSDHS). QYFD promotes not only H. pylori eradication but also significant relief of SSDHS symptoms and a reduction in inflammatory markers such as interleukin-6 (IL-6), interleukin-8 (IL-8), and tumor necrosis factor-alpha (TNF-α) [4].
• Rapid fire needling combined with Xiaoliu Jin Jianwei Decoction: This combination therapy demonstrated improvement in gastrointestinal symptoms (using the GSRS scale), mucosal histopathological parameters, and a reduction in high-sensitivity C-reactive protein (hs-CRP) and TNF-α levels in AG patients [5].
• Shugan Hewei Decoction: Effective in treating AG, significantly increasing overall therapeutic efficacy, improving primary and secondary symptoms, normalizing gastric function indicators (PG I, PG I/PG II, G-17), and ameliorating pathological mucosal changes such as intestinal metaplasia, glandular atrophy, and dysplasia [6].
• Matrine combined with omeprazole: A retrospective study showed that combination therapy with matrine and omeprazole improves gastric mucosal histopathological parameters (reduction in glandular atrophy, intestinal metaplasia, dysplasia, and inflammatory activity), gastric function indicators (motilin, gastrin, pepsinogen), decreases inflammatory cytokine levels (IL-2, IL-10, TNF-α), and facilitates H. pylori eradication [7].

Prevention and Monitoring

Since atrophic gastritis is a precancerous condition, special attention is paid to prevention and regular monitoring.

• Early detection and H. pylori eradication: Timely treatment of H. pylori infection is a key factor in preventing the development and progression of atrophy and, consequently, reducing the risk of gastric cancer [3].
• Management strategies for dyspepsia:
  • Test-and-Treat (TT): This strategy involves testing for H. pylori and eradicating it if positive in dyspeptic patients without alarm symptoms. The goal is symptom relief and prevention of adverse outcomes [3].
  • Test-Treat-and-Scope (TT-S): An expanded strategy that includes esophagogastroduodenoscopy (EGD) following testing and treatment. This approach provides a deeper understanding of the mucosal state and allows for a more precise assessment of atrophy degree and gastric cancer risk [3].
• Regular endoscopic surveillance: Patients diagnosed with atrophic gastritis, especially in the presence of intestinal metaplasia or dysplasia, are recommended to undergo regular endoscopic surveillance with biopsies for timely detection of precancerous changes and the prevention of gastric cancer.

Sources

1. Therapeutic regimens against Helicobacter pylori infection without proton pump inhibitors in patients with corpus atrophic gastritis: a real-life single-centre longitudinal observational study. https://pubmed.ncbi.nlm.nih.gov/39816929/
2. Impact of kimura-takemoto atrophy classification on first-line H. pylori eradication: a retrospective cohort study. https://pubmed.ncbi.nlm.nih.gov/42404559/
3. Gastric cancer secondary prevention in dyspeptic patients. https://pubmed.ncbi.nlm.nih.gov/41920508/
4. Efficacy and safety of adjunctive Chinese herbal decoction in treating Helicobacter pylori-positive chronic atrophic gastritis: a real-world retrospective study. https://pubmed.ncbi.nlm.nih.gov/41601815/
5. Rapid fire needling combined with Xiaoliu Jin Jianwei decoction improves gastrointestinal symptoms and gastric mucosal lesions in chronic atrophic gastritis. https://pubmed.ncbi.nlm.nih.gov/42007096/
6. Efficacy of Shugan Hewei Decoction in treating chronic atrophic gastritis and its influence on gastric mucosal pathology. https://pubmed.ncbi.nlm.nih.gov/41611595/
7. Serum level of (interleukin (IL)-2, IL-10, tumor necrosis factor (TNF)-a, motilin (MTL), gastrin (GAS), pepsinogen (PG), after adjunctive treatment in patients with chronic atrophic gastritis. https://pubmed.ncbi.nlm.nih.gov/41281277/
8. Characteristics of Gastric Endoscopic and Histopathological Findings in the South and Southeast Asian Populations. https://pubmed.ncbi.nlm.nih.gov/40995608/

The information provided in this article is for reference purposes only and cannot replace professional medical advice, diagnosis, or treatment. Always consult with a qualified healthcare provider regarding any questions related to your health.