Sometimes you may feel an upset stomach, or a loss of appetite, or a feeling of fullness in your stomach, right? Maybe the reason for that is not as simple as you think. Today we are going to talk about a condition that is a little deeper, but can be important for many people. That is a condition called Atrophic Gastritis . Don't worry, we will talk about this simply, in a way that you can understand.
What is atrophic gastritis?
Simply put, atrophic gastritis is a condition in which the lining of your stomach, the stomach lining, gradually thins and becomes chronically inflamed. Think of it like a protective membrane inside your stomach. This is what protects the stomach lining from the harsh acids in your stomach. In atrophic gastritis, this protective membrane is damaged and becomes thin.
Another special thing is that in this condition, some of the cells in your stomach start to resemble the cells in your small intestine. This is called ``intestinal metaplasia'' in medical terms. That means the cells in your stomach take on the appearance of the cells in your intestine.
There are two main types of this, right?
Yes, you are right. There are two main types of atrophic gastritis. Let's see what they are.
1. Environmentally induced atrophic gastritis (EMAG)
This is one type. Doctors call it `(Environmental Metaplastic Atrophic Gastritis)` or EMAG for short. The main cause of this is infection with the bacteria `H. pylori` (Helicobacter pylori).
Imagine, inside your stomach there is a protective mucous membrane, like an umbrella against the rain. This is what protects the stomach walls from the acidic gastric juices that help digest food. But when this bacteria called `H. pylori` comes, it acts as if it were piercing that umbrella. Then those acidic acids start eating away at the stomach walls. When this happens over the years, the stomach cells are destroyed, the lining is thinned, and the condition of EMAG is created.
2. Autoimmune atrophic gastritis (AAG)
This is the second type. It is called `(Autoimmune Atrophic Gastritis)` or AAG for short. Sometimes it is also called `(Autoimmune Gastritis - AIG)`.
Now look, we have a group of bodyguards. That's our immune system. Their job is to fight off disease-causing germs. But sometimes, as if they were attacking one of their own by mistake, these bodyguards start attacking our own healthy cells. That's what happens in AAG. Here, the immune system attacks the healthy cells in our stomach wall directly.
Are there any risks with either of these types?
Yes, both EMAG and AAG can increase your risk of developing small tumors in your stomach. These are called ``Neuroendocrine Tumors - NETs''. However, most of the time, these NETs are not cancerous (benign) , meaning they are not harmful. However, both EMAG and AAG can increase your risk of developing gastric cancer. Therefore, it is important to be aware of this.
Who is more likely to develop this EMAG?
People who are at higher risk of developing environmentally induced atrophic gastritis (EMAG) include:
- For those of Asian or Hispanic ethnicity.
- For those over 70 years of age.
- For those who eat too much salty food.
- For those with `H. pylori` infection.
- For those who live in crowded, crowded environments (as this can contribute to the spread of `H. pylori`).
- For those who smoke.
So who is more likely to develop AAG?
There are people who are at higher risk of developing autoimmune atrophic gastritis (AAG). They are:
- For women (more than men).
- For those of African American or Northern European descent.
- If someone in the family has previously developed AAG (there may be a hereditary link).
- For those with certain genetic mutations.
- For people with other autoimmune diseases. For example:
- Addison's disease
- Autoimmune thyroid diseases (e.g. Hashimoto's disease, Graves' disease)
- Type 1 diabetes
- Vitiligo
How common are these conditions?
According to statistics from the United States, it is estimated that about 15% of the population has atrophic gastritis (AG) . It is also said that the prevalence of AAG may be between 0.5% and 2%. This condition is not without its problems in Sri Lanka.
What are the specific reasons for the formation of EMAG?
As we have already discussed, the main cause of EMAG is infection with the bacteria `H. pylori`. This bacteria is most likely to be infected during childhood. There are several ways it can be transmitted. These are:
- Through direct contact with feces (feces).
- Through food.
- Through saliva.
- By vomiting.
- By water.
That means it's very important to take care of cleanliness to stay safe from this bacteria.
What are the causes of AAG?
What happens in AAG is that our body's antibodies – a type of protein that protects us from disease – attack our own healthy stomach cells.
Another thing is that these antibodies can sometimes attack a special protein called `Intrinsic factor` produced by our stomach cells. This `Intrinsic factor` is very important for the body to absorb vitamin B12 . So, if `Intrinsic factor` is missing, our body cannot absorb vitamin B12 properly. This can cause the body to not be able to produce healthy red blood cells, which can lead to a special type of anemia called `Pernicious anemia`. When vitamin B12 is not enough, it can also cause nerve damage (neuropathy).
What are the symptoms of EMAG?
The good news is that some people may not have any symptoms even though they have atrophic gastritis. However, when EMAG is caused by an H. pylori infection, symptoms such as:
- Pain in the upper abdomen.
- Iron-deficiency anemia.
- The food is tasteless.
- Nausea and vomiting.
- Peptic ulcers in the stomach or small intestine.
- Being thin for no reason.
What are the symptoms of AAG?
Like EMAG, some people with AAG may not have any symptoms. However, if AAG causes a vitamin B12 deficiency, symptoms related to anemia and nerve damage may occur. Symptoms include:
- Chest pain.
- Dizziness, lightheadedness, weakness.
- Heart palpitations.
- Mental confusion, such as delirium.
- Nausea and vomiting.
- Pale skin.
- Rapid pulse.
- Sensation of a ringing sound coming from inside the ears (Tinnitus).
- Numbness and loss of sensation in the limbs.
How does a doctor recognize this? (Diagnosis)
When you report symptoms like these, the doctor will first ask you questions and perform a physical examination, including palpating your abdomen to see if there is tenderness.
If atrophic gastritis is suspected, the doctor may suggest several blood tests , such as:
- Healthy red blood cell count (low levels can lead to anemia).
- Iron level.
- Types of antibodies (especially if AAG is suspected).
- Gastrin levels, a hormone that helps make stomach acid.
- Levels of `Pepsinogen`, a protein produced by stomach cells.
- Vitamin B12 levels.
In addition, the doctor may also perform an endoscopy .
- This involves inserting a thin tube (endoscope) with a camera attached through your mouth to take a good look inside your stomach. Don't worry, you'll be put to sleep or sedated before the procedure, so you won't feel any discomfort.
- At this time, a small piece of tissue from the stomach wall can be taken for a biopsy. This can confirm whether atrophic gastritis is present and whether the bacteria H. pylori is present.
- This can also check for tumors like the ``Neuroendocrine tumors - NETs'' we talked about earlier.
What are the treatments for this?
Treatment options depend on whether you have EMAG or AAG.
Treatment for EMAG
- If there is an H. pylori infection, antibiotics are given to kill it.
- Medications that reduce stomach acid can be given.
- It is also important to monitor the condition by having regular endoscopy examinations.
Treatment of AAG
- If vitamin B12 levels are low, vitamin B12 injections may be needed to increase them.
- If iron levels are low, iron infusions can be given intravenously .
If you see small lumps called NETs during an endoscopy, your doctor can remove them at the same time. This is called an endoscopic mucosal resection. As we mentioned earlier, these lumps are usually not cancerous (benign). However, it is a good idea to get them checked out every two years.
How to reduce the risk of atrophic gastritis (AG)?
To avoid H. pylori infection, which can cause EMAG, you need to be very careful about hygiene. Especially:
- After changing a diaper.
- After going to the toilet.
- Before eating.
Be sure to wash your hands thoroughly with soap. Instill the habit of washing your hands regularly in your children as well.
However, there is nothing we can do to prevent the autoimmune condition called AAG from occurring. However, it is important to be aware of its symptoms, seek medical advice promptly if necessary, and monitor the condition.
What happens when you live with this condition? (Outlook)
Although there is no cure for atrophic gastritis, most people can live a normal, symptom-free life. Some people may need to take vitamin B12 or iron supplements for the rest of their lives.
A small number of people with this condition, who are at a slightly higher risk, usually need to have an endoscopy every three to five years (endoscopic surveillance). However, although there is a risk of developing stomach cancer among these people, it is very low. People with those lumps called NETs may also need surveillance, but they are often noncancerous.
How to take care if you have EMAG?
If you have EMAG, you can do these things to reduce complications:
- If you smoke, definitely stop.
- Get used to a salt (sodium) controlled diet.
- See a gastroenterologist and have your condition checked at regular intervals .
How do you take care of yourself if you have AAG?
If you are deficient in vitamin B12, you can add foods rich in B12 to your diet. For example:
- Beef
- Clams
- Eggs
- Oily fish (like salmon, mackerel, and sardines)
- Fortified cereals
- Milk
- Yogurt
Also, people with AAG should definitely continue to see a gastroenterologist to monitor the condition and make necessary treatment changes.
Take-Home Message
Atrophic gastritis is a condition in which the lining of the stomach becomes thin and inflamed. There are two types: EMAG, which is caused by H. pylori infection, and AAG, which is caused by a problem with the immune system.
- Symptoms don't show up the same way for everyone. They can include things like stomach pain, loss of appetite, and vitamin B12 deficiency.
- This can only be accurately diagnosed through blood tests and endoscopy.
- Treatment includes medication for H. pylori, vitamin B12 injections, and iron.
- Many people can live a normal life. However, it is very important to stay in touch with a doctor and get the necessary tests and treatment.
If you have any further questions about this, or if you feel like you have these symptoms, please see a doctor for advice. Don't worry, there are solutions to everything!
` Atrophic Gastritis, Atrophic Gastritis, Stomach inflammation, Stomach, H. pylori, Vitamin B12, Anemia, Endoscopy, Gastritis
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